The soft-tissue assessment includes checking for visual signs of gingival inflammation, such as redness, swelling, alterations of contour and consistency, aberrant gingival form or the presence of fistulas.
Plaque monitoring is performed and documented at every maintenance visit, to allow longitudinal assessment of oral hygiene.
Probing is an important and reliable diagnostic parameter in long-term monitoring of all soft tissues including peri-implant soft tissues. The safety of probing around implant restorations has been well-established, and this procedure when done correctly does not jeopardize the integrity of oral implants. It is recommended to wait at least three months after placement before probing.
The absence of bleeding on probing can be taken as an accurate indication of stability. The recording bleeding on probing when performing periodontal evaluation to monitor peri-implant soft tissues is thus seen as imperative.
Mobility is a primary determining factor for implant health. Mobility should be assessed regularly; this can be done manually or by using an automated device. To properly assess mobility for multi-unit implant fixed prosthesis, it is recommended that the prosthesis is periodically removed. By removing the prosthesis, a more accurate assessment can be made regarding mobility, gingival health, and hygiene status.
Occlusion is checked at regular intervals to identify occlusal disharmonies. Studies indicate there is a direct correlation between occlusal overload and peri-implant bone loss. Premature contacts or other interferences are identified and corrected.
A periapical/vertical bitewing radiograph is taken at 6-8-month intervals and compared to the baseline to assess crestal bone. If the bone level is stable, another periapical/vertical bitewing will be taken after one year and compared. Preservation of crestal bone height is crucial to the long-term success of an implant.
As dental professionals, we are responsible for providing patients with the proper guidance and tools to be successful in maintaining good oral hygiene. It is also our responsibility to take the time to examine and record any changes or concerns we find during implant patients’ regular maintenance appointments. The more patients know about implant maintenance and care, the higher the patient compliance and thus achieve implant success in the long run.