Hygiene and maintenance
Advice no. 8: Maintain regular recall
Maintenance of dental implants can be one of the most neglected aspects by dentists and patients alike. Many patients perceive their need for treatment as complete once their implants and dentures are delivered. The average denture wearer visits a dentist or dental hygienist about every 14.8 years after getting their dentures.17
I tell my patients that “implants are teeth” so they must continue recall visits for life. I recommend at least two visits per year with increased frequency as needed. Peri-implant mucositis (similar to dental gingivitis) usually develops between recall appointments. Many denture wearers fail to adequately clean their implant abutments and dentures. Recall visits are an opportune time to assess the success of your patients’ home care and guide them in properly maintaining their implants. Peri-implant mucositis is a precursor to peri-implantitis (similar to periodontal disease with teeth). Peri-implantitis is critical to get under control if it occurs. Otherwise, the implants will be lost.
I recommend the following hygiene maintenance protocol for implant-retained removable dentures:
- At least two cleanings a year
- Examine implants at recall visits
- X-rays of the implants once a year
- Photograph points of interest for future comparison
- Replace worn nylon parts at recall visits
- Check the need for stripes once a year
Advice no. 9: Lie down often
As previously discussed, a close fit of the acrylic denture to the soft tissue will minimize stress on the implants. Jemt et al. showed that 24% of new mandibular dentures require ridges after one year due to residual ridge resorption under the distal extensions.18 Smedberg et al. showed that 40% of maxillary dentures require ridges within three years.19
The problem is that patients often don’t know if their dentures need to be replaced, since the components of the implants stabilize the denture. I recommend that you check once a year for the need to renew the denture. I use the following techniques.
Technique for determining the need for tilting — mandible:
I place my thumbs along the occlusal table from the canines to the molars and repeatedly press down on the denture. If I feel a gentle “squeak” then I know there is soft tissue support and a wrap is not indicated. If I feel solid contact on an abutment, or if I can’t feel a “junk,” I follow the maxillary protocol.
Technique for determining the need for jaw relief:
Since there are at least four implants, it is very difficult to feel a “junk”. Instead, I line the inside of the denture with a light impression material, place the denture on the abutments, and remove the denture after the material sets. Trace the impression material in several locations (Figures 16–18). If the scan is shallow and consistent through the denture, no ridge is indicated. If some areas are deeper, a line is indicated. Note: Attachments are clearly visible in Figures 17 and 18, but often a thin layer of impression material covers them.
