Preparing for success in dental implantology

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  Posted by: Dental Design      13th June 2022

For patients with partial or complete edentulism, dental implants provide the gold standard treatment solution. Modern materials and techniques are backed by science and designed to support optimised treatment outcomes, even in complex or compromised patients. However, there are still many potential complications that must be considered to deliver the best results. One of the most common issues is peri-implant disease, which, in the worse-case scenarios, can impact functionality, aesthetics and longevity of implants placed. Not only should the dental team take steps to minimise the risks, but patients must also appreciate the important role they play, before, during and after surgery and restoration.

Peri implant disease prevalence and risk factors

Despite advances in materials, techniques and technologies, peri-implant diseases remain prevalent in the modern population. An estimated 43% of patients with implants experience peri-implant mucositis and 22% develop peri-implantitis.[i] Studies have suggested that among implants that fail completely, approximately 8% could be blamed solely on infection of the surgical site.[ii]

There are several risk factors for peri-implant infection that the dental team have to make patients aware of when discussing the possibility of dental implants. Poor oral hygiene, a history of periodontitis, diabetes and smoking may all influence implant survival – although there remains some conflicting evidence regarding the effects of smoking.[iii] Previous infection seems to be a leading concern, with research suggesting that patients with a history of generalised aggressive periodontitis are up to 5 times more likely to experience implant failure and 14 times more likely to develop peri-implantitis than those with no history of the disease.[iv]

In addition to history of periodontitis, the Implant Disease Risk Assessment (IDRA) sets out seven other risk factors – percentage of sites with bleeding on probing, prevalence of periodontal pockets ³ 5mm, bone loss in relation to the patient’s age, periodontitis susceptibility as analysed by the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases, supportive periodontal therapy, implant restorative depth and prosthesis-related factors.[v] This IDRA provides a comprehensive guide to evaluate and predict peri-implant risk for each patient, enabling clinicians to tailor pre- and post-surgical care accordingly. This assessment can also be shared with the patient to help them better understand their current status and the risks associated with implant treatment, preparing them for treatment and enhancing quality of consent.

Patient communication  

The IDRA is just one part of the patient communication process. Individuals considering dental implant treatment should be educated to a sufficient degree that they fully appreciate the ramifications of both the surgical and restoration solutions proposed. It has been suggested that patients’ general understanding of peri-implantitis and its impact is poor.[vi] This makes it all the more important to explain its causes and symptoms, and ensure that patients are aware of the signs and symptoms for fast management and resolution. All communication should be delivered in language that the patient understands clearly and is not intimidated by – the dental professional responsible for this part of the patient journey would benefit from training in the area to ensure their confidence in leading such conversations.

Where disease does develop, early intervention is key. Starting with improved oral hygiene, the clinical team will need to collaborate to deliver non-surgical therapies efficiently, before considering anything more drastic. Support from the dental hygienist/therapist is often crucial in the weeks and months following implant placement, working closely with the dentist to manage any issues and prevent disease in its tracks. 

Prevention always better than cure

Where possible, disease should be prevented completely. Successful treatment and resolution of any existing periodontal disease prior to implant placement has been shown to encourage effective results post-surgery, so this should be a priority before dental implants are placed in affected patients. In fact, comprehensive oral hygiene – including interproximal cleaning – has been shown to deliver improved implant outcomes for all patients.[vii]

The dental team can optimise pathogen control in the mouth before and after surgery by utilising an anti-microbial oral rinse. To supplement this enhanced oral hygiene routine, patients can also continue this post-treatment protection at home. The Curasept Implant Pro Oral Rinse with DNA and hyaluronic acid – available from J&S Davis – is the ideal solution. It delivers prolonged anti-plaque and anti-bacterial protection with 0.20% chlorhexidine gluconate, combined with the patented Anti Discolouration System (ADS) to minimise staining. The DNA significantly reduces the inflammation of the oral mucosa and acts as a cellular bioactivator to stimulate the repair and regeneration of gingival tissues, whilst the hyaluronic acid hydrates the mucous membranes to help accelerate wound healing.

Team prep

Preparation is key to success in any field of dentistry, but it is especially important when approaching surgical procedures like implant placement. Careful case selection, assessment and treatment planning are the not-so-secret weapons in every clinician’s armamentarium. Ultimately, achieving function, aesthetics and longevity is a team effort, involving the dentist, dental hygienist/therapist, dental nurse, technician and patient. All must share the same goals and fulfil their commitments for the very best outcomes.

 

For more information on the industry-leading products available from J&S Davis,

visit www.js-davis.co.uk, call 01438 747 344

or email jsdsales@js-davis.co.uk.

 

[i] Office for Health Improvement & Disparities. Guidance. Chapter 5: Periodontal diseases. Updated November 2021. https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention/chapter-5-periodontal-diseases#:~:text=Peri%2Dimplant%20health,-Dental%20implants%20may&text=Among%20patients%20with%20implants%20the,22%25%20respectively%20(76). [Accessed April 2022]

[ii] Thiebot N, Hamdani A, Blanchet F, Dame M, Tawfik S, Mbapou E, Kaddouh AA, Alantar A. Implant failure rate and the prevalence of associated risk factors: a 6-year retrospective observational survey. J Oral Med Oral Surg. 2022; 28(2):19.
https://doi.org/10.1051/mbcb/2021045

[iii] Turri A, Rossetti PH, Canullo L, Grusovin MG, Dahlin C. Prevalence of Peri-implantitis in Medically Compromised Patients and Smokers: A Systematic Review. Int J Oral Maxillofac Implants. 2016 Jan-Feb;31(1):111-8. doi: 10.11607/jomi.4149. PMID: 26800167.

[iv] Hashim, D., Cionca, N. A Comprehensive Review of Peri-implantitis Risk Factors. Curr Oral Health Rep 7, 262–273 (2020). https://doi.org/10.1007/s40496-020-00274-2

[v] Heitz-Mayfield LJA, Heitz F, Lang NP. Implant disease risk assessment IDRA- – a tool for preventing peri-implant disease. Clin Oral Impl Res. 2020; 31:397-403. DOI: 10.1111/clr.13585

[vi] Brandariz AI, Alberto M, Wang HL, Inglehart M. Patient-Centered Perspectives and Understanding of Peri-Implantitis. Journal of Periodontology. 2017; 88. 1-15. 10.1902/jop.2017.160796.

[vii] Cheung MC, Hopcraft MS, Darby IB. Patient-reported oral hygiene and implant outcomes in general dental practice. Australian Dental Journal. 2021; 66: 49-60. Hashim, D., Cionca, N. A Comprehensive Review of Peri-implantitis Risk Factors. Curr Oral Health Rep 7, 262–273 (2020). https://doi.org/10.1007/s40496-020-00274-2


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