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All posts by Dr. Feisel Haji

Custom Fit Mouthguards VS. Off-The-Shelf Mouthguards

A common question that dentists hear from those who are in the market for a new mouthguard is,

“Do I really need a custom-fit mouthguard, or will an over-the-counter mouthguard work just as well?”

This is a valid question, and the answer depends on what your personal preferences are regarding comfort level, price range, materials, and protection levels. To help clarify which type of mouthguard may be the right one for you, we have laid out everything you need to know about the similarities and differences between custom-fit mouthguards and over-the-counter mouthguards.

Over-the-counter Mouthguards

What are they?

Both sports and over-the-counter mouthguards are made of plastic, but while most sports mouthguards are very thick and brittle, over-the-counter mouthguards are created out of a thinner and more pliable plastic that is meant to be more suitable to a wider range of people.Over-the-counter mouthguards are very similar to many mouthguards used by athletes while playing sports except over-the-counter mouthguards are intended to stop teeth from grinding during the night.

Over-the-counter mouthguards come out of their packaging as a smooth, preformed u-shaped tray and cover the entire top row of teeth in order to prevent upper and lower teeth from gnashing and grinding against each other. The mouthguard has to be fitted to your specific teeth before it is comfortable to wear and work effectively.

How are they fitted?

Generally speaking, the most common over-the-counter mouthguards are formed through a method called “boil and bite”. This means that the mouthguard must be placed in boiling water for a certain amount of time, specified by the instructions included with the mouthguard, in order for the plastic to become very soft and pliable.

After being heated sufficiently, the mouthguard is then taken out of the water and carefully placed in the mouth, over the teeth, and gently bitten down on so that the soft plastic moulds to the shape of the wearer’s teeth. The primary downside to these is that the plastic is thinner, which means that extra precaution should be taken to ensure that when moulding the mouthguard to the teeth, the mouthguard is not bitten through.

After the mouthguard has cooled and is properly formed to your teeth, you can then carefully make any adjustments to the mouthguard with a sharp and sturdy pair of scissors or a razor blade. Over-the-counter mouthguards are meant to be customizable, so if the mouthguard feels too long or is too high and aggravates the gums, it can be modified to suit your comfort level.

How well do they work?

When used for either sports or sleeping, the efficacy of over-the-counter mouthguards depends on a few things, such as these:

  • How intensely you grind, clench, and gnash your teeth together
  • The amount and type of outside force applied to the face (pucks, sticks, elbows)
  • The thickness of the mouthguard itself
  • Whether it was moulded properly after it was boiled
  • Its ability to stay on the wearer’s teeth, even when the mouth is open
  • A sleeper’s tendency to unconsciously dislodge the mouthguard

Protecting your teeth from grinding with an over-the-counter mouthguard is absolutely better than not protecting them at all. However, if your jaw moves enough to move or dislodge the mouthguard during sleep the mouthguard will no longer protect your teeth.

If you clench your teeth extremely hard, you may end up biting through the plastic or breaking the mouthguard which, again, would leave your teeth unprotected. If this sounds like your teeth grinding habits, a custom-fit mouthguard is going to be better suited to your needs.

How long do they last?

Because over-the-counter mouthguards are made from a pliable plastic, constant chewing, teeth clenching, and grinding wears down the plastic much quicker than the strong material used to make custom-fit mouthguards.

This means that over the course of a few months, over-the-counter mouthguards can break or become deformed and may no longer provide the same level of protection.

Where can I buy one and how much are they?

Over-the-counter mouth guards can be purchased at most pharmacies, drugstores, and some online retailers. However, if you are a first time buyer it is best to buy your mouth guard in person and speak with the pharmacy professional to ensure that you are getting the one best for you. Generally speaking, these mouth guards cost from $15 to $35.

Pros

  • Affordable
  • Easy to buy
  • Relatively quick to fit

Cons

  • Not suitable for violent teeth grinders
  • Do not last very long
  • Can be ill fitting
  • Less able to withstand forces during sports

Custom-fit Mouthguards

What are they?

Custom-fit mouthguards are prescribed and created by a dental professional from thermoplastic material and are based on a detailed mould taken of your mouth and teeth.

These devices are highly personalized as your dentist can adjust the thickness of the mouthguard depending on your level of teeth grinding and clenching, and they are designed to fit perfectly in your mouth with no adjustments needed. Custom mouthguards can be made for either sports or for nighttime teeth grinding, and are created differently depending on the intended use.

Most mouthguards are generally only fitted for the upper teeth, but can also be fitted for the bottom set of teeth in certain situations. Unlike over-the-counter mouthguards, no two custom mouthguards are the same, and for that reason they provide the most complete protection for your mouth.

How are they made?

The first step your dentist will take when creating your custom-fit mouthguard will be to take an impression of your teeth. This is generally done using a dental putty that forms to all the crevices of each tooth and creates an exact mould of your smile – unlike regular store-bought mouthguards which just form to the general shape of the tooth line.

This mould is then used in the dental office or, more often, is sent to a lab where the actual mouthguard is created. The structure is made by layering superheated plastic to precise specifications, and is then cooled to create an extremely durable piece of dental wear.

How well do they work?

Because custom mouth guards are so precisely made, they are able to provide you with optimal safety and comfort. This is something that over-the-counter mouthguards cannot ever achieve.

The level of protection afforded by custom-fitted mouthguards is unrivalled by any other mouthguard, and their durability is enhanced by the snug shape, which hugs each tooth closely, eliminating unwanted movement. For those who violently grind, clench, or gnash their teeth at night, custom-fit mouthguards can be made thicker, alleviating and reducing pressure on the jaw.

How long do they last?

Custom-fit mouthguards are very durable and do not lose their shape like store bought mouthguards tend to. The general rule of thumb for custom mouthguards is that every few years they may need replacing, depending on the level of wear and tear, and whether or not there have been any changes in the mouth or to the wearer’s teeth.

Children who are still growing will need their custom mouthguards updated more frequently to accommodate their changing mouths.

However, it is a good idea to bring your custom mouthguard with you to each dental checkup so that your dentist can ensure that it is still fitting properly and is not damaged.

How can I get one and how much do they cost?

Custom-fit mouthguards can only be obtained through your dentist. If you are eligible for one, your dentist will arrange a time when you can be fitted for a dental mould to begin the process of creating your custom mouthguard.

Because these mouthguards require professional attention and are so specific to each mouth, they can cost anywhere from $100 to $700 depending on what you will be using it for, how much material is needed, and other specifications your mouth may need. Be sure to check with your insurance provider whether or not the expense can be covered or partially covered according to your dental plan.

Pros

  • Best protection available
  • Extremely durable
  • Can both protect teeth and alleviate jaw tension

Cons

  • Can be expensive
  • Requires a dentist appointment

Talk to Your Dentist

Whether you are considering an over-the-counter mouthguard or think a custom-fit option might be the best for you, be sure to talk to your dentist about your specific needs. Contact us today if you have more questions about mouthguards

Article originally appeared at https://www.123dentist.com

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What You Need To Know About Dental Erosion

What is dental erosion?

Erosion is the loss of tooth enamel caused by acid attack. Enamel is the hard, protective coating of the tooth, which protects the sensitive dentine underneath. When the enamel is worn away, the dentine underneath is exposed, which may lead to pain and sensitivity.

How do I know I have dental erosion?

Erosion usually shows up as hollows in the teeth and a general wearing away of the tooth surface and biting edges. This can expose the dentine underneath, which is a darker, yellower colour than the enamel. Because the dentine is sensitive, your teeth can also be more sensitive to heat and cold, or acidic foods and drinks.

What causes dental erosion?

Every time you eat or drink anything acidic, the enamel on your teeth becomes softer for a short while, and loses some of its mineral content. Your saliva will slowly cancel out this acidity in your mouth and get it back to its natural balance. However, if this acid attack happens too often, your mouth does not have a chance to repair itself and tiny bits of enamel can be brushed away. Over time, you start to lose the surface of your teeth.

Are there any medical problems which can cause dental erosion?

Bulimia is a condition where patients make themselves sick so that they lose weight. Because there are high levels of acid in the vomit, this can cause damage to tooth enamel.

Acids produced by the stomach can come up into the mouth (this is called gastro-oesophageal reflux). People suffering from hiatus hernia or oesophageal problems, or who drink too much alcohol, may also find they suffer from dental erosion due to vomiting.

Can my diet help prevent dental erosion?

Acidic foods and drinks can cause erosion. Acidity is measured by its ‘pH value’, and anything that has a pH value lower than 5.5 is more acidic and can harm your teeth.

Fizzy drinks, sodas, pops and carbonated drinks can cause erosion. It is important to remember that even the ‘diet’ brands are still harmful. Even flavoured fizzy waters can have an effect if drunk in large amounts, as they contain weak acids which can harm your teeth.

Acidic foods and drinks such as fruit and fruit juices – particularly citrus ones including lemon and orange – contain natural acids which can be harmful to your teeth, especially if you have a lot of them often.

‘Alcopops’, ‘coolers’ and ‘designer drinks’ that contain acidic fruits and are fizzy can cause erosion too.

Plain, still water is the best drink for teeth. Milk is also good because it helps to cancel out the acids in your mouth.

Are sports drinks safe?

Many sports drinks contain ingredients that can cause dental erosion as well as decay. However, it is important for athletes to avoid dehydration because this can lead to a dry mouth and bad breath.

What can I do to prevent dental erosion?

There are a number of things you can do:

  • Have acidic food and drinks, and fizzy drinks, sodas and pops, just at mealtimes. This will reduce the number of acid attacks on your teeth.
  • Drink quickly, without holding the drink in your mouth or ‘swishing’ it around your mouth. Or use a straw to help drinks go to the back of your mouth and avoid long contact with your teeth.
  • Finish a meal with cheese or milk as this will help cancel out the acid.
  • Chew sugar-free gum after eating. This will help produce more saliva to help cancel out the acids which form in your mouth after eating.Wait for at least one hour after eating or drinking anything acidic before brushing your teeth. This gives your teeth time to build up their mineral content again.
  • Brush your teeth last thing at night and at least one other time during the day, with fluoride toothpaste. Use a small-headed brush with medium to soft bristles.

Should I use any other special products?

As well as using a fluoride toothpaste, your dental team may suggest you use a fluoride-containing mouthwash and have a fluoride varnish applied at least every six months. They may also prescribe a toothpaste with more fluoride in it.

How can it be treated?

Dental erosion does not always need to be treated. With regular check-ups and advice your dental team can prevent the problem getting any worse and the erosion going any further. If a tooth does need treatment, it is important to protect the enamel and the dentine underneath to prevent sensitivity. Usually, simply bonding a filling onto the tooth will be enough to repair it. However, in more severe cases the dentist may need to fit a veneer.

How much will treatment cost?

Costs will vary, depending on the type of treatment you need.

It is important to talk about all the treatment options with your dental team and get a written estimate of the cost before starting treatment.

Content originally appeared at: https://www.dentalhealth.org

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Could Your Own Stem Cells Be Used To Heal Your Decayed Tooth?

A dentist is researching alternatives to root canal treatment and extraction

Can decayed young teeth be saved with stem cells? Dr. Renato Silva thinks so.

When decay penetrates the nerve space in an adult’s permanent tooth—known as dental pulp—a root canal is the best solution. A dentist removes the nerve and pulp, and then cleans and seals the inside of the tooth.

But when that same problem occurs in a child or young adult, a root canal becomes much trickier, because the root of the tooth may not be fully formed. Dentists might try to clean and fill the root canal, or they might pull the tooth and replace it with an implant when the patient is older.

“We see a lot of kids come into our endodontic clinic and pediatric clinics with dental problems,” said Silva, D.D.S., Ph.D., associate professor and chair of the department of endodontics at The University of Texas Health Science Center at Houston (UTHealth). Factors that contribute to decay include not brushing and/or flossing, diet, saliva composition and genetics.

Depending on the age of the child, a permanent tooth will come in, but the root may take a few years to develop, said Ariadne Letre, D.D.S., Ph.D., director of research in the department of endodontics at UTHealth’s School of Dentistry and a member of Silva’s team.

Rather than choosing a root canal treatment or tooth extraction for young permanent teeth, Silva believes he can use stem cells to replace the damaged tissue with healthy tissue and promote root formation.

His research is in the preclinical stage, but results so far have been promising.

A microscopic image of tissue invagination into the tooth after 45 days of implantation.

Dental pulp is a complex bundle of tissue, blood vessels and nerves. The tissue dies when it is contaminated by bacteria. During a root canal, a dentist will dig out that contaminated tissue and replace it with an artificial material, Silva said, because you can’t leave an open space for bacteria to continue to grow. Even so, root canal therapy treated teeth are destined to be brittle and devitalized.

But what if there was a way to revitalize the tissue and make the tooth healthy again?

While pondering ways to promote root formation, Silva and his team came up with the idea of using stem cells retrieved from the root area deep inside the tooth called the apical papilla. Since they also needed some sort of scaffold for the cells, they devised one made of a polymer fiber impregnated with a protein called vascular endothelial growth factor (VEGF), to stimulate the growth of new blood vessels that would help with tissue and pulp regeneration.

“These stem cells of the apical papilla can turn into any type of tissue, and in our case, we need root and pulp tissue, so we thought, ‘Why not?’” Silva said.

After removing the decay from the tooth and cleaning out the root canal, Silva and his team fill in the area with stem cells and the VEGF scaffold, which will regenerate the pulp tissue, he said.

The stem cells come from extracting the third molar of the child—known as the “wisdom” tooth. Silva and his team collect the cells attached to the bottom of the tooth crown, isolate the stem cells and then use them in the decayed tooth.

Because the use of stem cells for dental treatment in humans is not yet approved in the United States, Silva and his team have been researching their theory on mice. After putting the stem cells inside the tooth, they implant the teeth on the back of mice to evaluate new tissue formation. The result has shown that the tissue and blood vessels from the mouse go inside the root and fill in the empty space, mimicking the original dental pulp tissue.

Once the use of stem cells is approved for this use, Silva and his team will move forward with isolating the stem cells of the apical papilla from third molars to deliver into the decayed tooth of the same patient.

“I believe our results are promising in light of future patient-centered approaches toward pulp and dentin regeneration therapies,” Silva said.

Article originally posted at: http://www.tmc.edu

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Oral Appliance Therapy

Oral appliance therapy is an effective treatment option for snoring and obstructive sleep apnea (OSA). A custom-fit oral sleep appliance can improve your sleep, restore your alertness and revitalize your health. Here is a guide to help you get started with this life-changing treatment.

About Oral Appliance Therapy

Worn only during sleep, an oral appliance fits like a sports mouth guard or an orthodontic retainer. It supports the jaw in a forward position to help maintain an open upper airway. Research shows that oral appliance therapy is an effective treatment option for snoring and obstructive sleep apnea.

If you and your doctor decide that oral appliance therapy is the best treatment option for you, then your doctor will write a prescription for you to receive a custom-made oral appliance. You also will receive a referral to a qualified dentist who can provide oral appliance therapy. More than 100 oral appliances have received FDA clearance. Your dentist will recommend the oral appliance that is best for you. Oral appliance therapy is covered by many medical insurance plans.

Advantages of Oral Appliance Therapy

Oral appliance therapy is an effective, non-invasive treatment that fits easily into your lifestyle. Patients like oral appliance therapy because it is:

  • Comfortable
  • Easy to wear
  • Quiet
  • Portable
  • Convenient for travel
  • Easy to care for

How a Dentist Can Help: The First Visit

Dentists work closely with physicians to treat snoring and sleep apnea. At your first visit, your dentist will talk to you about the benefits of treatment. You also will receive information on the potential side effects and the cost of therapy.

Then your dentist will conduct a complete clinical evaluation. This will include an examination of your teeth, jaw, tongue and airway, and possibly a new X-ray of your mouth.

Making and Fitting Your Oral Appliance

Oral appliances are customized using digital or physical impressions and models of your teeth. These models are sent to a dental lab where the appliance is made.

Once your oral appliance is ready, you will return to your dentist’s office for a fitting. Your dentist will adjust the appliance to maximize its comfort and effectiveness. You also will learn how to clean the oral appliance and maintain it. After this fitting, your sleep doctor may schedule you for a sleep study to verify treatment success.

Follow-Up Visits

Follow-up visits with your dentist will be needed to ensure the optimal fit of the oral appliance. Effective oral appliances are always custom fit and adjusted over time to ensure maximum effectiveness. Your dentist also will schedule you for an annual assessment. These routine visits are an important part of your long-term treatment success.

Living with Oral Appliance Therapy

Treating snoring or obstructive sleep apnea with oral appliance therapy can help you feel like a new person. You will find that your symptoms, and your quality of life, can improve dramatically when you remain committed to your treatment and use it nightly. It is likely that you will sleep better, have more energy and feel sharper throughout the day. You may find that your bed partner begins to sleep better, too!

Treating sleep apnea promotes a healthier heart, body and mind. With your dentist’s help, you can improve your sleep and your health!

 

 

Article originally appeared at: http://www.aadsm.org/

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Instrument Sterility at Soho Dental

sterile1

At Soho Dental, we take the sterilization of our surgical instruments very seriously.

The pictures above show what your instruments look like before your appointment at Soho Dental.  All our instruments are thoroughly cleaned, placed in cassettes, wrapped and then autoclaved.  The process of autoclaving sterilizes the instruments using high heat, saturated steam and pressure. Most importantly, your instruments remained sealed in the wrapping until they are ready to be used.  Just before your appointment, the packages are opened as the room is prepared for your treatment.

Regular testing of the sterilizer is done to ensure instruments are in fact being sterilized and that all infectious organisms are killed. With these testing procedures we can be confident that the instruments have been completely cleaned and sterilized.

A number of items in the dental office are used on patients only once and then discarded. Disposable items include gloves, needles and syringes, protective coverings for instrument trays, and certain instruments that cannot withstand the sterilization process. Discarded needles are placed in a designated container to prevent needle-stick injuries, not in the regular waste collection. Dentists are especially concerned about needle injuries and the risk of infection they pose, so they are handled very carefully.

The area in which your treatment occurs is cleaned and disinfected after each patient, and/or disposable covers are used to protect surfaces for contamination. These covers are replaced after treating each patient.

The above highlight only a few of our infection control measures. If you have any questions regarding our sterilization procedures, please do not hesitate to ask. We would be more than happy to answer any of your questions!

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Dr. Haji Continues His Commitment to Lifelong Learning

This week I have been away from the office to complete a course presented by the world renowned Dr Dider Dietschi from Geneva Switzerland. The title of the course was “Excellence and Innovations in Composites: Direct Anterior Techniques and the “No-Prep” Ultra-Conservative Treatment of Tooth Wear”

Dr Dietschi is an advocate of conservative treatments for extensive and complex dental problems like tooth wear. The knowledge and skills that he has shared will enhance my ability to provide complete dental care with primary concentrations in dental occlusion, the temporomandibular joints and comprehensive esthetic restorative dentistry.

This was a wonderful journey in which I was able to meet and learn from a true master, who  is a meticulous dentist and great teacher. I made new friends from around the world including Denmark, Kuwait, Lithuania as well as other fellow Canadians. It was such a joy to meet like- minded dentists who are committed to providing their patients with the very best in dental care!

-Dr Feisel Haji

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Cavities Underneath Old Fillings

Many patients are surprised to know that they can get a new cavity underneath a previous placed filling. This can occur for a number of reasons. It is very important to have your fillings checked regularly so that these cavities can be repaired before the tooth needs more extensive treatment.

This picture shows an old tooth coloured filling with a very small crack in the filling. The crack is enough to allow bacteria to enter the tooth and cause decay.

The filling is removed to get access to the decay. The decay is evident by the brown discolouration. The yellow tooth colour represents healthy dentin.

The decay has been removed. The picture shows healthy dentin free of bacteria.

A new filling has been placed which is nicely sealed and integrated to the surrounding enamel. Notice the natural contours and tooth anatomy which allow cleaning with floss and proper function with the opposing tooth.

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Esthetic Crowns

The materials that we have at our disposal in dentistry today are highly esthetic such that it is often difficult to distinguish between natural tooth structure and dental ceramics.

The patient in the photo had two old crowns on the upper front teeth that looked unnatural. The two teeth on either side of the crowns were grey from trauma and previous root canal treatment.

We replaced the two front crowns in addition to crowning the side teeth to improve the overall esthetics and her smile.  Notice how the new crowns are natural looking in terms of colour and contour.

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Dental Implant Maintenance

Does cleaning dental implants differ from cleaning natural teeth?

In a nutshell, cleaning around implants differs from maintenance of natural teeth for two reasons: The first is that each attaches to surrounding bone and gums in a very different way; secondly, the materials from which implants are made are very different from natural teeth.

Dental implants replace the root parts of the teeth. Artificial crowns, bridgework or removable dentures — tooth replacements that make up the visible (crown) part/s of teeth — are attached to the implants. In between the implant and the crown of a tooth there is often a connector known as an abutment. The success of the whole system is based on the implant’s attachment to bone. Titanium, the metal of which implants are made, is uniquely osteophilic — literally “bone-loving.” It fuses to bone in a process called osseointegration (“osseo” – bone; “integration” – fusion or joining).

Above the bone where the integration process ends, the abutment comes in contact with the gum tissue where it is supported by a connective (i.e. “connecting”) tissue composed of fibers made of a tough material called collagen. The fibers run beneath the surface parallel to the implant ending at the top of the bone. They hold the gum tissues against the implant surface.

At the very top of the implant assembly, the abutment and lower part of the crown attach to the gum (the surface “skin” layer) via a specialized structure known as an epithelial attachment (“epi” – on top; “thele” – nipple). The cells actually attach to the highly polished metal or ceramic, of which the implants are made, by means of microscopic suction pads.

By contrast, a tooth root is attached to the bony socket that surrounds it — by a periodontal ligament (“peri” – around; “odont” – tooth). The ligament is composed of tiny fibers that insert into the bone on one side and into the tooth root on the other. Above the bone, the fibers attach from the tooth into the gum tissue. An implant has no such attachment. Since the whole periodontal ligament has a greater blood vessel supply through which it can bring cells and nutrients, it is more readily able to resist and fight against infection.

Infection Is The Enemy

Cleaning implant-supported tooth replacements is just as important as cleaning natural teeth, as both depend on healthy surrounding tissues for support. Bacterial biofilm (plaque) collects on implant crowns just as it does on natural teeth, and must be removed on a daily basis at home. Without daily biofilm removal, infection can develop known as peri-implantitis (“peri” – around; implant “itis” – inflammation), which can result in loss of the attachment described above. Unlike inflammation around teeth, this reaction can be quite catastrophic both in rate and amount, quickly leading to a well- or dish-shaped loss of bone around an affected implant. Bone loss can rapidly progress to loss of the implant.

The dental hygienist has an important role to play in keeping dental implants infection-free, and there are many factors to be considered in selecting the right instruments for a professional cleaning. They include: the nature of the debris, meaning whether soft (biofilm, foods) or hard (calculus or tartar, calcified material); the location of the deposits; the type of surface on which they accumulate; and the stubbornness with which they adhere.

The Right Tools For The Job

Your hygienist must select instruments for cleaning that will not damage the crown, abutment, or the implant itself. Maintaining the highly polished, smooth surface of the abutment and crown are critical. If they are scratched they can attract and harbor bacteria. That’s why the instruments used, called scalers and curettes, are most often made of plastics and resins. Natural teeth don’t scratch in the same way, and therefore metal instruments can be used to clean them.

A number of power (ultrasonic) instruments have nylon or plastic sheaths or tips to minimize implant damage. They clean by using high-frequency vibration, which may be necessary if large quantities of debris have accumulated. They are used on a low power setting with a lot of water irrigation, and sometimes antibacterial solutions, to clean and flush material.

If any part of the implant body (root replacement portion) itself is visible, this may mean there is infection that has resulted in gum and/or bone loss. The implant surface becomes exposed following loss of its fusion to the bone. Implant surfaces are generally microscopically “roughened” to increase surface area for bone attachment. But this surface roughness makes implants difficult if not impossible to clean and disinfect. Additionally, some implants are screw-shaped and their threads just add to the cleaning dilemma.

Brushes are used to clean biofilm from exposed areas of an implant wherever possible. If calculus or dental cement (used to secure the crowns) is present on an implant surface, the hygienist needs to use instruments that are effective in removing these contaminants. In such cases the clinician must ensure no scratching or damage is caused by completing the task.

Despite these special cleaning challenges, implants are highly successful. In fact, studies indicate long-term success rates well over 95%. However, the prevention of peri-implant disease is fundamental to implant health, maintenance and function. And cleaning implants and their related components is an important part of success. Your question indicates that your hygienist is on top of it.

 

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