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

One of the main aetiologies for the rapid rise in periimplantitis is the lack of maintenance and poor oral hygiene among implant patients. Poor oral hygiene and the formation of plaque and calculus around the peri-implant mucosa and implant surface will lead to peri-implantitis. The earliest sign of inflammation around the peri-implant mucosa begins with the presence of bleeding. This is known as peri-implant mucositis. Peri-implant mucositis when left untreated leads to peri-implantitis. Peri‐implantitis is a pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant mucosa and progressive loss of supporting bone. The primary and most effective method for plaque control around dental implants is to maintain good oral hygiene at home and have regular dental checkups with professional dental cleaning. Apart from regular scaling, various mechanical and chemical plaque control agents are being prescribed to patients to maintain good oral hygiene around implants. A toothbrush is the most common tool used by patients for plaque control at home. Additionally, floss, interdental brushes, and oral irrigators (Waterpik) are being advised by dentists for plaque control. Since the removal of plaque from interproximal or interdental surfaces of the teeth, especially with dental implants where the presence of gingival embrasure is inevitable due to lack of inter-implant papilla, the use of interdental aid is deemed necessary. The use of only a toothbrush may not be effective to maintain optimal plaque control in individuals with gingival embrasure, pontics, and implant prosthesis. The bristles of toothbrushes may not be able to effectively remove plaque under the surfaces of implant crowns and bridges, leading to an increased risk of plaque buildup and inflammation around implants. Interdental aids have proven to be effective in decreasing plaque accumulation and preventing periodontal disease by 80% (ADA) and those with peri-implantitis. Although various interdental aids are available in the market, the use of interdental aids is limited among the general population.  It is also noted that floss and interdental brushes 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 its importance.

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