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The most conservative approach to treatment involves non-surgical therapy. This treatment modality includes three subcategories:
a) Pharmacological therapy.
b) Occlusal therapy.
c) Mechanical debridement.
Pharmacological therapy for patients presenting with an ailing implant involves subgingival irrigation for 10 days to 3 weeks (2 to 3 times per 24 hour time period). This may be completed at home following careful instructions from the clinician or dental hygienist. Chlorhexidine is most often prescribed because of its antimicrobial effect and substantivity at the affected site.
Other pharmacological therapies include local application of tetracycline fibers and systemic antibiotics. Bacteria associated with failing implants have been found to be sensitive to the following antibiotics: penicillin G , amoxicillin, combination of amoxicillin and metronidazole, and amoxicillin-clavulanate. Occlusal interferences may contribute to ailing and failing implants. Occlusal adjustment is necessary when premature contacts or interferences are present. The implant prosthesis also must be examined when grinding, bruxing, or other parafunctional habits are evident. The clinician must correct these occlusal errors to prevent overloading of the implant. Nightguard therapy may be indicated as well.
A third non-surgical therapy recommended for treating the ailing or failing implant is mechanical debridement. Local debridement of tissues surrounding an implant using either plastic hand instruments or ultrasonic instruments with a plastic tip has been suggested. Plastic instruments are necessary to debride plaque from titanium dental implants without damaging the soft titanium surface.
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