Maintaining effective oral hygiene around fixed prostheses is essential for long-term clinical success and patient satisfaction. While restorations can restore function and aesthetics, they also create unique challenges for plaque control, requiring targeted interdental cleaning strategies.
In this issue, we explore the importance of interdental cleaning, understand how fixed prostheses lead to plaque accumulation and provide practical, patient-friendly techniques and recommendations to help support optimal peri-prosthetic health and longevity of fixed restorations.
What is the need for interdental cleaning?
Toothbrushing does not effectively reach interdental spaces, leaving portions of the teeth inadequately cleaned.1
Why?- Interdental gingiva fills the space between two teeth apical to their point of contact, creating a ‘sheltered’ area.
- This area is challenging to access, especially when teeth are malpositioned.
- Calcium and phosphate for remineralisation
Initial papillary inflammation exposes the interdental area, creating local conditions conducive to the growth of bacterial plaque.
How Do Fixed Prostheses Increase Plaque Retention?
The design and fit of fixed restorations significantly influence biofilm accumulation.
Fixed prostheses increase plaque retention by introducing artificial interfaces, contours, and materials that are harder to clean than natural teeth.2
- Rough, overhanging or subgingival crown margins ⟶ Disrupt the natural cleaning mechanisms, increasing plaque retention.
- Excessive luting cement that extrudes into the gingival sulcus ⟶ Difficult to remove residue and a major trap for plaque.
- Over-contoured or bulky crowns fail to provide a natural, gentle slope required for self-cleansing ⟶ Leads to accumulation of supra-gingival plaque.
- When dental materials degrade, scratch, or are improperly polished, it creates higher surface roughness ⟶ Which creates a safe haven for bacteria to adhere and multiply much faster than on smooth enamel.
Inadequate plaque control around fixed prostheses can cause:
- Gingival inflammation
- Increased bleeding on probing
- Secondary caries on abutment teeth
So, regular disruption of interdental biofilm is critical to maintaining peri-restorative tissue health.
Individualised Interdental Cleaning Regimen
Interdental tool selection should be anatomy-driven as a one-size-fits-all approach can leave plaque behind.
Clinical recommendations to consider when recommending interdental aids to your patients:
-
Embrasure morphology
- Assess size and shape of the interdental aid.
- Interdental brushes are generally more effective in open embrasures3
- Select the largest brush size that fits comfortably without causing trauma.
- Dental floss is better suited for tight contacts with intact papillae.4
-
Pontic design
- Choose an aid based on the type and accessibility of the pontic.
- Super floss, floss threaders, or appropriately sized interdental brushes can improve plaque removal beneath fixed prostheses.
- Ensure patients can effectively clean the tissue-facing surface of the pontic.
-
Soft tissue contour
- Evaluate papillary height, gingival recession, and tissue health.
- Areas with recession or root exposure ⟶ Larger interdental brushes or soft rubber interdental cleaners.5
- Avoid recommending devices that traumatise inflamed or delicate tissues.
-
Manual dexterity
- Match the interdental aid to the patient's motor skills and physical ability.
- Patients with reduced dexterity ⟶ interdental brushes with ergonomic handles or powered flossing devices.6
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Patient compliance
- Recommend an interdental aid that the patient is willing and able to use consistently.
- Ease of use, comfort, and patient preference are key determinants of long-term adherence.
- Reinforce technique through demonstration and regular review at maintenance visits.
Here's a quick clinical reference to support evidence-based selection of interdental aids.
| Clinical feature | Recommended interdental aid |
|---|---|
| Tight contacts with intact papillae | Dental floss |
| Open embrasures | Appropriately sized interdental brush (largest size that fits comfortably) |
| Pontics and fixed prostheses | Super floss, floss threaders, or appropriately sized interdental brushes |
| Gingival recession or root exposure | Larger interdental brush or soft rubber interdental cleaner |
| Reduced manual dexterity | Ergonomically handled interdental brush or power-driven interdental cleaning device |
| Gingivitis (without proximal or secondary caries) | Dental floss |
| Gingivitis (with proximal or secondary caries) | Interdental brush (or dental floss if the brush cannot pass through) |
| Limited mechanical access | Water flosser |
| Poor patient compliance | The interdental aid the patient is most likely to use consistently |
Other Additional Tips
Demonstrate the right way to clean during recall appointments to improve patient compliance and technique.
Patients with fixed partial dentures should also be instructed to:
- Clean beneath pontics daily using super floss or floss threaders.
- Adapt the cleaning aid to contact the tissue-facing surface of the pontic.
Monitoring Oral Health in Patients With Fixed Prostheses
Reinforcement improves long-term outcomes. At each patient visit, you must
- Evaluate plaque accumulation using a plaque index.
- Assess bleeding on probing around abutment teeth.
- Examine marginal integrity and emergence profiles.
- Reassess interdental aid selection as periodontal conditions or prosthetic contours change.
Give your patients the superpower of interdental cleaning!
Colgate Interdental Brush & Special Floss
Colgate Interdental Brush
The interdental hygiene brushes are engineered for precision access, enabling your patients to target the areas most prone to plaque– their crowns and bridges!
The No. 1 choice for interproximal cleaning to maintain a healthy mouth, the Colgate interdental brush features:
- Spiral soft bristles: Effectively clean the interdental space
- Coated, flexible wire: Is gentle on the gums
- Non-slip grip: Enables easy handling
Colgate Special Floss
From braces to bridges, Colgate’s Special Floss fits all:
- Crowns and bridges
- Dental implants
- Wide interdental spaces
- Around orthodontic appliances
References:
- Thomassen, T. M. J. A., Slot, D. E., Graetz, C., Discepoli, N., Ehrenthal, J. C., Frese, C., Tomás, I., Dörfer, C. E., Van Der Weijden, F., & Sälzer, S. (2026). The Patient‐Centred Interdental Cleaning Concept—Consensus based on a round table. International Journal of Dental Hygiene, 24(2), 247–264. https://doi.org/10.1111/idh.70009
- Dragomir, L. P., Nicolae, F., Gheorghe, D. N., Popescu, D. M., Dragomir, I. M., Boldeanu, L., Boldeanu, V. M., & Popescu, M. R. (2023). The influence of fixed dental prostheses on the expression of inflammatory markers and periodontal Status—Narrative Review. Medicina, 59(5), 941. https://doi.org/10.3390/medicina59050941
- AlMoharib, H. S., AlAskar, M. H., Abuthera, E. A., Alshalhoub, K. A., BinRokan, F. K., AlQahtani, N. S., & Almadhoon, H. W. (2024). Efficacy of three interdental cleaning methods for Peri-Implant Health maintenance of single Implant-Supported crowns: a randomised clinical trial. PubMed, 22, 51–56. https://doi.org/10.3290/j.ohpd.b4854607
- Dental floss / Interdental cleaners. (n.d.). https://www.ada.org/resources/ada-library/oral-health-topics/floss
- Van Der Weijden, F., Slot, D. E., Van Der Sluijs, E., & Hennequin‐Hoenderdos, N. L. (2021). The efficacy of a rubber bristles interdental cleaner on parameters of oral soft tissue health‐a systematic review‐. International Journal of Dental Hygiene, 20(1), 26–39. https://doi.org/10.1111/idh.12492
- Edlund, P., Bertl, K., Pandis, N., & Stavropoulos, A. (2022). Efficacy of power‐driven interdental cleaning tools: A systematic review and meta‐analysis. Clinical and Experimental Dental Research, 9(1), 3–16. https://doi.org/10.1002/cre2.691