Implant crowns must be kept clean… but how?

PD Dr. Kristina Bertl, PhD MSc MBA

Implant crowns often have a different shape to natural tooth crowns, particularly in the molar region. This is primarily due to the fact that the implant diameter in the molar region is usually significantly smaller than the previous tooth root. This, in turn, makes it all the more important that patients are given precise instructions as to how and with what they should clean their new implant crowns at home.

Implant crowns must be kept clean… but how?

A recently published American study (Sirinirund et al. 2023) looked into this topic in more detail. The laboratory study looked at which oral hygiene products could be the most effective for implant crowns in the molar region. The following five oral hygiene products were tested:

1. regular dental floss
2. reinforced dental floss (superfloss)
3. interdental brush
4. electric interdental space cleaning (interspace attachment)
5. oral irrigator (Sonicare Airfloss)

The oral hygiene products were tested on one initial molar and the amount of artificial biofilm simulation that could be removed was collected in a standardised manner. Two further relevant parameters were also tested:

1. crown shape (straight, convex, concave)
2. level of experience (periodontist, dental hygienist, layperson)

The results were very interesting and can be summarised as follows:

1. A concave crown shape makes interdental cleaning easier and enabled more effective biofilm removal, particularly underneath the crown; the convex crown shape proved to be the most difficult to clean.
2. Regular and reinforced dental floss proved to be the most effective and was able to remove most of the artificial biofilm; the oral irrigator was the least effective.
3. The level of experience had no influence on the removal of biofilm, meaning that the laypersons were just as good at handling the oral hygiene products as the periodontists and dental hygienists.

In summary, it could be said that home oral hygiene on implants cannot be equated 1:1 with natural teeth. It was interesting to see that dental floss seemed to be the most effective, particularly for the underside of the implant crown. Nonetheless, it should be taken into account – even though this was not included in the study presented – that, depending on the size of the interdental area, it is presumably often necessary to use a combination of multiple oral hygiene products for interdental cleaning on implants, e.g. interdental brushes for the actual interdental area and dental floss for the underside of the implant crown.

Reference

1. Sirinirund, B., Siqueira, R., Li, J., Mendonça, G., Zalucha, J., & Wang, H.-L. (2023). Effects of crown contour on artificial biofilm removal efficacy with interdental cleaning aids: An in vitro study. Clinical Oral Implants Research, 34, 783–792.