Soft Tissue-to-Implant Interface
The successful dental implant should have an unbroken, perimucosal seal between the soft tissue and the implant abutment surface. To maintain the integrity of this seal, the patient must maintain a high level of oral hygiene
specific to dental implants. Clinicians, dental hygienists. and patients must understand and appreciate the necessity for a comprehensive implant maintenance program, including regularly scheduled recall visits. In the natural dentition the junctional epithelium provides a seal at thebase of the gingival sulcus against the penetration of chemical and bacterial ubstances. It has been demonstrated that epithelial cells attach to the surface of titanium in much the same manner in which the epithelial cells attach to the surface of the natural tooth, that is, through a basal lamina and by the ormation of hemidesmosomes. The connection differs from thatoccurring with natural teeth at the connective tissue attachment level. In the natural dentition, Sharpey’s fibers extend from the bundle bone of the lamina dura
and insert into the c ementum of the tooth root surface.Because no ementum or fiber insertion is found on the surface of an endosseous implant, the epithelial surface attachment is all-important. If this seal is lost, the periodontal pocket can extend directly to the oSseous structures.
Therefore if the seal breaks down or is not present,the area is subject to periirnplant gingival disease. Although the abutment-to-junctional epithelium attachment is not mechanically strong, it is adequate to
resist bacterial invasion with the assistance of adequatehome care. When implants are stable and they have a highly polished titanium collar transversing the tissue, gingival and periimplant health appear relatively easy to maintain. The lack of definitive gingival connective tissue
attachment appears to be less of a problem in osseointegrated implants than it was in impiants with fibrous corinective tissue attachments. Because osseointegrated implants have a different relationship between theimplant and bone, there appears to be different rnecha- . nisms working against nflammation caused by bacteria and their by-products. The pathogenicity of the bacteriaseems to be particularly diminished in the ompletelyedentulous patient restored with dental implants. Diseaseactivity around the natural dentition in the partially edentulous patient may contribute to a slightly higherincidence of periimplant disease in these patients.Implant survival depends on proper and timely homecare and maintenance. The dentist must ensure that thepatient receives thorough instruction in maintenancetechniques. The goal of implant maintenance is to eradicate microbial populations. Recall visits should be sched-
.uled at least ,every ;3 months for the first year, The sulculararea should be debrided of calculus by’ using plastic Dr wooden scalers. A rubber cup with low abrasive polishing paste or tin oxide may be used to polish implant abutments. Implant mobility should be evaluated and bleedingupon probing documented. Framework fit and occlusion should also be checked at recall appointments. These biomechanical factors are as important as oral hygienefor the long-term success of the dental implant.