Five tips on how to treat patients with periimplant mucositis
Do you have many patients who have been diagnosed with periimplant mucositis? Do you know what is important in the treatment of these patients? We would like to share five useful tips with you on this topic:
Tip 1: Pay special attention to high-risk groups
Periimplant mucositis is a very common condition. Systematic reviews have shown that more than 63% of the patients captured in the current data bases are affected. Smokers are particularly susceptible. Patients who wear implant-retained full dentures tend to have more plaque on the supporting elements than patients who wear partial dentures. Therefore, you should pay particular attention to these types of high-risk individuals!
Tip 2: Prevent more severe cases
Once periimplant mucositis has set in, the situation will deteriorate and periimplantitis can develop. In order to prevent this from happening, the inflammation must be treated, because the subsequent damage could be severe. The consistent mechanical removal of bacterial plaque has shown to be one of the most effective means of preventing inflammation. The additional and selective use of germ-controlling preparations can promote the success of the treatment.
Tip 3: Schedule regular recall appointments
Regular recall appointments are indispensable for patients with periimplant mucositis. The periimplant tissue must be examined with regard to signs of inflammation and any possible recession. Particular attention should be paid to plaque that has accumulated on implant restorations.
Making the bacterial plaque visible with a fluorescent disclosing liquid (e.g. Plaque Test) helps to make patients aware of any problems and allows them to be properly instructed. Susceptible areas which require particular attention during tooth brushing become clearly visible. Motivating oral hygiene techniques can be easily demonstrated. Furthermore, you can clearly explain the benefits offered by routine professional teeth cleaning. This will increase the readiness of patients to invest in these measures.
Tip 4: Clean teeth professionally and carefully
Regular professional teeth cleaning should maintain the surface quality of different, more or less resistant materials and tooth structures in the long term. This applies to implant-retained restorations as well as any existing restorations and natural tooth structure. Irreversible roughening by unsuitable cleaning agents – for example excessively abrasive prophy pastes or cleaning powders – should be prevented at all cost, because microorganisms tend to colonize rough surfaces much more quickly than smooth ones. Furthermore, composite resin and ceramic restorations lose their esthetic gloss and become more susceptible to staining when they are treated with strong cleaning agents.
Following the professional teeth cleaning measures, the application of a protective varnish may be indicated. Varnishes containing 1% chlorhexidine and 1% thymol (e.g. Cervitec Plus) protect susceptible areas and enhance local germ control measures.
Tip 5: Problem-oriented oral health care
The personal oral hygiene regime plays a significant role in the maintenance of oral hygiene and the long-term success of implant restorations. These measures are of particular importance in cases where mucositis has already developed. A clinical study (Hallström et al. 2015) describes a successful treatment strategy in these cases. It shows that the application of Cervitec Gel containing 0.2% chlorhexidine and 900ppm fluoride significantly reduces bleeding on probing (BOP). In addition, the pocket depth is shown to decrease significantly. During the entire study period, no cases of staining or altered taste were observed. The willingness of the patients to use the mild-tasting gel was very high.
An oral care gel should be very easy to use, because it must be integrated into the daily teeth cleaning routine with little effort.
Fig. 1: Periimplant mucositis (Photo: Prof. Dr S. Twetman)
Fig. 2: Gentle cleaning with pumice-free Proxyt prophy paste (Photo: Dr F. Zimmerling, Ivoclar Vivadent AG, Schaan/Liechtenstein)
Fig. 3: The oral care gel is easy to integrate into the daily tooth brushing routine.
Fig. 4: The smooth Cervitec Gel is easy to distribute with an interdental brush. (Photo: Dr F. Zimmerling, Ivoclar Vivadent AG, Schaan/Liechtenstein)
Cervitec and Proxyt are registered trademarks of Ivoclar Vivadent AG. The availability of products may vary from country to country.