Ep. 811 - Implant Maintenance Update: New Evidence, Better Outcomes

Are your implant maintenance protocols actually protecting your patients' implants — or quietly contributing to their failure?

Lynn Pencek brings a rare dual perspective to implant maintenance, having worked as both a clinical dental hygienist and an industry representative for major implant and instrument companies. She holds a Bachelor of Science from Thomas Jefferson University, a Master of Science in Dental Hygiene from the University of Maryland School of Dentistry, and has held faculty appointments at Thomas Jefferson University and the Community College of Philadelphia. Her hands-on experience with Nobel Biocare and the Envista team, combined with her role as school manager for Hu-Friedy and her service on the corporate council for Dimensions of Dental Hygiene, gives her an unusually comprehensive view of where clinical practice and industry intersect. She is the founder of Practice At Your Best, LLC and a nationally recognized continuing education lecturer in implant maintenance.

This episode tackles one of the most clinically underserved areas in modern dentistry: what actually happens to implants after they are placed. With 45 to 63 percent of implant patients presenting with peri-implant mucositis and up to one in five developing peri-implantitis, the stakes for getting maintenance right have never been higher. The conversation dismantles outdated assumptions about plastic instruments, fluoride safety, and polishing protocols, replacing them with current, evidence-grounded recommendations. Listeners will gain a framework for triaging implant patients, selecting the right instruments, and knowing when to refer — all grounded in clinical reality rather than habit.

Episode Highlights:

• Plastic instruments have long been considered the default for implant maintenance, but the evidence does not support their use. The rough nano-surface texture of implants causes plastic instruments to shed microparticles that are not biocompatible, embed in the biofilm, and contribute to ongoing inflammation — making them counterproductive to the goal of reducing peri-implant disease.
• Stainless steel scalers pose a specific biological risk when used on implant surfaces through a mechanism called metallosis. Metal ions shed from stainless steel instruments are deposited into the biofilm and engulfed by soft tissue cells via endocytosis, triggering an inflammatory response that compounds existing peri-implant disease. Titanium and anodized titanium instruments are preferred because any residual material left on the surface remains biocompatible.
• Air polishing with glycine or erythritol powder represents the current standard of care for biofilm removal on implant surfaces, including in subgingival and thread-exposed sites. A 2020 survey of approximately 1,600 hygienists found that 90 percent of those using air polishing felt effective at biofilm removal, compared to only 10 percent of those relying on plastic instruments — a finding with direct implications for practice investment decisions.
• Fluoride presents a nuanced risk for titanium implants that depends on concentration, frequency of application, and pH of the oral environment. Over-the-counter fluoride toothpaste used twice daily is considered safe, but high-concentration prescription fluoride applied daily in an already acidic oral environment can accelerate corrosion of exposed implant surfaces. Clinically applied neutral sodium fluoride varnish or hydroxyapatite-based remineralization agents are recommended alternatives for high-caries patients who also have implants.
• Desiccation therapy using a desiccant gel or liquid applied for 10 to 30 seconds subgingivally is an emerging adjunctive tool for implant maintenance that removes water from the biofilm, facilitates calculus removal, reduces red-complex bacteria, and provides a hemostatic effect. Application time should not exceed 30 seconds, the agent must be rinsed thoroughly, and while early evidence is promising, more in vivo research on implant-specific outcomes is still needed.

Perfect for: dental hygienists at all career stages seeking current evidence on implant maintenance protocols, general dentists managing implant patients in-house, periodontists looking to improve interdisciplinary communication workflows, and dental educators developing or updating implant-related curriculum content.

If you are still relying on the instruments and protocols you learned in school, this episode will change the way you approach every implant patient in your chair.