Search Dental Tribune

Guided Biofilm Therapy: The optimal solution for implant maintenance

To enhance implant maintenance, the application of EMS’s Guided Biofilm Therapy is becoming increasingly common in dental practices. (All images: EMS Dental Korea)

Thu. 31. October 2024

save

Implant-related diseases are generally categorised into two main types: peri-implant mucositis and peri-implantitis. There are various reasons for implant failure; however, studies have shown that implants may fail because of periodontal disease, especially in cases where they were placed after tooth loss due to periodontitis. Peri-implantitis, which involves bone loss, typically follows the stage of peri-implant mucositis. The symptoms of mucositis are similar to those of gingivitis in natural teeth, including gingival bleeding without the loss of connective tissue around the implant.

Early treatment is crucial to restore the gingivae to a healthy state. During examination, patients with mucositis may show significant subgingival plaque or foreign substances such as implant cement. It is important to check for inflammation by assessing bleeding on probing and using an explorer for subgingival probing, being careful to ensure that no damage is caused to the gingival

Plaque observed during subgingival probing on #47I.

Plaque observed during subgingival probing on #47I.

Stable gingiva observed six weeks after applying AIRFLOW on #47I.

Stable gingiva observed six weeks after applying AIRFLOW on #47I.

The importance of early maintenance and self-care education

Removing the causes of mucositis and providing comprehensive oral hygiene education that enables patients to manage their oral health effectively are key to extending the lifespan of implants. Therefore, implants should be regularly monitored and maintained through early professional intervention, including regular dental visits, supportive periodontal treatment and personalised toothbrushing education.

Gingival swelling and edema around an implant.

Gingival swelling and edema around an implant.

Using a Perio Brush (GC Korea) to perform TBI on swollen gingiva around an implant.

Using a Perio Brush (GC Korea) to perform TBI on swollen gingiva around an implant.

The key to implant maintenance: Biofilm removal

The core of implant maintenance lies in identifying and removing biofilm, the primary cause of implant-related complications. To do this, it is essential to assess bone loss around the implant and check for inflammation using radiographs. This should include panoramic imaging and periapical imaging using the parallel technique. A thorough evaluation of implant mobility, pain, residual cement and the appearance of calculus is necessary. Such comprehensive examinations are vital to accurately understanding the patient’s oral health status. In cases where peri-implantitis with bone loss is present, appropriate periodontal treatment and antibiotics are required to alleviate inflammation. After this, continuous implant maintenance at custom recall intervals and oral hygiene education are critical.

However, many still rely solely on professional tooth cleaning, which aims to keratinise the gingival epithelium rather than thoroughly remove biofilm. Consequently, even with professional care, residual biofilm may lead to ongoing inflammation.

The state of peri-implantitis during a maintenance visit.

The state of peri-implantitis during a maintenance visit.

Improvement one week after periodontal treatment.

Improvement one week after periodontal treatment.

Stabilised gingiva two weeks after periodontal treatment around the implant.

Stabilised gingiva two weeks after periodontal treatment around the implant.

Enhancing implant maintenance with Guided Biofilm Therapy

To enhance implant maintenance, the application of EMS’s Guided Biofilm Therapy is becoming increasingly common in dental practices. GBT uses the AIRFLOW Prophylaxis Master device with the AIRFLOW PLUS powder, which has been specifically designed for GBT, is erythritol-based and contains chlorhexidine, offering antimicrobial effects. Its fine particle size allows for minimally invasive biofilm removal from areas that are difficult to reach, such as between implant prostheses and implant threads. When used correctly, it can also be applied subgingivally.

The GBT protocol begins with assessing the patient’s oral condition and risk factors. After evaluating the patient’s health, biofilm is disclosed, allowing both the patient and the clinician to identify well-maintained versus neglected areas. This visual feedback is used to engage in motivational counselling and education to improve oral hygiene. The disclosed biofilm and calculus are then effectively removed using the AIRFLOW and implant-specific scaling tips, and the patient’s next maintenance appointment is scheduled.

Before Guided Biofilm Therapy.

Before Guided Biofilm Therapy.

After disclosing the biofilm.

After disclosing the biofilm.

After Guided Biofilm Therapy using AIRFLOW MAX.

After Guided Biofilm Therapy using AIRFLOW MAX.

AIRFLOW Plus Powder and AIRFLOW Prophylaxis Master.

AIRFLOW Plus Powder and AIRFLOW Prophylaxis Master.

PIEZON PI Max: Implant-specific scaling tip

The newly introduced PI Max implant-specific scaling tip is highly effective for removing calculus around implants. This tip is designed to be slender, like a probe, and is made from a carbon-containing PEEK material that does not damage the implant surface during the treatment. It allows gentle insertion up to 3 mm subgingivally, enabling maintenance of both implants and implant prostheses with minimal risk of damage. This ensures a pain-free experience for patients and makes it easier for clinicians to access the areas around implants that are difficult to reach.

PI Max scaler tip for implants and prosthetics.

GBT—setting a new standard for implant maintenance

GBT is an optimised tool for implant maintenance that goes beyond improving oral health; it plays a critical role in ensuring lifelong oral health. Both dentists and dental hygienists should take an active interest in using these tools. Even with busy chair time schedules, it is essential to implement maintenance programmes and incorporate the latest technologies, such as the AIRFLOW and other advanced equipment, to enhance the effectiveness of implant maintenance. Regular dental visits and personalised maintenance education are crucial for a preventive approach to patient care. Implant maintenance should be recognised not just as an isolated treatment but as an integral part of a holistic health approach that holds benefits for patients and dental professionals over the long term.

Tags:
To post a reply please login or register
advertisement
advertisement