Implants · patient case question
The mucositis recurs despite good hygiene. What is the definitive solution?
Patient case: An implant overdenture that traps food
Patient: Female, 68 years old
Chief Complaint: “My gums bleed around the posts and food gets stuck underneath.”
Background: Edentulous maxilla restored three years ago with an implant-supported overdenture. Non-smoker, no diabetes. She reports brushing the prosthesis daily.
Vital Signs: BP 128/76 mmHg · HR 72 bpm
Findings: Erythema and bleeding on gentle probing around all abutments, with no suppuration. Radiographs show NO peri-implant bone loss compared with the baseline films. Food debris packs beneath the prosthesis. The tissue surface of the superstructure is markedly CONCAVE and cannot be reached with any cleaning aid.
Show answer and explanation
Correct answer: D. Modify or remake the prosthesis so the tissue surface is CONVEX and cleansable
- A. Adding implants does not change the contour that is causing the problem, and placing fixtures into inflamed tissue is poor planning. More implants beneath a non-cleansable prosthesis simply creates more sites to become inflamed.
- B. Long-term systemic antibiotics suppress the flora without touching the plaque trap that is generating it, and they carry resistance and adverse-effect burdens that cannot be justified for a design fault. Antimicrobials have an adjunctive role at most in peri-implant disease.
- C. Explanting functioning implants that show no bone loss is a drastic response to a correctable design fault, and it would return the patient to the unretentive maxillary denture the implants were placed to avoid.
- D. CORRECT. A CONCAVE tissue surface traps food and plaque against the mucosa, and no amount of instruction will let the patient clean a space that cannot be reached. The design principle for any implant-supported prosthesis is a smooth, CONVEX, highly polished intaglio surface with adequate clearance beneath the framework — enough room to pass an interdental brush or superfloss freely. Reshaping or remaking the superstructure to that contour removes the CAUSE, rather than repeatedly treating the effect.
Note: The general principle: ACCESS FOR HYGIENE is a design requirement in implant prosthodontics, not an afterthought. The same reasoning governs the choice between SCREW-RETAINED prostheses — retrievable for cleaning, repair and reassessment — and CEMENTED ones, where retained subgingival cement is itself among the leading causes of peri-implantitis. When the restorative margin will be subgingival and cement removal cannot be verified, screw retention is the safer design.