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After-Care

Proper aftercare is essential following implant treatment. Patients need to have a clear understanding of how to care for their dental implants and be aware of any signs that might indicate a problem. Regular follow-up appointments and dental hygiene visits are crucial, allowing clinicians to monitor the progress of osseointegration and healing. These appointments also provide opportunities to detect and prevent peri-implantitis in the long term.

 

Ongoing maintenance

While dental implants generally have high success rates, various factors can influence their longevity. To maintain implant health, it is crucial to provide patients with personalised oral hygiene advice, enabling them to care for their implants and overall oral health effectively.

Quality periodontal care and diligent implant maintenance are essential to prevent complications and ensure the long-term success of dental implants. Patients should be equipped with the necessary tools to clean around their implants thoroughly. The use of antimicrobial mouth rinses may also be recommended to help control bacterial levels, particularly around the implant and restoration.

Establishing and maintaining a regular maintenance program is vital for reducing the risk of biological complications and managing any biomechanical issues that may arise. A recall interval of 5–6 months for peri-implant maintenance therapy is often suggested (Monje et al., 2016), though this should be tailored to each patient’s risk profile, especially in those with a history of periodontal disease (Heitz-Mayfield, 2008).

To further enhance the prevention of peri-implant disease, the Implant Disease Risk Assessment (IDRA) tool can be utilised. The IDRA is a comprehensive tool designed to evaluate and manage the risk of peri-implant diseases. It takes into account various factors such as patient medical history, implant characteristics, and maintenance practices. By using IDRA, clinicians can develop personalised maintenance strategies that minimise the risk of peri-implantitis and other complications.

A baseline postoperative periapical radiograph should be taken when definitive restorations are placed, with subsequent radiographs used to monitor bone levels over time.

Some marginal bone loss around implants is expected during the first few years after placement, typically due to the bone's adaptive response to surgical trauma and implant loading. This bone remodelling usually results in a loss of 0.9–1.5 mm in the first year, followed by approximately 0.1 mm annually thereafter in the absence of disease.

Significant crestal bone resorption after the first year, known as aseptic loosening, may be due to biological reactions to non-optimal implant or prosthetic components, suboptimal surgical or prosthetic treatment, or patient-specific factors (Albrektsson et al., 2017).

It is important to differentiate this initial, self-limiting marginal bone loss from peri-implantitis, which is a later, rapidly progressing infectious disease. Proper risk assessment and management, as outlined by Heitz-Mayfield (2008) and supported by the IDRA tool, are crucial in preventing implant-related complications and ensuring the longevity of the implants.