How do you look after teeth on implants?

The root of a natural tooth is not attached directly to the bone. Between the root and the bone there is a thin cushion of connective tissue called the periodontal ligament. This cushion both spreads the force of chewing and carries a rich blood supply; the cells that fight inflammation reach the area quickly through those blood vessels. An implant has no such cushion; it is in direct contact with the bone.

The difference continues in the gum. Around the root of a natural tooth, collagen fibres grip the root like a cuff and run at right angles to its surface; this arrangement is a real barrier that makes it harder for bacteria to work their way down. On an implant surface, by contrast, the fibres run parallel to the surface and do not close off as tightly. The result is that the seal of gum around an implant is more permeable than the one around a natural tooth.

The price of this shows when care is neglected. The same amount of plaque causes bone loss faster around an implant. The European Federation of Periodontology states this plainly: disease around implants destroys tissue and bone much faster than periodontitis, and it is also harder to treat. This does not mean implants are weak; it means cleaning does not forgive delay.

The second difference comes from the shape of the bridgework. A full-mouth fixed bridge is not made up of individual teeth; it is a single-piece bridge carried by several implants. There are no gaps between the teeth in the usual sense; instead, a narrow space is left between the body of the bridge and the gum, and this is the main place that needs cleaning. The bristles of a toothbrush do not get into that space. Ordinary floss is also designed for individual teeth; it has to be threaded in under the bridge from the side and passed along from one end to the other.

The third difference is the most insidious: you do not feel it. With a natural tooth, decay causes pain, and sensitivity to cold sends you to the dentist. An implant has no nerve inside it; plaque building up under the bridge for weeks does not make you feel anything. The warning comes not from the tooth but from the gum, and it starts with a single sign: bleeding when you brush or pass the interdental brush through.

The three differences lead to one conclusion. When you move to fixed teeth, the work of looking after them does not get smaller; it moves. No more decay, no more denture adhesive, no more dentures in a glass overnight; in their place come ten minutes a day of methodical cleaning under the bridge and a check-up at the clinic every six months. Before you leave the clinic, we show you on your own bridge which size of interdental brush to use and where to thread the super floss.

The daily routine is the same for everyone. What changes is how often you have check-ups and which extra measures come in. If you see yourself in the second list, your schedule becomes tighter.

The order matters: mechanical cleaning first, then rinsing, and brushing last. If you do it the other way round, nothing removes the plaque left under the bridge.

1. 1

   Interdental brush: this is where the real work happens

   A small brush with a handle and tiny bristles arranged in a cylinder at the tip. It is pushed in horizontally between the implants and into the space under the bridge, then moved back and forth a few times. The size is what matters: the right size goes into the space without being forced, but is not loose either. We choose the size at the clinic and give it to you in writing.

2. 2

   Super floss: thread it under the whole length of the bridge

   Super floss is floss in three sections. The first section, with a stiff end, is threaded under the bridge like a needle; the fluffy, spongy middle section wipes the wide surface between the body of the bridge and the gum; and the thin section wraps around the neck of the implant. Go in at one end of the bridge and work your way along, section by section, to the other end.

3. 3

   Water flosser: flushes out what is left

   The fine jet of water under pressure is aimed under the bridge from the side and moved slowly along its whole length. A water flosser does not replace mechanical cleaning; it comes after it, flushing out the debris that has been loosened and rinsing the gum pocket. Start at low pressure and increase it as your gums get used to it.

4. 4

   Brushing: along the gum line

   Twice a day, with a soft-bristled brush and fluoride toothpaste. Place the tips of the bristles along the line where the gum meets the bridge and clean with small circular movements. Stay away from abrasive whitening toothpastes; they scratch the glossy surface of the bridgework, and a scratched surface holds more plaque.

5. 5

   A full round in the evening, a short one in the morning

   Brushing is enough in the morning. In the evening, the full routine: interdental brush, super floss, water flosser, brushing. Saliva flow drops during the night and bacteria multiply most easily in those hours; the main clean is the one you do before bed.

6. 6

   A check-up at the clinic every six months

   At the check-up, the gum pocket is measured, we check for bleeding, hard deposits you cannot reach are cleaned off with tips suitable for implants, and the screws of the bridgework are checked. We take imaging once a year; changes in the bone level only show up on an X-ray.

These tools do not replace one another; they clean different surfaces. The shape of your bridge decides which of them does the main work.

What causes an implant to be lost is usually not the surgery but this inflammation, which progresses silently years later. Its early stage is reversible; its late stage is hard to treat. What matters is how early you notice the difference.

In the first days, cleaning is careful and limited; as healing progresses, the routine moves to its full form. We give you the schedule below in writing when you leave the clinic.

1. The first days

   We do not put strain on the surgical area. Gentle cleaning with a soft brush, the mouthwash you were told about at the clinic and rinsing with warm salt water are enough. You do not use the interdental brush or the water flosser during these days.

2. The first week

   The swelling goes down and the gum starts to settle. You extend brushing to the gum line. We bring in the water flosser, at its lowest pressure, on the day your dentist says you can.

3. The first month

   The gum settles into its new shape and the full routine begins: interdental brush, super floss, water flosser, brushing twice a day. We give you a check-up appointment during this period; we ask you to show us how you clean and point out the areas you are missing.

4. The first year and after

   A check-up every six months and imaging once a year. The image from the first year becomes the reference; comparing against it lets us see even the smallest change in the bone level. If you smoke or have had advanced gum disease in the past, the interval moves to three months.

5. Looking after the bridgework

   The outer layer of the teeth wears over time and the retaining screws come loose. When needed, the bridgework is removed, cleaned and refitted; this is a normal part of maintenance.

We do not give figures on this page. The yearly cost of maintenance varies from patient to patient and is set out item by item in writing along with your treatment plan. These are the items that determine the amount:

How often you have check-ups

The standard routine is a check-up every six months. If you smoke, have had advanced gum disease in the past or your blood sugar is unstable, the interval moves to three months and the number of check-ups a year doubles.

Imaging

The image taken once a year is the only way to monitor the bone level. If you are in a higher-risk group, it comes up more often.

Whether a night guard is needed

If teeth grinding is found, impressions are taken and a custom-made guard is prepared. A guard wears over time and is replaced; it is an item you can plan for.

Maintenance of the bridgework

Over the years, removing and cleaning the bridgework, replacing screws or repairing the outer layer will come up. The material of the bridgework determines the scope; we tell you in writing from the start which material we use.

The price of neglect

Treating peri-implantitis costs more than maintenance; if bone loss progresses, surgery comes into it. Regular maintenance is the cheapest item.