- As a hygienist you will be seeing patients with implants on a regular basis. In the UK, it is estimated that >100 000 implants are placed per year.
- Peri-implant disease can be divided into peri-implant mucositis and peri-implantitis. Peri-implant mucositis is a reversible inflammatory process in the soft tissues surrounding a functional implant. Peri-implantitis is an inflammatory process that is additionally characterised by the loss of peri-implant bone. The prevalence of peri-implant disease is significant according to the EAO systematic review where 1 in 5 patients are reported to suffer from peri-implantitis.
- Peri-implant disease may be asymptomatic for the patient until it reaches an advanced/severe stage and therefore, it is important that all hygiene therapists are aware of the condition and treatment modalities. According to the EFP, a diagnosis of peri-implant mucositis is made when there is bleeding on gentle probing (<0.25 N). Peri-implantitis is characterised by changes in the level of crestal bone in conjunction with bleeding on probing with or without concomitant deepening of peri-implant pockets; pus is also common (Lang & Berglundh 2011).
- For patients who may be considering implant treatment or for those who have had implants placed, it is important to be aware of the risk factors for peri-implant disease. There is strong evidence for poor oral hygiene, a history of periodontitis and cigarette smoking (Heitz-Mayfield 2008). You may pick these up during your history taking and it is important these risk factors are under control prior to providing implant treatment. Your role will involve, oral hygiene instruction, smoking cessation therapy as well as stabilisation of the periodontal condition and long term periodontal and peri-implant tissues maintenance.
- You must gently probe around all implants to check pocket depths and make a note of any bleeding/suppuration. You may use a metal/plastic probe. You need to watch out for a progressive increase in pocket depths and bleeding/suppuration and when noticed discuss with the dentist for the next treatment steps. Clinical probing does not harm the implant or its soft tissues (Ettner et al 2002). Also, check for mobility of the implant as this shows a lack of osseointegration and essentially implant failure (Salvi et al 2004). Be aware apparent mobility may also be because of the crown/screw loosening.
- A baseline radiograph and a baseline six-point pocket chart should have been taken at the time of prosthesis installation. If there are any changes in clinical parameters indicating disease then a further radiograph is indicated. It is important to remember that the radiograph will only show us mesial and distal bone levels and bone loss can take place anywhere around an implant. A peri-implant defect usually assumes the shape of a saucer but you can also see vertical/horizontal bone destruction.
- Disclose plaque regularly so you can provide tailored oral hygiene advice, which may be challenging around implants. It is important to show patients in their mouth and make the most of all the tools available. The tools will be the same as that used for your periodontitis patients. Remember prevention is the best treatment for peri-implant disease!
- For peri-implant mucositis, non-surgical periodontal therapy remains the primary treatment measure. However, the treatment of peri-implantitis is not always predictable and often requires surgery. It is important to refer any case you feel uncomfortable in treating as early as possible.
- Regular supportive periodontal therapy is critical for implant patients. Peri-implant infections occur in a significant percentage of patients who are not on a strict maintenance programme.
- Always maintain good communication with the dentist who placed the implant (if possible)/another dentist to highlight any concerns and ensure the patient is well looked after!
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