Like other periodontal conditions, as clinicians, regular periodontal examinations, radiographs and early diagnosis are the best ways to prevent irreversible damage to periodontal tissues. We always stress to our patients the importance of good oral hygiene in the prevention of periodontal disease; a frequent recommendation being dental floss!
Could dental floss cause irritation of the mucosa and consequently peri-implant disease?
There are two broad categories of peri-implant disease:
- Peri-implant mucositis: a reversible inflammatory process
- Peri-implantitis: an irreversible inflammatory process with bone-loss
The primary aetiological factor is sub-gingival plaque biofilms, especially build-up around the implant.
An observational study conducted in Norway monitored 10 implant patients following placement of their dental implants (Lang, Schulten, & Christiaan, 2015). These patients had regular dental examinations, oral hygiene advice and interventions as required.
When these patients developed peri-implant disease that was not healing following multiple supra and sub gingival debridements, an exploratory surgical procedure was performed.
“All ten patients revealed the presence of remnants of dental floss around the rough part of the dental implants (Fig. 1).” After removing the floss remnants and carrying out debridement, 9 out of the 10 cases resolved completely.
The team also carried out an in-vitro experiment by rubbing dental floss on implants. After just 10 seconds, the implant surfaces showed remnants of wax and fibres. The use of interdental brushes did not leave behind any remnants.
It seems that “remnants of dental floss certainly promoted plaque retention and may have acted as ligatures”. Other materials that have shown to cause plaque retention is excess, set luting cement. It is worth noting that “remnants of dental floss will have an effect, when bone loss has already taken place and rough implant surfaces are exposed”.
It may be time to question the Good Practitioner’s Guide to Periodontology 2016, which recommends floss as one of the cleaning aids to improve peri-implant hygiene. As a clinician, you might want to recommend alternative cleaning aids such as interdental brushes!
Lang, N. P., Schulten, E. A. J. M., & Christiaan, M. (2015). Dental floss as a possible risk for the development of peri-implant disease : an observational study of 10 cases, 618–621. https://doi.org/10.1111/clr.12650
Images from the above article.