360 degree flossing - What is that?
Implant hygiene is another area where good evidence is sparse and therefore, we must resort to following due process and common sense.
Hygiene around implants is largely about disturbing biofilm adhesion.
[RIGHT- 360 deg floss - wrapping the floss around the crown]
We must respect the different physiology that we find in peri-implant tissues. Blood supply is poor and hemi-desmosome attachment is weak. Peri-implant collagen fibres are circumferential, at best providing a cuff around crowns and abutments.
The aim here is to maintain healthy protective tissues above the rough implant surface to prevent / reduce bacterial and viral colonisation.
Although radiographs are limiting in that they only really show mesial and distal crestal bone levels they do help us visualise how deep the implant is in relation to the soft tissue cuff and the shape of the sub gingival contour that needs to be cleaned [See image left].
CBCT reviews are inappropriate due to the radiographic exposure and because the artefacts created around implants degrade the diagnostic value.
The transition from oral mucosal level to implant is sometimes called a pocket - which it isn’t. Probing it is also complete nonsense as all we can hope to do is confirm where the implant is and do a lot of harm in the process.
So having armed ourselves with this understanding we teach patients to disturb this biofilm with whatever they can manage. Manual or electric brushing, micro brushes, floss, super floss, rubber points. There is a case for augmenting this process with simple antiseptics such as diluted bleach, bicarbonate of soda or peroxil.
[RIGHT- TePe brushes have a place but watch out for a TePe shaped soft tissue defect in the aesthetic zone]
One of the most effective techniques is 360 degree flossing.
Floss through the contacts with adjacent teeth or crowns and cross the ends over so that the floss wraps around the Implant crown.
As the ends of the floss are gently pulled, the floss will naturally slide to a narrower diameter and in so doing disturb the biomaterial adhesion.
Voila. I get patients to do this bi weekly and see amazing results.
[LEFT Cross the floss and gently pull so that it slips up into the narrower subgingival abutment or crown contour]