hygiene the international C.E. magazine of dental hygiene

22 I I C.E. article_ implant maintenance of a natural tooth. Often the adjacent teeth can be used as a guide to determine the proper contours. The protocol for margin location of a standard Implantrestorationisstillunderdebate.Astheloca- tion of the crown abutment margin is placed deeper subgingival, the ability to access and maintain the site become more difficult (Linkevicius, 2012). What doesthisallmeanfortheclinicianandpatientinthe maintenance of the implant prosthesis? Access to the subgingival area of the implant prosthesis for proper maintenance is vital to the health and success rate of the prosthesis. As margin locationandemergenceprofilesextendfarthersub- gingival, the ability to maintain these sites becomes more challenging. Evidencehasshownthatpowerscalerswithnon- metallictipscanbebeneficialinmaintainingtheim- plant prosthesis (Sato, 2004). Several manufactures offertipdesignsthatwillaccommodatethedifferent types of power scalers. DENTSPLY Professional has an insert whose unique design allows a polymer sleeve to be assembled to the active tip area of this ultrasonic implant insert (Fig. 4). When fully as- sembled, the Cavitron® SofTip™ Ultrasonic Implant Insert can easily be incorporated into a clinicians’ implant maintenance procedure. Incorporatingultrasonicsscalingintotheimplant maintenance protocol may have several benefits. Combining mechanical movement and lavage can aid in the removal of biofilm and other debris in the implant prosthesis sulcus. Wilkins wrote in 2012: “Studies indicate cavitation is capable of destroying surfacebacteriaandcanremoveendotoxinfromthe root surface.” And: “Oscillation of the ultrasonic tip causeshydrodynamicwavestosurroundthetip.This acoustic turbulence is believed to have a disruptive effectonsurfacebacteria”(Wilkins,2012).Multiplein vitrostudieshavediscussedthatcavitationmayhave the potential to disrupt the cell wall of the bacteria, and acoustic turbulence is believed to have disrup- tive effect on the surface bacteria (Baehni, 1992; McInnes,1993;Walmsley,1990).However,furtherin vivostudiesneedtobeconductedtodetermineifthe same outcomes are achieved in the sulcus. Another benefit to incorporating power scaling into the maintenance procedure is the ability to adapt the active tip area into the implant sulcus. Incorporatingverticaladaptationoftheactivetip,at azero-to15-degreeangle,totheimplantrestoration can allow for significant subgingival surface contact for efficient deposit removal. When the emergence profile follows the anatomical shape of a natural tooth, this instrumentation technique can be an ef- fective method of maintaining the site. Finally, easy access for the patient is extremely important in the success of the implant prosthesis. There are a variety of interdental brushes, cleaners, andflossoptionsavailabletothepatient.Itisimpor- tantthatthecleanersbeeasytouse,notcausetissue trauma in the implant sulcus, or surface damage to the esthetic materials in the restoration. Dental implants are increasing in demand in part by their high success rates and the improved esthet- ics they provide the patient. A key to this success is having the proper design incorporated into the restoration. When designed properly, the implant restoration can be easily maintained by both the patient and clinician._ hygiene 1_2013 Fig. 3_Ideal sulcus formation created by proper emergene profile of the implant abutment. Fig. 4_Cavitron SofTip Ultrasonic Implant Insert (Photo/Provided by DENTSPLY Professional.) ShirleyBranam,RDH,MBA,isaclinicaleducatorforDENTSPLYProfessional,servingthecentralregionof theUnitedStates.SheearnedaBachelorofScienceindentalhygienefromtheUniversityofMichiganand anMBAinhealthcaremanagementfromtheUniversityofPhoenix.Shehasmorethan20yearsofclinical and educational experience in the dental assisting and dental hygiene professions. While a member of the University of Michigan School of Dentistry, she held various appointments including hygiene faculty member,staffhygienistinthegraduateprosthodonticclinicandresearchcoordinatorassistant.Herareas of expertise include clinical dental hygiene, biomaterials, implants and local anesthesia. Gerhard(Gary)Mora,CDT,BS,isdirectorofdentallaboratorysupportfortheUniversityofMichiganDental School. He earned an associate in applied science degree in dental technology and Bachelor of Science in business administration from Ferris State University, where he later was on the faculty in the dental technologyprogram.Heisacertifieddentaltechnicianandhasmorethan37yearsofexperienceinden- tistry.Hisexpertisewithdentalmaterialsresearchanddigitaldentistryhasresultedinoriginalpublications and presentations at meetings such as IADR/AADR and CEREC 25 & 27.5. He teaches in the advanced education in general dentistry residency program and will be on staff for the new computerized dentistry programstartinginJuly.Hisexpertiseincludesfixedprosthodontics,dentalmaterialsanddigitaldentistry. _about the authors hygiene Fig. 3 Fig. 4