Gingival Hyperplasia with Hybrid bridges: comments?

Does anyone know how often or if hybrid implant retained bridges (screw retained) need to be removed for hygiene purposes?

J Oral Implantol- Gingival Embrasure Proliferation-2014 Dec- 41(6): e297-300 Gingival proliferation or hyperplasia occurs in area where there may be compression. As with a denture epulis, which may be the same thing.

My experience is if the prostheses is self cleansing ie has a polished convex intaglio surface and the patient has good oral hygiene there is minimal if any hyperplasia. All of my hybrid prostheses fit passively, gently contacting the gingival surface.

I will try and be slightly less sarcastic than Paul, but in my limited experience really tight tissue adaptation and concave surfaces that can't be cleaned are the worst for inflammation. I struggle with keeping the acrylic close to the tissue for esthetic and phonetics but like to have some room for cleaning. The lab is helpful here. As for removing, I try (notice I said "try") to remove the prosthesis once a year or two. It is a challenge and we replace all of the prosthetic screws when we do this. Which can be costly. I am open to other suggestions. Great questions!

Hybrid prostheses should only be removed if there is a peri-implantitis which requires revision. The removal can cause screws to break and they need to be replaced if removed due to pre-load deformation with initial torquing. My protocol is to create spluice-ways where patients can get proxy-brushes and waterpicks around the facial and lingual while maintaining proximity to the tissue and to inform the patient that 3-4 month prophys are mandatory to avoid tissue overgrowth. Tissue surface convexity is a must! So many labs create ridgelaps and this is a haven for bacteria. People that routinely remove these things are not explaining all the problems! You need the healing abutments to place immmediately upon removal as tissue closes over the implant quickly if they are not shallow or equi-gingival. Then you may need a CO2 laser (LightScalpel is a 10,600 nm laser that is awesome for this!) to remove tissue or worse-try and pack cord! Best of luck and lest I get sarcasm I have my DABOI/ID, FAAID, DICOI so I won't steer you wrong.

In a lot of the cases I see the tissue is not pathological, it is often very healthy tissue that forms a symbiotic relationship to the prosthesis. Other times its inflamed tissue due to lack of proper cleaning.

Be careful that the patient uses the medicine for hypertension. Many of my patients have used these drugs. The best treatment is: to use of soft tissue laser.

Ha ha ha. Paul thanks for the referrals to Fine Dental Care in Wayne, NJ USA. As a general dentist, I generally do 10-20 arches per year. I've been doing All-on-X cases for probably a decade for so and implants for just about 30 years. I hear the frustration about removing prostheses and rarely remove them myself. However, I have come up with a very quick way to do so. Usually, it takes less than 5 minutes to remove and 5 minutes to replace. At every dental convention, I go to, I try to get companies to help hide the screw holes better. Here's what I do, I use Examix Polyvinyl Impression material to seal the screw holes. The yellow color of the heavy body is slightly off compared to the tooth shades but hides fairly well and I use the pink light body for hiding screw holes due to its match to the ginigival material. It works so incredibly well short or long term. Just take your explorer and pull it out when needed. It comes out intact. Insert the prostheses, torque the screws and squirt your screw holes with your impression syringe and dismiss the patient. Easy, easy, easy!