Dental hygienist Karen Walker talks about treatment protocols she established 15 years ago and which mirror those now recommended by the British Society of Periodontology (BSP).
On 21 November at 7pm, I will be presenting on Dentistry Live on the topic of ‘Prevention and treatment of peri-implant disease using detailed hygiene maintenance’. I could give you hundreds of reasons why my content can truly help dental practices. Instead, let’s look at facts:
According to healthcare-focused market research firm Insights10, the UK dental implant market was valued at $2,095.80M in 2023 and is predicted to grow at a CAGR of 7.8% from 2023 to 2030, to $3,545.50M by 2030. I am sure my peers would concur that the number of patients with dental implants coming through their doors is also on the rise?
In March 2024, the BDJ released findings of a study that reported a lack of awareness of diagnostic criteria of peri-implantitis among general dental practitioners, even though the legal implications of failing to diagnose this condition were clearly understood. This study highlighted the need for further education about the diagnostic criteria, implant referral scenarios and risk factors of peri-implantitis to enhance patient care.
I have been working at The Campbell Clinic, a specialist implant practice, for the past 15 years. We place hundreds of implants annually and I am part of its Academy faculty, through which we hope to raise the standards in implant dentistry by creating the impetus for dentists to grow their knowledge and clinical competence.
It has been reassuring to see that an increasing number of dental practices are reaching out to us for support about peri-implantitis diseases. However, the motivation has tended to lean more towards pre-implant placement and not really for general dental practitioner treatments. This is the reason why I am so keen to talk at Dentistry Live and try and encourage more of my peers to upskill themselves in simple steps.
Validated approach
The peri-implantitis protocols I developed with Dr Colin Campbell 15 years ago have been scrupulously tested by us and have been entirely satisfactory, nevertheless it was not a validated approach, as no real recommendations had been published to substantiate a gold standard protocol.
However, in 2023, The European Federation of Periodontology (EFP) brought out guidelines that mirrored what we had put in place. These were subsequently adopted by the BSP which really validated our approach.
Years prior to this, I had the privilege to be the DCP representative for the Association of Dental Implantology (ADI) to create a protocol for the treatment of peri-implantitis diseases and try to disseminate these to the profession. I also lectured a lot on the subject when I was a KOL for Dentsply. I think every little step can make big changes.
With more and more patients having implant treatments, there is a growing need to understand the risk of developing peri-implant diseases. We know that there are over six million smokers in the UK, and the habit is still considered to be the largest systemic contributing factor to developing peri-implantitis. The effect of electronic cigarettes/vaping on peri‑implantitis has yet to be confirmed, but contributory risk factor is considered to be high.
We are also aware that diabetes has been shown to increase a patient’s risk for developing peri-implant disease, as it can inhibit the body’s immune response and interfere with bone regeneration and wound healing. So it is concerning that more than one in 14 people live with diabetes in the UK and it is estimated that as many as one in 10 UK adults could be living with diabetes within a decade.
My question to you is this: ‘How often have you found yourself unsure about how to handle a patient with peri-implant disease and your instinct is to immediately refer them for specialist treatment?’
Comprehensive diagnosis
Patients do not want to be referred to a different practice, they want their general practice to be a one-stop shop. From a business perspective, it makes no commercial sense to send away patients as it means a loss of potential revenue. I strongly believe in a team approach when treating peri-implantitis and in more autonomy being given to hygienists. The team can easily acquire the necessary skills and confidence to take on peri-implantitis disease management.
During my Dentistry Live session, I will go through a comprehensive diagnosis. Every patient should have a bespoke treatment plan, and this includes how you advise them to manage their condition between appointments. Patients cannot be expected to use recommended products at home as part of their implant maintenance regime without you demonstrating expressly how to use them in their own mouths.
I have used Philips Sonicare toothbrushes for the last 30 years and they have been an integral part of what I always recommend. The small heads are ideal for patients with complicated bridges and full arch implant treatments. The Philips Power Flosser is also essential to help clean the interproximal areas effectively. I take time to show my patients how to use these optimally and ensure they leave the practice with the right skillset to clean effectively at home.
Sharing knowledge
Of course you cannot make them do it, but this is why I value products I can trust: Philips Sonicare toothbrushes are backed by over 175 clinical studies and have reported long-term compliance, so I feel that my patients are in good hands when I cannot see them. I also help my patients to use interdental brushes, an ortho brush and Xfloss.
I would love practice owners and their teams to join my Dentistry Live presentation to take up the opportunity to learn more about peri-implantitis disease management within a general practitioner setting and look into ways to upskill themselves.
This might talk my way out of a job as we would get fewer referrals, but sharing knowledge is really important and it feels like the right thing to do, to give something back to the profession!
For more information about Dentistry Live, visit dentistry.co.uk/webinar/dentistry-live-non-surgical-treatment-of-peri-implant-disease.
