Evaluation of the knowledge, attitude, and practice of using interdental aids and factors affecting its non-adherence among the people with dental implants: a mixed-methods study

Dental implants have becomea viable and promising treatment alternative for replacing missing teeth inpatients with good general oral health and adequate bone dimension.Around 909,643of the Indian population receive implant treatment per year. The most importantadvantage of dental implant is that it helps to restore the occlusion andreplace missing teeth without compromising the adjacent teeth as an abutment.It enhances the quality of life and has a good long-term prognosis compared tomany prosthetic treatments such as post and core and multiple crowns andbridges. With rapid awareness about dental implants, many patients are seekingimplant placement in both rural and urban areas. However, one should notethat even though the placement of dental implants is rapidly increasing, thelevel of awareness regarding how to maintain the implants after placement isless among both dentists and patients. Many patients suffer from implant failureand post-placement complications, with periimplantitis being the most common. According to theliterature, approximately 79% of individuals rehabilitated with implants areaffected by peri-implant mucositis, and 50% of implants are affected withperi-implantitis. At the present times, peri-implantitis has become aglobal burden that occurs with a frequency from 1% to 47% at implant level.

One of the main aetiologiesfor the rapid rise in periimplantitis is the lack of maintenance and poor oralhygiene among implant patients. Poor oral hygiene and theformation of plaque and calculus around the peri-implant mucosa and implantsurface will lead to peri-implantitis. The earliest sign ofinflammation around the peri-implant mucosa begins with the presence ofbleeding. This is known as peri-implant mucositis. Peri-implantmucositis when left untreated leads to peri-implantitis. Periâ€implantitis is apathological condition occurring in tissues around dental implants,characterized by inflammation in the peri-implant mucosa and progressive lossof supporting bone. The primary and most effectivemethod for plaque control around dental implants is to maintain good oralhygiene at home and have regular dental checkups with professional dentalcleaning. Apart from regular scaling, various mechanical andchemical plaque control agents are being prescribed to patients to maintaingood oral hygiene around implants. A toothbrush is the most common tool used bypatients for plaque control at home. Additionally, floss, interdental brushes,and oral irrigators (Waterpik) are being advised by dentists for plaquecontrol. Since the removal of plaque from interproximal or interdental surfacesof the teeth, especially with dental implants where the presence of gingivalembrasure is inevitable due to lack of inter-implant papilla, the use ofinterdental aid is deemed necessary. The use of only a toothbrush may not beeffective to maintain optimal plaque control in individuals with gingivalembrasure, pontics, and implant prosthesis. The bristles oftoothbrushes may not be able to effectively remove plaque under the surfaces ofimplant crowns and bridges, leading to an increased risk of plaquebuildup and inflammation around implants. Interdental aids have proven to be effective indecreasing plaque accumulation and preventing periodontal disease by 80% (ADA)and those with peri-implantitis. Althoughvarious interdental aids are available in the market, the use of interdentalaids is limited among the general population.  It is also noted that floss and interdentalbrushes are prescribed by dentists, but many people do not use them regularly.There is a general lack of awareness among the people regarding how to use it, adherence to usage, and recognition of itsimportance.

Therefore,with this objective in mind, this mixed-method study aims to assess theknowledge and attitudes of patients with dental implants toward interdentalcleaning aids, and the factors that are responsible for their non-usage. Thestudy also aims to assess any pitfalls and shortcomings that exist in oralhygiene instruction given by dentists, which leads to non-adherence.