Introduction

Extensive experience in using the dental implantation method in Russia has revealed the main complication of implantation both at the stages of prosthetics and at different periods of operation of prostheses on implants – inflammation in peri-implant tissues [1-8]. The prevalence of inflammation is limited in the gums around implants-mucositis and accompanied by resorption of the underlying bone tissue – perimplantitis, according to various data, occurs at least 30% and 10%, respectively, on the example of three years after the completion of prosthetics [9-12]. In the absence of treatment, peri-implantitis ends with implant disintegration; treatment of peri-implantitis is a complex problem associated, in addition to eliminating inflammation, with the need to restore lost bone tissue [13-19].

All studies aimed at the prevention and treatment of mucositis and peri-implantitis indicate a negative role of insufficient oral hygiene [20-22]. Against the background of the well-known low motivation of the population to ensure an adequate level of individual oral hygiene, the development of effective approaches to the hygienic state of the mouth at the stages of implantological treatment remains an urgent task. Hygienic aspects in patients with implants can be considered in several directions: in the dynamics of the course of implantological treatment, consisting of several surgical and orthopedic stages; in the dynamics of the use of prostheses on implants; optimization of the volume of individual oral hygiene using specific hygiene methods and medical support.

The nine-year experience of prosthetics on implants described by Uzunyan N. A. reflects only the removal of implants due to peri-implantitis depending on different implantation conditions [23-27]. The work describes that 2% of implants were removed after 5 years, 7.6% - after 7 years, and 7.7% - after 9 years, which indicates the onset of the phase of full adaptation of the implant to the conditions of functioning for 7 years. The frequency of implant removal depends less on the state of health, and more on the initial state of periodontitis and hygiene (in patients with periodontitis, implant disintegration was 7.9%, without periodontitis 4.1%; with a satisfactory level of hygiene 4.3%, with insufficient hygiene-9.5%). There was no statistically significant difference in the frequency of implant removal between implants of different localization, while disintegration was more common in Lekholm/Zarb type IV (10.5%) with the complete absence of teeth (13.4%), and in short implants (12.9%). The provoking role of cement fixation of prostheses on implants for the development of peri-implantitis, which leads to the disintegration of 9.7% of implants over nine years, is shown.

In a difficult clinical situation – with the complete absence of teeth, D. A. Bronstein used implants with a long-term analysis of peri-implant tissues (10 years) [13]. Previously, during the same period, the results of implantation were analyzed by different doctors in Moscow concerning patients with the partial and complete absence of teeth. Among more than 4,500 implants after 10 years of loading, 44.6% had mucositis, and 30.8% had perimplantitis (the initial one is twice as common as in the degree of half the length of the implant. 5.1% of implants were removed due to peri-implantitis. In the group of own observation for ten years, the listed indicators were 30.4%, 40.7%, and 12.5%. The conclusion is made about more favorable results of prosthetics on implants in the partial absence of teeth, despite the lower microbial contamination of the oral cavity in the complete absence of teeth (apparently, the smaller number of support implants and, mainly, the removable nature of prosthetics in the complete absence of teeth)

Three years of follow – up of prostheses on implants in patients with metabolic syndrome, undertaken by Remizova A. A., revealed a good level of hygiene only in 12.7% of people with fixed prostheses and 9.7% - in removable prostheses on implants [28-30]. Gum recession was very often observed in implants: 38.2% of patients with fixed and 39.1% with removable prostheses; the SPI index was 4.77 and 5.83, respectively.

Rubtsova N. G. focused her research on clinical and laboratory evaluation of the cleaning ability of toothbrushes in patients with orthopedic structures on dental implants [29, 31-34]. She studied the state of the mouth in 476 patients with orthopedic structures on intraosseous implants. At the same time, 30 people cleaned their natural teeth and prosthetic structures on implants with a manual toothbrush. The remaining patients were divided into subgroups depending on the period from the moment of completion of prosthetics and depending on the use of different toothbrushes (electric, sound, ion, ultrasound). Brushing your teeth was recommended twice a day for 3 minutes. The survey included a survey, a questionnaire, and the determination of hygiene indices. Before the start of differentiated use of brushes, 70% of patients with implants had three months of brushing their teeth with a regular manual brush, the level of hygiene continued to be unsatisfactory for many, while the majority of patients with other brushes had a sufficient level of hygiene (79.4-100%). The greatest cleaning effect of an ultrasonic toothbrush (medium hardness, with multi-level trimming of the brush field and an average vibration frequency of 96 million per minute (1.6 MHz) is proved. According to the PLIC index, the cleaning efficiency of manual toothbrushes is 47.4%, electric 52.3%, sound 61.6%, ionic 59%, and ultrasonic 65.3%. Scanning electron microscopy showed the wear of toothbrushes in three months to the extent of 58.4% – for manual, 41.1% – electric, 40.9% – sound, 42.5% – ion, 27.5% –ultrasound. After the survey, we received disappointing data on the attitude to oral hygiene in patients with implants. 58.5% of respondents do not comply with dental hygiene recommendations, 31.2% do not comply with the terms of medical examination. Among hygiene products, the majority choose only a manual toothbrush (76% of respondents), the rest – electric; half of the respondents use dental irrigators, and interdental hygiene products-no more than 10.0%. The hygiene value is shown by a strong positive correlation with the cytological study parameters (rs = 0.796 to 0.962).

The purpose of the article 

Justification of the periodicity of professional oral hygiene and the volume of individual oral hygiene at the stages of implantological treatment and use of dentures on dental implants.

Objectives of the work

1. Study long-term clinical and radiological indicators of the effectiveness of prosthetics on implants, index indicators of hygiene, and condition of periodontal and peri-implant tissues.
2. Study the factors and degree of decrease in the effectiveness of implantation, hygiene, and periodontal indices in patients with dentures on dental implants.
3. Analysis of the role of systematic medical examinations, professional oral hygiene, and full-fledged individual hygiene in maintaining hygienic and periodontal indicators for users of prosthetic implants.
4. Compare the effectiveness of different volumes of individual oral hygiene, including interdental products, irrigators, and “Phagodent” gel-based on bacteriophages in individuals with dental implants.
5. Analysis of the subjective assessment of the hygienic aspects of prosthetics on implants in people with high motivation to care for the oral cavity and those who do not comply with the terms of medical examination and professional hygiene.

Materials and Methods

The Department of dentistry №.3 of the North Ossetian State Medical Academy of the Ministry of Health of the Russian Federation analyzed the results of prosthetics on implants of 158 people (the first group), consisting of 93 women and 65 men; 74 patients aged 20 to 40 years and 84 patients aged 40 to 60 years. Before the start of prosthetics, 26 people had a complete absence of teeth (on one or both jaws), while the remaining 132 had a partial absence of teeth (K08.1).

363 titanium intraosseous implants from different companies were previously installed using the classic two-stage method and had different prosthesis designs. Among the prostheses on implants, most were metal-ceramic crowns or non-stretched bridge prostheses (151 prostheses, 106 people, 219 implants), and among the removable ones-with beam fixation on two, three, or four implants (17 prostheses in 17 people on 54 implants); 9 people with the complete absence of teeth (9 prostheses, 51 implants) had fixed dentures on five or six implants with a shortened dental row from the standard dental rows – the so-called conditionally removable dentures; among the fixed prostheses in a small number were all-ceramic crowns and bridges (31 prostheses, 26 people, 39 implants). The first group was divided according to the terms from the moment of completion of prosthetics: one year – 55 people, two years – 51, and three years – 52.

Dispensary control included clinical and index evaluation of periodontal and peri-implant tissues, professional oral hygiene, occlusal correction, and semi-annual orthopantomography [1, 3, 4, 35, 36]. Also, the index examination of hygiene and periodontitis was carried out in the following periods: before the start of treatment (when applying to the clinic), after pre-implantological sanitation of the mouth (including periodontal treatment and professional hygiene, before the manufacture of permanent prostheses (at the end of the period of osseointegration and use of temporary prostheses).

Results and Discussion

Before the start of implantological treatment, the following indicators of hygiene and periodontal disease were detected in the experimental group (Table 1).

Table 1. Hygiene and periodontal indicators in the examined group before the start of implantological treatment.

Following the algorithm of implantological treatment, the indicators of hygiene and periodontal tissues varied significantly. As a result of dental and periodontal rehabilitation before the implants were installed, all indicators significantly improved: OHI-S-0.8±0.2; gingivitis index GI-0.7±0.2; Muhllemann index-0.4±0.1; PMA index-22.2±3.1%; OI index-0.9±0.2; Halimeter index-102±14.3 ppb; detection of periodontal pathogens-13.3%.

As a result of the period of implant osseointegration (up to six months), the lack of individual hygiene in many patients worsened the indicators on average for the group: OHI-S – 1.5±0.3; gingivitis index GI – 1.3±0.9; Muhllemann index – 1.0±0.3; PMA index – 31.4±9.9%; OI index – 1.6±0.3; Halimeter index – 206±34.2 ppb.

Performing professional hygiene in patients before installing gum shapers or abutments again improved the state of hygiene and periodontal health: OHI-S-0.5±0.1; gingivitis index GI-0.7±0.2; Muhllemann index-0.5±0.2; PMA index-24.3±8.1%; OI index-1.0±0.1; Halimeter index-99±17.5 ppb.

Made, as a rule, from polymer materials, temporary fixed prostheses significantly worsened the hygienic condition of the mouth due to their ability to adsorb plaque and made it necessary to conduct professional hygiene before fixing permanent prostheses. Thus, the indices OHI-S, IGSK, GI, Muhllemann, PMA, OI, and Galimeter index deteriorated to 2.1±0,3; 1,9±0,2; 1,4±0,1; 1,2±0,2; 31,8±6,6%; 1,7±0,3%; 266±30 ppb.

During the experiment quarterly indicators in the dynamics of the functioning of prostheses on implants were determined before the professional hygiene (Table 2).

Table 2. Indicators of hygiene and periodontium in dynamics of implant treatment.

Note: 1 – OHI-S; 2 – index of hygiene of super constructor (IH_s); 3.GI; 4.MI; 5.PMA 6.OI; 7. Halimeter index; 8. Periodontal pathogens.