It’s all in the make up
Dental hygienist Tracey Lennemann considers how best to establish firm foundations to avoid implant failure
High on the list of causes for implant complications is failure of supporting tissues around implants. Breakdown of these surrounding tissues influences the aesthetic appearance of implants and supra-structures, increases risk of implant failure and is very disappointing to the patient.
Peri-implant mucositis is defined as a reversible inflammatory reaction in the soft tissues surrounding an implant. Peri-implantitis is an inflammatory reaction with loss of supporting bone in the tissues surrounding an implant.1 An increasing number of studies suggest that anaerobic plaque bacteria may have an adverse effect on peri-implant tissue health.2 Peri-implant tissue is colonised by the same flora as the periodontium and that disease of this tissue is very similar to gingivitis or periodontitis.3 A patient with poor oral hygiene or with a pre-existing periodontal condition is more susceptible to bacterial implant failure and aesthetic collapse than a patient with good oral hygiene. To reduce implant failure and improve aesthetic results, it is vital to assess, treat and stabilise the periodontal condition of your patient before, during and after implants are placed. Here are some important questions and recommended steps to follow when evaluating a patient for implants.
How detailed is your initial treatment planning? Are you regularly educating patients about oral disease and the link to their general health? Do you have a protocol for updating health histories and taking X-rays? You should be updating and reviewing each patient every recall.
1 Periodontal risk assessments
These assessments are of extreme importance to determining therapeutic option for patients. Complete yearly periodontal charting, including measuring of bone loss, pocket depths, recession, furcation involvement, mobility, abrasion and/or any other defects found. Plaque indexes, bleeding/inflammation indexes, oral hygiene indexes, taking, updating and interpreting X-rays and DNA testing of subgingival bacterial colonies (with high risk patients), help evaluate the status of disease or health of a patient.
2 Contraindications and other risks
Smoking, uncontrolled diabetes, multiple health problems, osteoporosis and poor oral health are some of the factors contributing to implant failure. Intra- and extraoral examinations are also important to the general health of patients. They are carried out when the patient shows signs of high-risk factors contributing to each specific condition. Have you implemented any of these advanced screenings into your implant assessment and oral hygiene programmes? If not, it’s time to start.
3 Pre-implant therapeutic treatments
After assessing the patient, an individual treatment plan must develop. General light plaque debridement with ultrasonic power scalers and some hand instruments, polish and oral care instructions which can be split into two appointments, depending upon the condition of the disease and time allotment is recommended. Non-surgical periodontal treatment (curettage) and pre-surgical periodontal treatment (soft and hard tissue curettage), that use hand instruments for removing rough root surfaces and dead tissue in deep pockets can be completed in multiple separate visits. Are you advancing your skills for periodontal therapy? Are you using the latest instruments and techniques for optimal treatment results?
The hard facts
* A patient with poor oral hygiene or with pre-existing periodontal condition is more susceptible to bacterial implant failure and aesthetic collapse than a patient with good oral hygiene
* You must assess, treat and stabilise the periodontal condition of your patient
* You should be updating and reviewing each patient every recall before, during and after implants are placed
* Complete yearly periodontal charting, including measuring of bone loss, pocket depths, recession, furcation involvement, mobility, abrasion and/or any other defects found
4 Continued assessment
After implants have been placed, monitor oral hygiene during the placement stages. Has the patient understood how to maintain the healing caps or abutments, implants and supra-structure? Are they able to clean around the prosthetic components? If the prosthetic components are not easily accessible to the patient, the risk of plaque accumulation increases along with peri-implant mucositis and peri-implantitis. Peri-implant cementitis is also an increasing factor with bacterial accumulation and implant failure. Be sure to control and remove all cement after placement and ensure oral hygiene measures around all prosthetics. Just focusing on aesthetics without maintenance is a recipe for failure.
5 Regular maintenance intervals
Oral hygiene monitoring and regular hygiene visits are fundamental steps in maintaining health tissues, implants and oral health. Evaluation of plaque scores, bleeding, X-rays and deposits must be completed. The prostheses should be checked for signs of wear or breakage and fixed restorations should have the cementation or screw fixation checked. Improved oral hygiene along with regular implant maintenance visits is an essential process for preserving healthy implant supporting tissues and will increase implant success and aesthetics. Make the small changes today to create a solid foundation for tomorrow.
• References available on request
World Congress of Implant Aesthetics
With an emphasis on integration between clinical science and practice, the World Congress of Implant Aesthetics (WCIA) 2012 is open to all those interested in the field of dental implant aesthetics. Carl Misch is presenting for 4 hours
17-18 October 2012
Registration fee: £299 (£249 if registering before 1 July 2012)
One-day registration fee £199
Closing date for registration
30 September 2012
(limited places available)
Tracey Lennemann RDH, BA is an international speaker and trainer. She has been a clinical dental hygienist since 1986 in the USA and Europe. In addition to completing her Associate Degree in Dental Hygiene (Spokane, Washington, USA), Tracey also holds a Bachelors Degree from Eastern Washington University. Since 1988, Tracey has practised in Munich, Germany, and Austria and works alongside Dr Parag at Facial Wellness. Tracey also develops individual workshops for private continuing education programmes and symposiums.