Cleansability and maintenance of implant-supported full-arch prostheses

Why start with a maintenance plan?

In a systematic review of 18 studies (3 randomised, 1 non-randomised controlled and 14 prospective studies), peri-implantitis prevalence in fully edentulous patients was reported at 1.5% to 29.7% at patient level and 2.1% to 20.3% at implant level; the review concludes that edentulous patients restored with fixed or removable implant restorations were frequently affected by peri-implant disease.⁵ In an umbrella review of reviews with at least 5 years of follow-up, peri-implantitis prevalence ranged from 4% to 18%; the same review reported screw loosening in 5% to 15% and veneer chipping in 15% to 35% with veneered zirconia. Prosthesis survival was 89.5% to 96.8% over 5 to 15 years.⁶ The two reviews differ in scope: the first covers fixed and removable restorations, the second fixed complete-arch prostheses followed for at least 5 years, so their ranges cannot be compared directly. The ranges describe findings across studies; they are not pooled estimates or predictions for an individual restoration. The abstract of the umbrella review does not state whether the rates are reported per patient, per implant or per prosthesis.

The EFP S3 guideline approaches this through prevention: prevention starts when implants are planned, placed and loaded; once implants are in function, a supportive care programme with periodic assessment of tissue health is structured; if disease is found, appropriate treatment follows.¹

Design and patient factors

In a study of 23 partially edentulous patients referred for peri-implantitis treatment, 74% of the implants had no access for proper oral hygiene. Sites without access were associated with peri-implantitis, and peri-implantitis was rare where access existed; the authors stress the importance of prosthetic designs that allow hygiene access around implants.³ As the patients were partially edentulous and referred for treatment, the finding cannot be carried over directly to full-arch patients. A narrative review of maxillary full-arch restorations lists difficulty with daily hygiene access among the contributors to biological complications and advises placing implants so that a prosthesis with full access for maintenance can be made.⁴

In the AO/AAP meta-analysis on prosthesis design, emergence angles below 30° and a concave or straight emergence profile were associated with lower peri-implantitis risk; each finding rests on two studies (p = 0.05 and p = 0.03), so the analysis does not establish a universal design threshold. In the same analysis, a one abutment-one time approach was associated with less marginal bone loss than repeated abutment disconnection; the abstract does not report the size of the difference, and the finding concerns abutment disconnection, not removal of the prosthesis.⁷ In the umbrella review, monolithic zirconia and screw-retained frameworks showed lower technical complication rates.⁶ Screw and cement retention are compared in a separate article.

Among patient factors, a meta-analysis on primary prevention found lower odds of peri-implantitis in diabetic patients with good glycaemic control than in diabetic patients with poor glycaemic control (OR 0.16; indirect evidence), and less inflammation and less change in marginal bone level at sites with augmented keratinised mucosa than at implants with deficient keratinised mucosa. Studies on smoking cessation and oral hygiene behaviour were inconclusive.² According to the 2017 World Workshop consensus report, the evidence on the effect of keratinised mucosa on long-term peri-implant health is equivocal, although it may have advantages for patient comfort and ease of plaque removal.⁸

Step-by-step maintenance protocol

1. Plan implant positions so that the prosthesis leaves hygiene access around each implant.^{1, 4}
2. Assess the emergence angle and profile for hygiene access. Angles below 30° and a concave or straight profile were associated with lower peri-implantitis risk, but each finding rests on two studies and does not set a universal threshold.⁷
3. Where keratinised mucosa is deficient, augmentation may be considered after clinical assessment. In the meta-analysis augmented sites showed less inflammation and bone level change; the consensus report considers the evidence on long-term health equivocal but notes possible advantages for patient comfort and ease of plaque removal.^{2, 8}
4. At delivery, show home care for each implant site. There is not enough evidence to identify the optimal mechanical home care method; recommendations are carried over from natural teeth. One review found powered toothbrushes performed better than manual ones but drew no firm conclusion; the Cochrane review found no statistically significant difference.^{9, 10} A 2025 meta-analysis in patients with peri-implant mucositis found no statistically significant difference between toothbrushing alone and toothbrushing with a water oral irrigator, and describes the evidence on interproximal cleaning devices as limited.¹¹
5. Set up the supportive care programme according to the patient's risk profile. A review on full-arch maintenance frequency included 11 studies; 8 reported the frequency of supportive care and 3 the procedures used, and none was at low risk of bias. Its authors state that no specific frequency can be derived and suggest considering professional oral hygiene every 6 months and prosthesis removal at least once a year, tailored to the patient's risk profile.¹² In a systematic review of 25 studies on supportive care in the management of peri-implant mucositis and peri-implantitis, supportive care, particularly with individualised risk-based recall intervals, improved clinical outcomes such as probing depth and bleeding on probing compared with standard or no maintenance; high heterogeneity between studies limited definitive conclusions. The authors advise tailoring recall intervals to patient-specific risk factors, including history of periodontitis, smoking status and systemic health.¹³ Record in the plan whether and when the prosthesis will be removed, and why.
6. Record baseline radiographic and probing measurements once the prosthesis is completed.⁸
7. Deliver professional oral hygiene according to the programme set in step 5 (the review authors suggest considering it every 6 months); at each review, record bleeding on probing, suppuration, probing depths and the position of the mucosal margin; compare them with baseline.^{8, 12} Bleeding on gentle probing is the main sign of peri-implant mucositis; in peri-implantitis, increased probing depths and/or recession of the mucosal margin and radiographic bone loss are added. If either is detected, appropriate management follows.^{1, 8}
8. Add technical checks to the programme: screw loosening and veneer chipping are the main technical problems reported with these prostheses.⁶
9. With diabetic patients, discuss the link between glycaemic control and peri-implant health with the patient and their physician.²

Common errors and fixes

Level of evidence

What is known

Regular attendance at supportive care is associated with a lower risk of peri-implant disease; the review's abstract presents these primary prevention findings as indirect evidence.² The guideline recommends that prevention begin at planning and that a structured maintenance programme be put in place.¹ Sites without hygiene access are associated with peri-implantitis; this finding comes from a small cross-sectional study in partially edentulous patients.³ The 2017 World Workshop consensus report recommends obtaining baseline radiographic and probing measurements after completion of the implant-supported prosthesis.⁸

What is not known

No specific recommendation could be derived on how often the prosthesis should be removed; none of the 11 studies in the review was at low risk of bias.¹² In the review supporting risk-based supportive care, high heterogeneity limited definitive conclusions and generalisability.¹³ Evidence on the optimal home care method is insufficient; the Cochrane review found no reliable evidence on which regimen is most effective for long-term maintenance and notes that this does not mean current regimens are ineffective; a 2025 meta-analysis describes the evidence on interproximal cleaning devices as limited.^{9, 10, 11} The design findings rest on few studies (two each for emergence angle and profile).⁷ The evidence on the long-term effect of keratinised mucosa is equivocal.⁸ Certainty levels of the guideline recommendations are not given in the abstract and are therefore not stated here.

At the chair

• Do implant positions allow the prosthesis to leave hygiene access?
• Have the emergence angle and profile been assessed for hygiene access?
• Is keratinised mucosa adequate?
• Was home care shown to the patient at delivery?
• Are dates and frequency for supportive care and prosthesis removal written down according to the patient's risk?
• Were baseline radiographic and probing measurements recorded once the prosthesis was completed?
• Do reviews record bleeding, suppuration, probing depths and mucosal margin, compared with baseline, and include technical checks (screws, veneering)?

References

1. Herrera D, Berglundh T, Schwarz F, Chapple I, Jepsen S, Sculean A, et al. Prevention and treatment of peri-implant diseases-The EFP S3 level clinical practice guideline. J Clin Periodontol. 2023;50 Suppl 26:4-76. PMID: 37271498 · DOI: 10.1111/jcpe.13823
2. Carra MC, Blanc-Sylvestre N, Courtet A, Bouchard P. Primordial and primary prevention of peri-implant diseases: A systematic review and meta-analysis. J Clin Periodontol. 2023;50 Suppl 26:77-112. PMID: 36807599 · DOI: 10.1111/jcpe.13790
3. Serino G, Ström C. Peri-implantitis in partially edentulous patients: association with inadequate plaque control. Clin Oral Implants Res. 2009;20(2):169-74. PMID: 19077152 · DOI: 10.1111/j.1600-0501.2008.01627.x
4. Block MS. Maxillary Full Arch Restorations - Biological Complications: A Narrative Review Outlining Criteria for Long Term Success. J Oral Maxillofac Surg. 2023;81(9):1124-1134. PMID: 37301227 · DOI: 10.1016/j.joms.2023.05.008
5. Ramanauskaite A, Galarraga-Vinueza ME, Obreja K, Sader R, Schwarz F. Prevalence of Peri-implant Diseases in Patients with Full-Arch Implant-Supported Restorations: A Systematic Review. Int J Prosthodont. 2021;34:s27-s45. PMID: 33571325 · DOI: 10.11607/ijp.6488
6. Tomar S, Agnihotri N, Vhanmane G. Prosthetic complications of implant-supported complete arch prostheses: An umbrella review of systematic reviews. J Prosthet Dent. 2026;136(1):52-59. PMID: 41927400 · DOI: 10.1016/j.prosdent.2026.03.013
7. Lin GH, Lee E, Barootchi S, Rosen PS, Curtis D, Kan J, et al. The influence of prosthetic designs on peri-implant bone loss: An AO/AAP systematic review and meta-analysis. J Periodontol. 2025;96(6):634-651. PMID: 40489290 · DOI: 10.1002/JPER.24-0144
8. Berglundh T, Armitage G, Araujo MG, Avila-Ortiz G, Blanco J, Camargo PM, et al. Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Clin Periodontol. 2018;45 Suppl 20:S286-S291. PMID: 29926491 · DOI: 10.1111/jcpe.12957
9. Louropoulou A, Slot DE, Van der Weijden F. Mechanical self-performed oral hygiene of implant supported restorations: a systematic review. J Evid Based Dent Pract. 2014;14 Suppl:60-9.e1. PMID: 24929590 · DOI: 10.1016/j.jebdp.2014.03.008
10. Grusovin MG, Coulthard P, Worthington HV, George P, Esposito M. Interventions for replacing missing teeth: maintaining and recovering soft tissue health around dental implants. Cochrane Database Syst Rev. 2010;2010(8):CD003069. PMID: 20687072 · DOI: 10.1002/14651858.CD003069.pub4
11. Bishti S, Wolfart S, Tuna T. Optimizing implant hygiene: the added value of interproximal cleaning devices around implant-supported restorations-a systematic review and meta-analysis. Int J Implant Dent. 2025;11(1):64. PMID: 41114861 · DOI: 10.1186/s40729-025-00652-4
12. Lanzetti J, Crupi A, Gibello U, Ambrogio G, Longhi B, Roccuzzo A, et al. How often should implant-supported full-arch dental prostheses be removed for supportive peri-implant care to maintain peri-implant health? A systematic review. Int J Oral Implantol (Berl). 2024;17(1):45-57. PMID: 38501398 · DOI: not listed in PubMed
13. Mojaver S, Zad A, Sarmiento H, Fiorellini JP. Efficacy of supportive peri-implant therapy in the management of peri-implant mucositis and peri-implantitis: A systematic review. J Am Dent Assoc. 2026;157(2):141-152.e4. PMID: 41204923 · DOI: 10.1016/j.adaj.2025.08.015

Methods note

The first search was run in PubMed on 4 November 2026; on 5 November 2026 every source was re-verified against its PubMed record (NCBI E-utilities). One review in the previous version was removed: its study population was healthy, non-smoking adults and it was not specific to full-arch prostheses. The home care sentences based on it were removed as well. After an external review on 5 November 2026, two sources were added (PMID 41114861 and 29926491), and one more after a second external review (PMID 41204923); their bibliographic data were checked against the PubMed esummary record and their findings taken from the abstracts. The search covered the prevalence of peri-implant disease with full-arch implant prostheses, prosthesis design and cleansability, home care and supportive care frequency. Systematic reviews, meta-analyses and guidelines were given priority. Author, title, journal, year and DOI of every source were checked against its PubMed record; findings were taken from abstracts only, and full texts were not read. This is not a systematic review; it was prepared from one database by one reader.

Author: Dr. Ferit Çiftçi · Dentist · Author page · Last updated: 5 November 2026

This text is not patient information. Treatment decisions are made after an examination and for each person individually.

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