Is food impaction a real problem for implant patients?

Is food impaction a problem for your implant patients? It is, according to 70 % of patients with posterior implants, as recent study published in Clin Oral Impl Res has showed.

The good news is that only 1 in 5 of these patients reported to be “moderately” or “severely” affected by food impaction, while the majority perceived it rather as a tolerable “nuisance”. But could there be more to food impaction than nuisance? The short article below will help you to find what is the risk and how to prevent it!

Could food impaction cause more problems?

To start with some fundamental risks, implant sites with food impaction showed higher plaque, bleeding and deeper probing depths than corresponding sites with no food impaction.
Interestingly, food impaction was more common in sites with a better papilla fill, at least as determined by Jemt’s index score of 3. This warrants some discussion, but it is indicative of how the aesthetic-driven 2D indices we use (like papilla height or papilla fill) are inadequate to serve 3D structures of the complex interproximal space.

The interdental space of the posterior teeth is defined by the shape of the Col, which often takes a mild crater shape in between the visible pappilae on the buccal and the lingual side, possibly trapping food in the presence of higher pappilae on each side.  If you remember from your dental school histology,  Col is a valley-like depression which connects the gingival papillae situated in the interproximal space between two teeth. It lies below, and conforms to the shape of, the interproximal contact. It is covered by non-keratinized epithelium. The col is considered an important site for the initiation of chronic periodontitis.
To that end, a visible “black triangle” might be preferable around posterior implants to the better looking 2Dimensional “papilla fill”, which however conceals a small cave...!

Unlike the triangular shape that is often depicted, the interproximal papilla and space follows the curve of Col, which might result in food trapping even when the visible pappila appears high.

Can we prevent food impaction? 

Can we prevent, or at least reduce the impact of food impaction in posterior implant prosthesis? It proves to be a challenging task, but combining the understanding of the design principles of the Implant Supracrestal Complex with the findings of the study by Dr. Souknilan Chanthasan recently published in COIR , I think we can get identify some critical parametres and get some valuable directions.

The 3Dimensional position of the implant appears to be critical determinant for food impaction. In particular, the closer proximity of the implant to the neighbouring tooth was - maybe unsurprisingly – associated with higher food impaction.
Similarly, cement retained crowns came with more food impaction, but as cement retention is more often used to compensate for compromised implant position, this might be indicative of the importance of proper 3D placement. Further design features of the emergence profile, such as position of the contact point can be very important determinants as well. Loose contact, longer contact length, lower contact point level, closer distance between ISSC and tooth, lesser embrasure surface area, were found significantly more associated with food impaction. 
Also surprisingly to many, food impaction was significantly more associated with Tissue than with Bone level implants. Although the study was not designed to find differences between the two, this might be suggestive of the importance of individualizing the design of the supracrestal complex, rather than expecting a simple choice of implant to do the job automatically. More to discuss...! but for more , take a look at the actual study!

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