The long-term care of dental implants

Looking after your dental implants from the outset is vital for long-term success.  They should not be regarded as ‘fit and forget’.  Whether you have had an implant to replace one or multiple teeth, good oral hygiene and regular check-ups are essential.  Neglected implants develop plaque and tartar and can also be susceptible to bacteria, which may result in gum disease.  Left untreated, this can lead to peri-implantitis, which is comparable to periodontal disease around natural teeth.  The condition is likely to cause soreness, bleeding, general discomfort and eventual bone loss around the implants.  If detected early, it can be managed and treated, which is why regular check-ups and maintenance are so important.

According to the Oral Health Foundation, “How well you look after your implants and whether you go for your regular maintenance appointments, will have the biggest impact on how long they will last.  If your implants are well looked after, and if the bone they are fitted to is strong and healthy, you can expect them to last for many years.”  


How do I care for my dental implants on a daily basis?

Just because implants are ‘artificial’ tooth roots, doesn’t mean your oral cleaning regime should be any less stringent.  Plaque also collects on implant crowns and harbours bacteria.  If it is left with the perfect environment to flourish, bacteria can multiply and release toxins, which are an irritant to surrounding tissues.  Both natural teeth and dental implants depend on healthy surrounding tissues for support.  

Dr Colin Neil, principal dentist at Confident Dental Implants, Stroud, explains, “As part of your daily oral hygiene routine, you should aim to clean around each implant twice a day, using a toothpaste if you wish.  You should brush all the surfaces of the implant tooth, or teeth, that you can access with a conventional toothbrush, either manual or electric.  For the surfaces you can’t reach, for instance in between teeth, you can use floss, or an interproximal brush and/or an oral irrigator device.” 

Unwaxed tape or implant-specific floss may be needed, in order to protect the tissue surrounding the implant.  Interdental toothbrushes and other cleaning aids, such as water flossers are useful tools.  A single-tooth implant should be treated and cleaned like a natural tooth.  It is permanently fixed, so the crown is not normally removed for cleaning.  You may have implants in areas that are difficult to reach, such as at the back of your mouth.  Your dental team will show you how to clean them and advise on the appropriate equipment to use.

How many check-ups should I expect?

Regular check-ups and visits to the hygienist are another important part of dental implant aftercare.  For the first few months after your implants have been placed, your dentist may ask to see you more frequently.  It is likely that you will need to return to the clinic within a couple of weeks, so your dentist can check on how well your implants are healing.

Osseointegration, the process where the implant fuses with surrounding bone, can take several months, so you will need to be monitored regularly.  Once your implant dentist is satisfied your treatment is performing as planned, ongoing care will be similar to any patient with natural teeth, and will eventually be combined into your usual check-up appointment.  The frequency of these examinations will be recommended and tailored to your individual needs by your dentist.

How can a dental hygienist help me?

The role of the hygienist is very important.  Their job is to monitor the health of the tissues surrounding the implant and identify any potential problems, such as peri-implant mucositis or peri-implantitis.  Hygienists take special precautions when cleaning implants and will select the correct techniques and instruments, made from specific materials, to avoid causing damage when scaling, probing and polishing.  Regular hygiene appointments can also help to remind you how to correctly maintain implants, and improve your cleaning technique as required.  

Early detection of infection

If you suspect that you may have bleeding from your gums, or an infection, make an appointment with your dentist straight away.  Peri-implant mucositis is inflammation around the gums of the implant tooth, caused by the build-up of bacteria in the mouth.  It is treatable and reversible, if detected early.  If the plaque isn’t removed, it can lead to peri-implantitis.  This is a more serious condition, as bone loss can occur and your implant may be at risk of developing further problems, ultimately leading to the implant becoming loose.

How do I care for an implant bridge or denture?

Some implant restorations can be slightly more time consuming to keep clean, for example, an implant bridge or denture.  How you clean your replacement teeth depends on whether they are permanently fixed in the mouth or removable.  If you are unsure of what to do, or the type of equipment to use, ask your hygienist or implant dentist. 

Looking after an implant-supported fixed bridge

If you have more than one tooth missing in a row, an implant-supported dental bridge may be suitable.  Unlike a conventional bridge, implants are used to support the replacement crowns and are designed to take the full force of eating and chewing.  The pressure is absorbed by the implant and jaw bone. 

Your implant-supported bridge will be permanently fixed in place and should be treated and cleaned like natural teeth.  As part of your daily oral hygiene routine, you should brush and floss as normal.  Cleaning around the implants with an interproximal brush will help.  You should floss between the bridge and gums, as well as between any natural teeth.

Dr Steve Larcombe of St Lawrence House Dental Practice, Winchester explains, “Pre-cut floss sections with stiffened ends to pass through the gap and a spongy section to collect bacteria, is recommended.”  

A water flosser that loosens and flushes away plaque with a pressurised water stream may also be beneficial.

Dr Colin Neil comments, “Although this is a fixed option, it may be necessary for the dentist to remove the fixed bridge from time to time, allowing access for deeper cleaning and removal of any trapped oral debris.  This also enables the implants in your jaw to be checked, and the bridge thoroughly cleaned outside the mouth.  Afterwards, your implant-supported restoration can be reconnected by your dentist.”

What to do with implant-retained removable dentures

Implant-retained dentures are removable and are sometimes called overdentures.  They are held in place by implants and spread pressure between the implants and the gums.  An implant-retained denture has special attachments that connect with the implants placed in the jaw, which allow you to remove it at least twice daily for cleaning.  You should also brush around the attachments and the gum area.  Just as with conventional dentures, you should, ideally, not sleep with them in your mouth.  They can be stored overnight in a denture cleanser solution or water.

How can a healthy lifestyle help my dental implants?

Healthy lifestyle choices are essential to the long-term care of dental implants.  Excessive smoking and drinking habits will contribute to poorer oral health, which may, consequently, affect the longevity of dental implants. 
Smoking increases the risk that implants may not heal properly after they are placed.  Nicotine constricts blood vessels and reduces blood flow to the soft tissues, which can affect the immune response.  This slows the process of healing and affects the long-term health of gum and bone.  Smoking makes implants more likely to fail over time.

The healing process can also be impaired by poor diet and excessive alcohol consumption.  It is wise to avoid alcohol for two weeks after implant placement, until the tissues surrounding the implants heal correctly.  

Dr Asif Hamid of Fitzroy Dental Practice, London adds, “Drug use, uncontrolled diabetes and cardiovascular problems can also increase the likelihood of gum disease and the potential for tooth loss.  Similarly, anaemia and vitamin D deficiency in patients are known to compromise implants.”

Implants vulnerable to stress

Extreme biting forces, night-time clenching or an accidental injury to the mouth can cause problems for dental implants.  The connection between the implant and bone could be weakened and without this bond, your replacement teeth could come loose.  Your dentist can provide mouth guards to wear at night or during contact sport to prevent damage.

Long-term success

Your dentist will have placed your implants with the best chance of long-term success.  Much of the assessment and precise planning takes place in advance to achieve this.  However, there are also many factors under your control which can contribute to the longevity of your new teeth.  Your commitment to the long-term care of dental implants is that you maintain good oral hygiene and a healthy lifestyle.  According to The Association of Dental Implantology, “It is the quality of your personal attention to oral hygiene and willingness to attend regular maintenance reviews that will have the most influence on how long they will last.”

To find out more about your suitability for dental implants, contact a local implant dentist for an initial FREE consultation.

This article was written with advice from:

Dr Asif Hamid

Dr Steve Larcombe

Dr Colin Neil