Dental implants

• Ensure that a baseline peri-apical radiograph of the implant, aligned using the long cone paralleling technique, is obtained one year after superstructure connection to facilitate long-term implant maintenance.

• Assess the level of oral hygiene and, if necessary, use Oral Hygiene TIPPS to address inadequate plaque removal. Where applicable, give smoking cessation advice.

• Examine the peri-implant tissue for signs of inflammation and bleeding on probing and/ or suppuration. Probe gently around the superstructure to feel for excess residual cement and sub-mucosal plaque and calculus. Measure baseline probing depths using fixed landmarks.
  N.B. The BPE is not appropriate for the assessment of dental implants.

• Remove supra-mucosal and sub-mucosal plaque and calculus deposits using an appropriate method. Remove sub-mucosal excess residual cement if this is detected. Local anaesthesia may be required.

• Assign a risk level and schedule recall appointments accordingly.

Peri-implant mucositis is defined as inflammation of the peri-implant mucosa with no evidence of crestal bone loss. The tissues will appear red and swollen and may bleed on gentle probing.

• Where there are signs of peri-implant mucositis:

• • Exclude the presence of peri-implantitis by carrying out a radiographic examination to assess peri-implant bone levels compared with the baseline radiograph
  • Treat as described in the maintenance section above
  • Re-assess at a future visit to ensure that the inflammation has settled and a stable situation has been achieved

Peri-implantitis is defined as infection with suppuration and inflammation of the soft tissues surrounding an implant, with clinically significant loss of peri-implant crestal bone after the adaptive phase. The tissues will appear red and swollen, may bleed on gentle probing and there will be suppuration.

• Where there are signs of peri-implantitis:

• • Carry out a radiographic examination to evaluate peri-implant bone levels compared with the baseline radiograph
  • If clinically significant progressing crestal bone loss is detected, refer back to the clinician who placed the implant. If this is not possible, treat as described in the maintenance section above plus:

• • • Arrange a follow-up appointment after 1-2 months to assess the outcome of treatment. Where there is no improvement, seek advice from secondary care
    • If the inflammation has settled and a stable situation has been achieved, arrange radiographic follow-up in 6-12 months