Implant maintenance

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2) INSTRUMENT SELECTION

The maintenance of smooth surface of the titanium without pits and scratches is important to prevent plaque accumulation. Stainless steel and titanium – tipped instruments are detrimental to a smooth titanium surfrace.2 Cavitron and sonic scalers have also been found to gouge titanium.3 A plastic sleeve over a sonic scaler appears not to alter titanium4 and may be used in cases of heavy calculus accumulation. Air polishing systems will blast many scratches into the titanium and should not be used. The most important consideration is selecting calculus and plaque.5 The following are general guidelines for maintenance of implants6;

1. Special instruments are recommended for assessing and debriding implants. Plastic instruments are used most commonly because the plastic material is softer than the implant material

2. Metal instruments (e.g. stainless steel, carbon steel, and ultrasonic instruments) may leave scratches on the surface of the implant. This may promote accumulation of plaque. Surface coating of an implant may be disturbed, thereby reducing the biocompatibility of the implant with the surrounding tissues. 3. Some plastic instruments contain graphite fillers; these types of instruments may be used on the implant superstructure (prosthetic denture or bridge) but should not be used directly on the implant abutment (to avoid scratching of the abutment surface).

4. Wrench – shaped, crescent-shaped, and hoe shaped plastic working ends are useful for the debridement of an implant’s superstructure. Working ends that are similar in design to conventional metal probes, sickle scalers, and curettes are useful for the assessment and debridement of an implant abutment. 5. Calculus is removed easily from implants because there is no interlocking or penetration of the deposit within the implant surface. Light lateral pressure with a plastic scaler or curette is recommended. Care must be taken not to scratch the surface of the implant.

Certain implant scalers can be sharpened. If implant hygiene instrument are sharpened , it is important to use a sharpening stone that has not been used for metallic instruments, since metal from the stone can be embedded into an instrument’s surface. A variety of nonmetallic, plastic, graphite, nylon- coated, or Teflon –coated instruments are abailable and have been proven safe to use on titanium implant surfaces.

3) POLISHING

Rubber cup polishing with toothpaste, fine prophy paste, commercial implant polishing pastes, and tin oxide have been shown not to alter titanium surfaces.2 Before polishing, calcified deposits should be removed. In addition to a rubber cup, a rubber point or soft unitufted rotary brush may be use

4) SUBGINGIVAL IRRIGATION

Irrigation of the implant sulcus by chemotherapeutic agents may be useful as a long –term maintenance procedure. The irrigation canula should have a nonmetallic, rounded tip with side escape portals. During its use, the canula is not inserted to the base of the implant sulcus, preventing fluid distention into surrounding tissues. Chlorhexidine gluconate is a useful irrigant.