Prevention with implants and dentures

Anyone with dentures is not among the patients who need less prevention but among those who need more. The reason is simple: every transition between tooth and material is a place where plaque finds a hold, and every implant sits in tissue built differently from that around a natural tooth.

Why an implant is more vulnerable than it looks

A natural tooth is anchored in the bone resiliently by fibres. These fibres run crosswise and form a barrier against bacteria coming from above. An implant does not have them — it is directly joined to the bone, and the fibres of the surrounding gum run lengthwise. If bacteria enter, they meet less resistance, and the breakdown can proceed faster than on a natural tooth.

There is also this: an implant cannot develop caries, but it can loosen and be lost. The cause is almost always the same — an inflammation of the surrounding tissue.

Two stages

• Peri-implant mucositis: the gum around the implant is inflamed and bleeds on contact; the bone is unchanged. Reversible if it is recognised and treated.
• Peri-implantitis: the bone around the implant breaks down. Not reversible — the bone that has been lost does not come back. Treatable, but demanding, and not always successful.

The path from the first stage to the second is the reason why follow-up care with implants is not optional. Anyone who has their implants checked regularly is caught at the mucositis stage. Anyone who does not come, at the peri-implantitis stage.

What is different about the follow-up care

On implants, different tools are used than on natural teeth. Metal hand instruments and coarse jet powder can roughen the surface, and a roughened surface is harder to keep clean. Instruments made of plastic, titanium or ceramic are therefore used, along with fine powders such as glycine or erythritol.

Measurements are also taken: bleeding, pocket depth and, at set intervals, an X-ray check of the bone level. Without a comparison value from the beginning, it is hard to judge later whether anything has changed — the image taken after fitting is therefore more than documentation.

Three to six months has become established as the interval, depending on the findings, on oral hygiene and on whether the person smokes. smoking is a particularly unfavourable factor with implants.

Crowns, bridges and partial dentures

Fixed dentures also have margins, and these margins often lie exactly at the gum. Three places are particularly important:

• The crown margin. Beneath a crown the underlying tooth can develop caries — often without complaints, because the nerve reports more faintly under a crown.
• Beneath a bridge. Between the bridge element and the gum there remains a gap that cannot be reached with a brush. For that there is dental floss with a stiffened end, introduced from the side, or special brushes.
• The retaining elements of a partial denture. Clasps rest against the tooth and gather plaque there. The clasp teeth are statistically the teeth most often lost next.

Removable dentures

Dentures need two things that are often confused: cleaning and checking the fit.

Cleaning is done daily, mechanically — with a denture brush and soap or a washing-up liquid, not with toothpaste. Its abrasiveness is too high for the plastic and over time produces dull, rough patches. Cleaning tablets are an addition, not a replacement: they loosen discolouration but they do not brush.

The fit changes, because the jawbone beneath a denture recedes over the years. A denture that wobbles or presses does not belong in a drawer and not in adhesive cream, but at the practice — pressure points can damage the mucosa permanently.

And the mouth itself needs care, including where there are no teeth left: palate, tongue and alveolar ridges are cleaned with a soft brush or a damp cloth. At night the denture should as a rule come out, so that the mucosa can recover.