The American Dental Association describes periodontal maintenance as a “procedure . . . instituted following periodontal therapy (which) continues at varying intervals, determined by the clinical evaluation of the dentist, for the life of the dentition (for the life of the teeth) or any implant . . . (and) includes the removal of plaque and calculus from the supragingival and subgingival regions, (including) site specific scaling and root planing.”
A periodontal maintenance procedure is not the same treatment as a regular cleaning even though a hygienist may perform both services. A periodontal maintenance procedure, formerly known as supportive periodontal treatment (SPT), includes but is not limited to:
- An update of your medical and dental history
- X-ray review
- Intraoral and extraoral exam of the cheeks, lips, gums and throat
- Tooth, gum and bone (periodontal probing around the teeth) examination by the dentist (Unlike in your general dentist’s office, the exam fee is included in the periodontal maintenance fee for our office. This helps you get more bang for your insurance buck.)
- Review of home care
- Scaling, Root planing and polishing the teeth as needed
- Gum and pocket irrigation with medicine, as needed
The typical maintenance interval, especially immediately right after active periodontal treatment such as scaling and root planing or surgery is every three months. This is usually done at the periodontist’s office for the first few visits to make sure you are periodontally stable. Once we have a good history of stability we like to alternate your 3-month maintenance visits with your general dentist. This allows us and your general dentist to work as a team in maintaining your periodontal health. This recall interval may be lengthened or shortened over time depending on the history of stability and your effectiveness with home care as a patient. The important thing to remember is that once you have been diagnosed and treated for periodontitis you are a periodontal patient for life.
A very important scientific study demonstrates the importance of periodontal maintenance. The study had three groups of people; one group who had periodontal disease but received no treatment for the disease; another group who had disease and received treatment but did not follow a maintenance program; and the last group who had the disease, was treated and followed a regular maintenance program. The study found that the first group ended up losing about one tooth every three years, while the second group lost one tooth every five years and in the last group it took about 10 years before a tooth was lost. So, as you can see, as in many other chronic conditions, successful long-term control of the disease and prevention of tooth loss depends on a life-time of periodontal maintenance.
Once a dental implant is placed and restored it is just as important if not more so for the need of regular implant maintenance at least every six months. Implants are just as susceptible to disease as teeth and can also undergo mechanical failure if not properly restored and cared for. Implants just like teeth can remain healthy or develop diseases such as peri-implant mucositis or even worse, peri-implantitis.
In health, the implant site is characterized by absence of erythema (redness), bleeding on probing, swelling and suppuration.
In health, there are no visual differences between peri-implant and periodontal tissues. However, the probing depths are usually greater at implant versus tooth sites. The papillae at the interproximal sites of an implant may be shorter than the papillae at interproximal tooth sites.
It is necessary to probe peri-implant tissues to assess the presence of bleeding on probing, and to monitor probing depth changes and gingival margin migration. This assessment may alert the periodontist to the need for therapeutic intervention. There is evidence that probing of the peri-implant tissue using a light probing force is a safe and important component of a complete oral examination.
It is not possible to define a range of probing depths compatible with peri-implant health; but of greater importance are the clinical signs of inflammation (swelling).
The main clinical characteristic of peri-implant mucositis is bleeding on gentle probing. Erythema (redness), swelling and/or suppuration may also be present.
These clinical signs of inflammation are necessary for a diagnosis of peri-implant mucositis.
An increase in probing depth is often observed in the presence of peri-implant mucositis due to swelling or decrease in probing resistance.
There is strong evidence from both animal and human experimental studies that plaque is the primary cause for peri-implant mucositis. Studies have shown that implants exhibiting peri-implant mucositis can easily progress to peri-implantitis if not routinely maintained.
Fortunately, there is evidence from experimental human studies that peri-implant mucositis can be resolved with at 6-month maintenance visits in order to deal with the principal cause – plaque accumulation. The patient’s response to plaque accumulation may vary between patients, with such factors as smoking, diabetes mellitus, and radiation therapy playing significant roles.
Peri-implantitis is a plaque-associated pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant mucosa and subsequent progressive loss of supporting bone.
There is evidence that patients exhibiting poor plaque control and not attending regular maintenance therapy are at higher risk of developing peri-implantitis.
Peri-implantitis sites exhibit clinical signs of inflammation, bleeding on probing and/or suppuration (pus), increased probing depths and/or recession of the gingival margin in addition to radiographic bone loss compared to previous examinations. At sites presenting with peri-implantitis, probing depth is correlated with bone loss and is, hence, an indicator for the severity of disease. It is important to recognize that rate of progression of bone loss may vary between patients.
You have made a significant investment in your periodontal health by choosing a dental implant as a restorative option. Don’t put this significant investment at risk by failing to maintain your dental implant in a healthy condition by attending your implant maintenance appointment every 6 months.