Prevention and treatment of peri-implant diseases: Cleaning of titanium dental implant surfaces

The research presented in this thesis assessed the effect of variable instruments on differed titanium dental implant surfaces. Furthermore, a clinical guideline was developed and recommendations are made regarding the diagnosis, prevention and treatment of peri-implant diseases. Air abrasive devices appear to be effective in removing biofilm from both smooth and rough titanium surfaces, without causing major changes on the surface structure and having the least effect on the biocompatibility of the treated surfaces. The selection of the powder seems to be of importance. Powders with tricalcium phosphate as additive may have a beneficial effect on the biological responses. From the available chemotherapeutic agents, citric acid and hydrogen peroxide seem to have the best potential. Regular controls and meticulous maintenance from both the patients and dental care professionals are mandatory to avoid problems. Baseline clinical and radiographic recordings are important to be able to follow implants over time and to differentiate between health and disease. The first time to assess probing pocket depths around implants should be around 8 weeks after prosthetic installation in order to give the soft tissue the necessary time to adapt. Changes in clinical and/or radiographic parameters can be an alarming sign. Patients should receive individually tailored instructions for optimal oral hygiene. Prevention and early diagnosis of problems is the key for long-term success with dental implants.