Plaque Accumulation Beneath Maxillary All-on-4™ Implant-Supported Prostheses.
BACKGROUND
Maxillary prostheses supported by four implants, following the All-on-4(™) principles, have become an accepted effective treatment for totally edentulous patients. Maintaining the hygiene of such fixed implant-supported prostheses is challenging.


OBJECTIVE
The purpose of this clinical study was to evaluate the distribution of plaque on the fitting surface of All-on-4 fixed prostheses in order to find new strategies for maintaining their hygiene.


METHODS
Twenty All-on-4 maxillary fixed prostheses collected from 20 patients, 6 months after delivery, were stained with methylene blue to disclose plaque accumulation at the fitting surfaces of the prostheses. Digital photographs of the fitting surfaces of the prostheses were recorded and processed. The distribution of accumulated plaque was evaluated statistically.


RESULTS
The average percentage of area covered with plaque was 28 ± 8% of the total area of the fitting surface of the prostheses. The fitting surfaces of the prostheses had three times more plaque on the palatal area (52.5 ± 7.33%) than on the buccal area (17.3 ± 7.33%, p < .05). The interimplant proximal areas of the fitting surface covered with plaque were high when the distance between implants was short (r = -0.326, p = .014).


CONCLUSIONS
These findings suggest that the hygiene of the All-on-4 prostheses could be improved by maximizing the distances between the inserted implants in the jaw, minimizing the prostheses' palatal extension and guiding patients to optimize their oral hygiene practices targeting the palatal area of their prostheses.
Division of Restorative Dentistry, Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.
Samer
S
Abi Nader
Division of Restorative Dentistry, Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.
Hazem
H
Eimar
Royal Medical Services, Jordanian Armed Forces, Amman, Jordan.
Moath
M
Momani
Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.
Ke
K
Shang
East Coast Oral Surgery Center (private practice), Moncton, New Brunswick, Canada.
Nach G
NG
Daniel
Division of Restorative Dentistry, Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.
Faleh
F
Tamimi
D000328:Adult; D003773:Dental Plaque / Q000453:epidemiology* / Q000209:etiology; D019094:Dental Prosthesis, Implant-Supported / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008437:Maxilla / Q000601:surgery; D008875:Middle Aged; D009066:Mouth, Edentulous / Q000601:surgery*; D009910:Oral Hygiene / Q000379:methods* / Q000523:psychology; D011792:Quebec / Q000453:epidemiology
clinical study; fixed implant prosthesis; peri-implantitis; plaque accumulation; prosthesis hygiene