Dental plaque control-related behaviour among patients with dental implant-supported restorations

Pages: 164-171

Cărămidă Mariana (1)

(1) Teach. Assist.; Oral Health and Community Dentistry Department, Faculty of Dentistry, “Carol Davila” Medicine and Pharmacy University, Bucharest, Romania

Abstract

Peri-implant inflammation is frequently met in the absence of both patient and professional administered plaque removal.

Aim: to assess the habits the behaviour related to the individual and professional plaque removal among patients wearing dental implant supported restorations

Material and methods: cross-sectional study, in 2018, in Romania, on a sample of 94 subjects with at least 1 implant-supported restoration. The assessment was performed using a self-administered questionnaire.

Results: 93.61% of subjects brush twice daily, but only 82.97% use interdental cleaning products. Even if 97.87% of subjects declare they received oral health counselling from their dentist, only 42.55% go to the dental office for professional cleaning at least 2 times a year after the dental implant restoration was finished.

Conclusion: among the subjects assessed, individual dental plaque control behaviour was satisfactory but the behaviour related to professional plaque control was improper.

Keywords: dental implants, oral hygiene, peri-implantitis

Introduction

Dental implants are nowadays commonly used due to their multiple benefits for edentulous patients. But even if the quality of implants has improved constantly over time, on one hand, and that the treatment of periodontal inflammation around natural teeth have proved to be efficient and successfully under evidence-based guidelines [1], on the other hand, still the peri-implant inflammation is frequently met, with its superficial form, mucositis, affecting more than 50% of implant-treated patients [2] while its deep form, peri-implantitis, affecting between 28% and 56% of the patients [2], and, moreover, its treatment is unpredictable [3]. Inflammation is the most common complication of dental implants [4] and, unfortunately, compared to the periodontal inflammation around natural teeth, once initiated, it develops deeper in shorter time and its response to the anti-inflammatory treatment is slower and incomplete in most of the cases [5,6].

For primary and secondary prevention of mucositis and peri-implantitis the control of biofilm is the cornerstone, therefor proper oral hygiene at home and supportive therapy are of utmost importance. Supportive therapy consists of professionally mechanical plaque removal with hand and powered instruments and, in addition, of oral hygiene instructions for patients. It should be delivered regularly at a time span depending on individual risk level  and its impact on implant survival is major since studies show that 43.9% of cases of mucositis, in 5 years in the absence of the supportive therapy, convert to peri-implantitis [5]. Home care regimen for patients for biofilm control consist of mechanical plaque removal with either manual or powered toothbrush [5,6], as well as interdental cleaning products preferably interdental brushes and oral irrigator [7].

Aim

The aim of this study was the assessment of the behaviour related to the individual and professional plaque removal among patients wearing dental implant supported restorations.

Materials and method

The present cross-sectional study was conducted in 2018, in Bucharest, Romania, by the Oral Health and Community Dentistry Department (“Carol Davila” Medicine and Pharmacy University, Faculty of Dentistry) on a sample represented by 94 subjects with a mean age of 44.13 ± 10.87 years, of which 50 were men (53.19%) and the inclusion criteria was the presence of at least one implant-supported restoration for at least 6 months prior to the participation in the study. The assessment was performed using a self-administered questionnaire. Descriptive analysis was performed for frequency and means calculation.

Results

Subjects included in the study had between 1 and 7 dental implants, with a mean number of 2.82 ±1.39 implants/patient, and for 72.34% (N=68)  of patients the treatments were performed for more than 1 year prior to the study.

Regarding the oral home care regimen, even if almost all the subjects brush twice daily (93.61%), the proportion of patients using regularly interdental cleaning products are low, with oral irrigator being the most frequently mentioned product used (42.55%) among the subjects enrolled in this study. On the other hand, mouthrinse with antispetics is used by 57.44% of participants (Table 1).

         Table 1. Individual Plaque removal habits

         Regarding the supportive therapy, less than half of the subjects went at least twice a year to the dental office for the professional cleaning, 19.15% every 3-4 months and 23.40% every 6 months, while there is a worrying percent of participants (10.65%) who never underwent this preventive treatment after the implant-supported restorations were finalised. And these happen despite the fact that 97.87% of subjects declared they had received oral health instructions from their dentist (Table 2).

   Table 2. Professionally Plaque removal habits

Discussions

In the present study the proportion of subjects using powered toothbrush is higher than that of manual toothbrush users, and even if the superiority of powered toothbrushes over the manual ones is still to be established when it comes to patients with dental implants [7], there are studies showing strong evidence supporting better clinical outcomes and implant survival when powered toothbrushes are used [7].

Moreover, in the present study there was observed an important proportion of subjects using antiseptic oral rinses, even if by now there is no clear evidence of improved clinical parameters and implant survival as a results of using antiseptics as adjunctive mean in oral hygiene routine, even when clorhexidine was used [7]. However, this patients’ preference could be justified by the fact that this is an easy to use product compared to interdental cleaning product.

When it comes to the low rate of supportive therapy adherence despite the dentist involvement in oral health counselling, there should be taking into consideration that these counselling sessions in the dental office proved over time to be efficient only when the discussions are based on psychological approaches, namely self-determination process, when dentist engages the patients to adhere to the recommendations offered by increasing their capability (physical and psychological), their opportunity awareness over the proper oral hygiene behaviour and their motivation [8].

Conclusions

In the present study, subjects show a satisfactory behaviour regarding individual dental plaque control but improper habits regarding supportive therapy, namely professional plaque control.

Reference

1. Loos BG, Needleman I. Endpoints of active periodontal therapy. J Clin Periodontol. 2020;47:61–71.

2. Derks J, Tomasi C. Peri-implant health and disease. A systematic review of current epidemiology. J Clin Periodontol 2015; 42 (Suppl. 16): S158–S171

3. Lindhe, J., Meyle, J. & Working Group D of the VI E.W.o.P (2008) Peri-implant diseases: Consensus Report of the Sixth European Workshop on Periodontology. Journal of Clinical Periodontology 35 (Suppl 8), 282–285.

4. Renvert S, Polyzois I. Risk indicators for peri-implant mucositis: a systematic literature review. J Clin Periodontol 2015; 42 (Suppl. 16): S172–S186.

5. Jepsen S, Berglundh T, Genco R, Aass AM, Demirel K, Derks J, Figuero E, Giovannoli JL, Goldstein M, Lambert F, Ortiz-Vigon A, Polyzois I, Salvi GE, Schwarz F, Serino G, Tomasi C, Zitzmann NU. Primary prevention of periimplantitis: managing peri-implant mucositis. J Clin Periodontol 2015; 42 (Suppl. 16): S152–S157.

6. Salvi GE, Ramseier CA. Efficacy of patient-administered mechanical and/or chemical plaque control protocols in the management of peri-implant mucositis. A systematic review. J Clin Periodontol 2015; 42 (Suppl. 16): S187–S201.

7. Salzer S, Slot DE, Van der Weijden FA, Dorfer CE. Efficacy of inter-dental mechanical plaque control in managing gingivitis – a meta-review. J Clin Periodontol 2015; 42 (Suppl. 16): S92–S105.

8. Newton TJ, Asimakopoulou K. Managing oral hygiene as a risk factor for periodontal disease: a systematic review of psychological approaches to behaviour change for improved plaque control in periodontal management. J Clin Periodontol 2015; 42 (Suppl. 16): S36–S46.

Share this article:

You might be interested: