Fig. 7: Calculus is removed with the aid of a plastic curette.
It is a safe assumption that the calculus under the prosthesis and around the implant platform had been accumulating from the day the prosthesis was inserted. Despite good home care and faithful hygiene recall appointments, it should have been assumed that calculus unable to be reached with routine care would accumulate. The “hybrid” prosthesis can introduce unusual prosthetic contours that are difficult, if not impossible, for routine hygiene to access. After the prosthesis was cleaned and reinserted, the patient was instructed to use a solution of 0.06% chlorhexidine in the oral irrigator reservoir rather than water. At a two-week follow-up, the patient noted the symptoms had been relieved. While oral irrigation with chlorhexidine will help reduce the plaque and gingivitis, this patient will still need to have his prosthesis removed periodically. How often? Patients who were on three- or four-month hygiene recalls when they had teeth will still generate significant amounts of calculus. In this clinician’s opinion, prosthesis removal on an annual basis may be necessary in order to combat the factors that lead to tooth loss. The goal is to have proactive discussions with patients about their various implant prostheses and determine their ability to be maintained hygienically. Clearly, the retrievability of a prosthesis becomes more critical as more unusual prosthetic contours are introduced.Editor’s note:
Drs. Scott Froum and Chris Salierno will be presenting on implant complications on Aug. 4, 2012, in Las Vegas. For more information, click here
Chris Salierno, DDS, is a general dentist practicing in Melville, N.Y., and co-editor of Surgical-Restorative Resource
e-newsletter. He lectures and writes about practice management and clinical dentistry. Additional content is available on his blog for dentists: www.thecuriousdentist.com
. You may contact Dr. Salierno by email at [email protected]