If the titanium oxide layer of the dental implant is disrupted during oral hygiene procedures, the soft tissues may be exposed to titanium metallic ions that can cause potentially cytotoxic reactions compromising the dental implant. Therefore, detailed instructions by the dental professional should be given initially to the patient and reinforced at each recare appointment to prevent trauma or infection to the tissues around the dental implant. The removal of early pathogenic bacterial accumulation on the dental implant surfaces and the elimination of the majority of plaque biofilm by the patient are crucial for long-term peri-implant success. The preventive maintenance steps for dental implants involve two distinct aspects: (1) patient self-care, and (2) clinical maintenance procedures by the dental team.
No single oral hygiene device has been shown to remove plaque from all surfaces of an implant reconstruction. While there are numerous types of manual and power brushes, flosses, and other oral hygiene products on the market, the literature substantiates the need to minimize the number of devices initially prescribed for patient self-care. Patient compliance is an essential aspect of any maintenance program and predominantly depends on the relative simplicity of a procedure, the time required, and a minimum number of recommended devices initially. Studies indicate when multiple oral hygiene devices are prescribed at one time, patients can become discouraged and as a result, may be less motivated. However, research shows additional plaque inhibition with a combination of toothbrushing, interdental aids, and antimicrobial mouthrinses. For this reason, it is important to consider appropriate combinations when making recommendations to individual patients.