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Plaque-control procedures must start immediately after uncovering the implants. It is important that the dental hygienist customize a home-care regimen based on the patient's awareness and ability and the type of prosthesis present.
There are two specific areas of focus for home-care procedures around implants. The first is the portion of the titanium abutment exposed above the soft tissues in the oral cavity, as well as the small portion just below the gingiva. The second area requiring plaque control is the prosthetic component, consisting of the rigid cast framework and tooth replacement materials.
A multitude of home-care devices exist to assist in mechanical oral hygiene regimes. These devices include various manual or powered toothbrushes and specific interdental aids. Soft or ultrasoft manual toothbrushes are the traditional means of plaque removal. However, brush heads come in many different shapes and sizes, and brushes should be prescribed individually depending on the implant type and the patient's abilities. An excellent area-specific soft nylon brush is the single-tufted brush. This brush is for use on individual implants, one implant at a time, and the shaft can be bent for better access.
Various interdental devices are available, including interdental brushes, rubber-tip stimulators, wooden cleaners, and numerous types of dental floss. The brush attachment for interdental brushes is available as a plastic or nylon-coated wire rather than a metal wire to prevent scratching of implant surfaces. Interdental brushes are used only if sufficient interdental embrasure exists. Various floss types, such as tufted floss or floss cords (PostCareTM, Sunstar Americas Inc., Chicago), along with folded gauze or traditional floss, are effective and safe interproximal plaque-removal aids.
Clinical use of antimicrobials (chemotherapeutic agents) can adjunctively help to inhibit plaque and gingivitis around implants. These agents may be delivered by rinsing or applied topically (via toothbrush, floss, or cotton-tipped applicator). Irrigation can be used if pathologic changes are present.
The use of chlorhexidine gluconate and Listerine has been shown to be advantageous in the inhibition of bacterial plaque in implant patients.
Some practitioners may recommend home irrigation devices, but patients should be advised to use gentle pressure, ensuring that the irrigant is not forced into the sulcus. Excessive fluid pressure with the tip positioned apically could damage the perimucosal seal. Using either a sideport blunt-tipped canula or a rubber-tip irrigating device is less likely to violate this seal.
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