RISKS AND BENEFITS OF PERIODOTNAL PROBING AROUND DENTAL IMPLANTS

Over the years we have vacillated as to whether it is acceptable to perform periodontal probing around dental implants. We have generally advocated for checking periodontal health this way, but recommended plastic probes and avoiding deep probing. There are some common sense ideas I will share here, but as a general answer, there is no problem with gentile (less than 0.25 Ncm = gentile touch pressure) periodontal probing around the neck of an implant to evaluate pocket depth. 1) Risk of damaging the tissue around the implant. As long as the tissues are healthy this should not be a problem. I feel that the general health of the patient is most important here. If there is immune disease, decreased resistance to infective diseases, or the presence of chronic generalized gingival conditions such as might appear with a diabetic or a mouth breather, it would be wise to minimize probing. Use of a softer probe such as a flexing plastic probe may be helpful. 2) Risk of damage to the implant surface by the probe. I feel that this concern is unfounded. Studies have shown the opposite; that any roughening of the surface actually makes it more “sticky”. Also, the contamination by dissimilar metals has been shown to be a false idea or at least very rarely a problem. 3) Risk of bacterial inoculation (introduction of bacteria). Again, this is an individual case and individual health/resistance to disease concern. If you know that the implant is buried deeper than normal – such as may be the case with an anterior tooth – deeper probing should be avoided. Let me explain this again. When we place implants in the “esthetic zone” – front tooth area – especially if there is a lot of tooth and gums showing in the smile – we have to place them deeper in the gum tissue to have them “emerge naturally” or look natural as the crown appears to come out of the gums. These tissues are often naturally thinner and more fragile. I would avoid regular or “routine” probing unless there are clinical signs that warrant the check. The gum tissues around implants “like” the titanium surface and will adhere to it if they are not disturbed. The act of probing deeper tissues also places germs in the deeper tissues. If this is going to be done I would suggest irrigating the area with a dilute 1-to-100 povidone iodine irrigation before and after probing to help reduce the germ counts.

Overall, for otherwise healthy individuals it is fine to check periodontal health around implants with a careful, gentile technique.