How to Prevent the Loss of a Dental Implant

Dr. Jill Morris discussed why dental implants fail and the latest research on implants and how to clean around implants. There seems to be an epidemic in America concerning infection of dental implants.

Today I'd like to write about how to clean and take care of dental implants.

An implant is not a tooth, it is a medical device and must be treated differently than a tooth. Implants are screws that go into the bone to hold crowns to replace missing teeth. They can be metal-free ceramic screws made of zirconia, or they can be made of titanium which is metal, like what is used for hip and knee replacements. The screw diameter is much smaller than the root of the tooth it replaces, so it traps food more easily under the crown.  

Implant loss is becoming a concern in dentistry.  I hear numbers in the literature claiming a 20% to 60%  infection rate of implants.  Most people lose their implants due to bone loss and infection.  Harvard has done a study to discover why implants are having so much bone loss. They took biopsies of the tissue and bone around the infected implants to try to figure out why they were failing. Many times plaque and tarter had built up on the implant parts due to poor home-care by the patient. This caused bone loss just like gum disease that we often see around natural teeth.

Unfortunately, most of my patients believed that once they got an implant, it would be trouble-free. Patients have told me that they've had nothing but trouble with their teeth their whole life and if they pull their teeth and get implants, they'll never have to worry again. They are under the misconception that they can't get gum disease around an implant like a natural tooth. Many of them are losing their natural teeth because of gum disease, so the same bacteria living in their mouths infects the implants too.

Another thing that  Harvard researchers found was microscopic pieces of floss around the infected implant. The floss would get stuck and shredded around the screw threads of the implant. The floss couldn't be seen or felt and it would wick the bacteria into the tissue and bone of the implant causing bone loss and the eventual loss of the implant. So home-care is extremely important. We recommend to our patients never to floss around either side of an implant. We also see that the teeth around implants have a higher risk of developing a cavity because of the tendency for food to collect between the crown and the implant.

You overcome this by waterpiking around the implant crown at the gum line and between the teeth. You can also use the small proxy brushes in the area if they fit into the spaces without forcing. We recommend the Sonicare brand electric brush to be used at the gum line. I recommend watching my other video on brushing natural teeth effectively.

For our patients that have implant bridges that are connected to implants as shown in the video, we recommend a special Waterpik tip that cleans the tissue side of the bridge by squirting water under the bridge. This tip helps to prevent bad breath and bone loss from bacterial build-up.  And remember, get your head down over the sink with the tip of the Waterpik in your mouth before turning on the Waterpik so you don't make a mess in the bathroom.

A second issue that the dental profession has discovered is the development of spaces around implants over time causing food impaction and decay of the adjacent teeth. With the natural aging process, humans have something called 'forward face movement' in which the teeth actually gradually move forward and shift around implants. Because the implant is solid in bone, it does not follow this natural drift, so the teeth move away from the implant creating these spaces. For this reason, we recommend to our implant patients that they wear a thin retainer when they sleep at night, like an Invisalign retainer, to keep the natural teeth from drifting.

In another blog, I will discuss a new exciting discovery I've made that kills disease-causing bacteria in the mouth. We have seen most of our implant patients keep their implants for many years through proper homecare and nighttime retainers. Implants can be trouble-free for years and create a situation for a lifetime of enjoyment of food.