"Tell Your Patients to Stop Flossing and your hygienist to Stop Checking Pocketing.", By Dr. Boris Pulec, MDS


    I have been a dentist for over 26 years and my present practice has over 10,000 patients. Recently I have decided to change the instructions I give to my patients that have fixed prosthetics supported by dental implants. This includes NO Flossing. This decision originated through empirical observations and biological facts. Dental implants are not natural teeth and the anatomy between the two is significantly different. This idea originated while I was writing the article regarding dental implants maintenance protocols. http://www.consult-pro.com/articles/monitor_maintenance_dental_implants.html In this article I explain how delicate the connection between the gingival tissues and the implant surface is and how pocket probing may break the connection. Dental implants do not have a cementum layer covering the surface, and thus, a soft tissue attachment similar to natural teeth does not exist. What exists instead is a peri-implant soft tissue seal.(2) In this seal, the junctional epithelium still attaches to the implant surface via hemidesmzosomes, but the gingival fibers do not insert into the implant as they do with natural teeth. The gingival attachment to implants is much weaker and can easily be broken without significant pain to the patient. Operators who are used to probing around natural teeth may inadvertently and routinely probe beyond this weak attachment. Consequently, while routinely probing pocket depths around dental implants, the operator may inadvertently break the seal in 6 or more locations. The results of this are two-fold. The first being a greatly over-exaggerated pocket depth reading, and the second being the creation of passageways through which opportunistic bacteria can gain access to bone and propagate its loss.


© 2012 Dr. Boris Pulec MDS. All rights reserved. Used by permission from www.consult-pro.com.

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