Clinical
problems Maintenance and
In the last of his series of articles on the All-on-4 technique, Kevin Lochhead looks at the
Maintenance At the outset of any treat- ment plan – be it implant or conventional – a maintenance plan must be addressed. This should include: ı. Suggested oral hygiene regime, and problems that could arise requiring inves- tigation 2. Expected, professional, regular maintenance required 3. Review protocol 4. How unexpected problems will be managed.
Oral hygiene It should be stressed to patients that long-term implant success is dependant on good oral hygiene. There is some evidence to suggests that heavy plaque and calculus build up can have an effect on peri-implant bone stabilityı. Bone loss is greater still for poor oral hygiene in bruxers and smokers. Every patient
should receive an appointment to practically demonstrate correct use of interdental brushes/super floss and the water jet (Figure ı). With regard to problems that will require the patient
current regimes for maintenance and the most common problems encountered during and after treatment
to return for review, patients should be counselled to be alert to acute inflammation of tissue round the implants, pus exudate, unpleasant smell or pain when brushing/flossing. Symptoms of parafunc-
tion should also be watched for – muscle pain, headaches, clicking joints, sensitive or loosening of opposing teeth.
Professional
maintenance and review In the first instance, this should be “needs based”, depending on the patient’s remaining dentition. An opposing periodon- tally involved arch will require a signifi- cantly more in-depth
recall programme than an implant-supported bridge. There is currently no
single accepted recall regime for implant patients. We base our system on that used by the Brånemark clinic in Gothenburg, which has been successfully imple- mented for more than 40 years: ı. Initial review after one month – review oral health, occlusion and any concerns. Take baseline radiographs. 2. Review at one year, two years, five years and ı0 years, with additional
Scottish Dental magazine 41 Continued »
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