Implant Maintenance

Periodontal maintenance or supportive periodontal therapy is an essential part of keeping your mouth healthy. All patients treated for periodontal disease, those who have never had periodontal disease and even patients with dental implants, benefit from this treatment.

Bacterial accumulations have been shown to cause tooth decay, periodontal disease and many problems with dental implants when left on teeth, gums and implants. Even motivated patients with meticulous home care still leave areas of hidden plaque accumulation.

When bacterial plaque remains on teeth or implants it hardens into calculus which requires professional removal. If not removed in a timely manner, the plaque and calculus harbor bacteria and toxic by-products that damage adjacent gums, bone, teeth and implants. It has been shown that generally 3 month intervals for periodontal maintenance is adequate to prevent new or recurrent problems. Certain factors effect the maintenance interval such as health status, cigarette smoking, certain medications, effectiveness of home plaque removal, success of previous treatment and susceptibility to disease recurrence which can increase the need for frequent maintenance visits.

During your appointment, our gentle, skilled hygienists review your health history and update your records. Dental x-rays are assessed and updated if not current or if you are having problems. We thoroughly examine your gums and teeth and perform an oral cancer screening. They are then meticulously cleaned with a personalized regimen using dental scalers, ultrasonic machines and air polishers.

If any changes are noted for the worse in your teeth, gums, bone or implants, there are many options that can be utilized to keep your oral health optimal. Early detection is the key to minimize treatment needs. If teeth are found to have decay, fractures or failing restorations, we will promptly notify your general dentist of the problem to allow for predictable correction. We always recommend an “alternating recall” where the patient rotates their cleanings between our office and their general dentist’s office to allow more critical monitoring of teeth and restorations. It is vital that patients on an “alternating recall” stay on schedule with both our office and the dentist’s office.

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Prophylaxis, or Regular Cleaning

A regular cleaning is recommended for patients who do not have bone loss, periodontal disease, or infection around the teeth. There should be no bleeding, mobility of the teeth, receded areas, or gaps where the spaces around the roots of the teeth are exposed. In other words, the mouth should be healthy with no bone or gum problems. A regular cleaning, or prophylaxis, removes soft plaque, tartar, and stains from the teeth above the gum line, and only slightly below. A regular cleaning is usually done 2 to 3 times a year, depending on how quickly stain, plaque, and tartar accumulate. It is considered a preventive procedure by your insurance carrier, since regular cleanings will help prevent periodontal disease.

If you have periodontal disease that has resulted in bone loss, gum “pockets” deeper than 4 millimeters, bleeding gums, exposed root surfaces, or if you have had periodontal surgery or root planning to treat periodontal surgery or root planning to treat periodontal disease, a regular cleaning is not appropriate. Periodontal maintenance scaling is needed to maintain gum and bone health. This procedure includes removal of plaque and tartar from above and below the gum line, all the way down the length of each tooth to where the root, gum, and bone meet. Rough areas of the roots are smoothed if needed, pocket depths are carefully monitored, and inflamed pockets may be irrigated with antibacterial medicines if necessary.

Periodontal maintenance is considered a basic service by your insurance carrier, and may be subject to a yearly deductible. PM is usually performed 3 to 4 times a year, depending on several factors: how quickly the plaque and tartar accumulate, how much bleeding or inflammation is present, how stable the present condition is, how well you are able to maintain your teeth at home on a daily basis, and any health risk factors you may have.

There is plenty of evidence and studies that validate the importance of shorter recall intervals for patients with a history of periodontal disease. For obvious ethical reasons there aren’t many studies that demonstrate the effect of not treating or maintaining the periodontal health of a patient. However, there are a few. In the paper by Loe et al., they demonstrated significant progression of periodontal disease in a group of patients who had no periodontal therapy over a 15 year period. This was also demonstrated by Lindhe et al. in 1989 when a sample set of the Japanese population were observed for two years without any periodontal treatment or maintenance. There was evident progression of periodontal disease throughout the group, although the extent of the disease varied. For the last 60 years, there has been much research done that shows the benefits of regular periodontal maintenance. Lovdal et al., in 1961, found that a combination of oral hygiene instruction and cleaning performed 2 to 4 times a year for five years greatly reduced the incidence of tooth loss and inflammation. In 1981, Axelsson and Lindhe’s study results indicated that early follow-up is linked to a reduction in disease and the progression of caries and periodontal disease can effectively be halted. Such combinations of active periodontal treatment, oral hygiene instruction and regular re-care have increasingly demonstrated improvements in periodontal health. These all make a strong clinical argument for more regular periodontal maintenance therapy.

Even more recently, in 2003 Page et al. made an online web based system for determining a patient’s risk of developing periodontal disease and risk of progression of periodontal disease called the Periodontal Risk Calculator (PRC). This is a multi-step process and records data on: Patient Age, Smoking History, Diagnosis of Diabetes, History of Periodontal Surgery, Pocket Depth, Bleeding on Probing, Furcation Involvements, Restorations or Calculus Below the Gum Line, Bone Loss Visible on X-Rays, and Vertical Bone Loss. The PRC gave strong predictions about disease risk and progression. Even without the calculator, most periodontists know that the more of these risk factors you have, the higher your risk is for problems.

We know that there is a relationship between chronic inflammation in the gums and overall health, especially heart disease and diabetes. Keeping the gums and the bone surrounding your teeth as healthy as possible is an important part of your regular dental visits or hygienist.

We are proud of our maintenance services and are often told by our patients that they “have never had a better cleaning in their life.” We have many patients referred by friends that have never had periodontal problems for our outstanding preventative services.

Loe H, Anerud A, Boysen H, Morrison E. Natural history of periodontal disease in man. Rapid, moderate and no loss of attachment in Sri Lankan laborers 14 to 46 years of age. J Clin Periodontol 1986; 13: 431–445.

Lindhe J, Okamoto H, Yoneyama T, Haffajee A, Sockransky S. Periodontal loser sites in untreated adult subjects. J Clin Periodontol 1989;
16: 671–678.

Lovdal A, Arno A, Schei O, Waerhaug J. Combined effect of sub-gingival scaling and controlled oral hygiene on the incidence of gingivitis. Acta Odontol Scand 1961; 19: 537–555.

Axelsson P, Lindhe J, Nystrom B. On the prevention of caries and periodontal disease. J Clin Periodontol 1991; 18: 182–189.

Axelsson P, Lindhe J. The signi cance of mainte- nance care in the treatment of periodontal disease. J Periodontol 1981; 8: 281-294.

Page R, Martin J, Krall E, Mancl L, Garcia R. Longitudinal validation of a risk calculator for peri- odontal disease. J Clin Periodontol 2003; 30: 819–827.