Implants is a tricky subject with not much covered in dental school, and much of the learning occurs after graduation. Via patient experience on clinic and a multitude of webinars- this post is about what I've learnt for the initial assessment and why we should probe implants.
Exam: In addition to the standards of examinations for non-implant patients, for patients with implants, I like to:
-Palpate palpate.
-Probe and look for bleeding on probing.
-Document calculus.
-Note residual cement.
-Note any mobility or pain.
-Record the crystal bone height.
-It's always important to document things well, and an addition to this could be taking photographs or using an intra-oral camera.
Feel the fear and probe it anyway
As clinicians, we have a duty of care for our patients, and should also provide holistic care. By probing around implants we can identify the incidence and necessitate treatment of peri-implant disease. In brief, we can identify risk factors, identify, and act.
Baseline data can be recorded 6 months after implants are fitted, and can be recorded annually at assessment, and at every recall. However, If the patient has bad oral hygiene- we can bring them back every 2 months to check up on progress and provide support.
'Supportive Implant therapy' is what the maintenance stage is called. This includes oral hygiene advice and behavioural modifications.
'Non surgical Implant therapy' is the treatment stage, which is imperative to removing plaque retentive factors and disturbing the biofilm.
If we do this we can stand a chance of improving or preventing:
Peri-implant mucositis = a legion in the soft tissues without bone loss.
and preventing or stabilising:
Peri-implantitis= inflammation with bone loss.
This is some food for thought. Please refer to guidelines from qualified dental care professionals for advice or treatment protocols.
Another excellent reference: Jepsen S, Berglundh T, Genco R, Aass AM, Demirel K, Derks J, Figuero E, Giovannoli JL, Goldstein M, Lambert F, Ortiz‐Vigon A. Primary prevention of peri‐implantitis: Managing peri‐implant mucositis. Journal of clinical periodontology. 2015 Apr;42:S152-7.
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