**3.2 Phase 2: hygiene phase**

Following the systematic assessment phase arduously performed by the clinician, it is now the responsibility of the patient, a co-therapist, to meticulously and habitually follow the implant oral hygiene protocol instructed by the clinician. After the implant


#### **Table 7.** *In-office oral implant hygiene care aids.*

*The Dental Implant Maintenance DOI: http://dx.doi.org/10.5772/intechopen.101187*

placement, patients usually have improper oral hygiene practice either due to the fear of damaging the implant or because of overzealous oral health care practice. Hence, as clinicians, it is important to convey both verbally and visually the different oral health care aids that can be practiced safely by the patients to achieve long-term implant success.

The following are the agendas to be covered in the hygiene phase:

Directing the patient to control the underlying medical conditions which may cause peri-implant diseases and gradually implant failure.

Educating the patient about the importance of maintaining implant oral health and recall visits.

Training the patient to use different In-home hygiene products for the maintenance of implant oral health.

Oral implant hygiene methods can be broadly categorized as At-home implant care (**Table 6**) and In-office implant care (**Table 7**).

### **4. The implant health scale**

The success of an implant should not focus on the implant fixture alone but also on the success of the entire implant prosthesis. A natural tooth in the oral cavity is not described as a success or failure, instead, a health scale is used to determine the condition and survival of the tooth.

Similarly, the implant health scale was introduced by James and further modified by Misch in the year 1993 [67, 68]. The Internation Congress of Oral Implantologists (ICOI), in Italy Consensus Conference, Pisa, on 5th October 2007, further modified the James-Misch Implant scale and approved a health scale with four categories for endosteal implants that describe their clinical conditions i.e. implant success, implant survival (satisfactory and compromised), and implant failure [69] (**Table 8**).



**Table 8.**

*Dental implant health scale, international congress of oral implantologists, Pisa, Italy consensus conference, 2007.*

After the final implant assessment phase, the clinician should categorize the implant health based on the assessed clinical condition of the implants.

### **5. Conclusion**

The immediate outcome of implant dentistry for patients is usually esthetics and function. But long-term implant prosthesis success depends on an array of factors such as implant quality, implant surgery procedure, peri-implant health, implant/ prosthesis mobility, pain, exudate, etc.

A systematic review [70] was conducted to evaluate the different implant oral hygiene methods that are available and are in use by the general public and the dental team for the debridement of plaque and maintenance of implant oral health. It was concluded, that the knowledge that exists among the clinicians and the general public about oral hygiene maintenance is concerning natural teeth and no particular protocol or regimen were being followed [70]. Hence, academics and private clinics must start spreading awareness both verbally and visually about the different implant oral hygiene aids which can be used to achieve long-term implant success.

The only elucidation to achieve long-term successful implant prosthesis is frequent maintenance recalls, regular professional and at-home implant hygiene care, as well as treating any peri-implant pathology at its earliest. In this chapter, we have meticulously compiled in toto the dental implant maintenance protocol and hope that the information provided will be helpful for the implant interdisciplinary team to guide the patient, educate them and simultaneously work with them to achieve long-term implant success.
