The dentist will see you now, and again, and again

Preferential treatment

Dental implants have become renowned as an increasingly reliable treatment solution for partially or fully edentulous patients. When placed successfully they are aesthetically brilliant, with functionality akin to the natural dentition, and can provide an improved quality of life compared to alternative prostheses, such as conventional dentures.[i] However, I won’t be the first to tell you that they need to be treated slightly differently from the natural dentition that they mimic so well.

A patient’s permanent teeth are anchored into place via a periodontal ligament, which also accommodates for natural protective defence mechanisms.[ii] The localised cells can produce pro-inflammatory cytokines when stimulated by bacterial endotoxins, creating a local immune response.[iii] In the natural dentition, this plays an essential role in the control of the periodontal pathophysiology.[iv]

When a dental implant comes into play, clinicians place it directly into the jaw bone and rely on osseointegration for the stability that the periodontal ligament would generally provide. However, in its absence, the implant is not as well protected.[v] Clinicians familiar with the construction of an implant will know its susceptibility to infection. Studies of peri-implant microflora reveal bacteria such as Staphylococcus aureus – which is not common around teeth – has an affinity for the titanium structure, and is associated with bleeding on probing and suppuration,[vi] and more importantly implant failure.[vii]

With regards to the physical build of an implant, two-piece implants unavoidably present a micro-gap between the implant and abutment, creating the potential for bacterial colonisation. This presents the chance for interference with peri-implant tissue health, leading to potential bone loss,[viii] which will of course risk treatment failure.

Defensive actions

Since the risks associated with a dental implant are different to that of a natural tooth, there must also be a change in approach to care, from both the patient and the clinician. Daily implant maintenance is of upmost importance, and can only be carried out by the individual themself. However, dental professionals must inform patients of the most viable routines that can set them up for success. In the day-to-day, this would require consistent toothbrushing, with a variety of manual, powered and sonic brushes proven effective.[ix] Stressing the importance of interdental cleaning is also crucial to shift the bacteria-heavy debris that can build up and threaten potential implant failure: conventional toothbrushes cannot access proximal surfaces in the same manner as an interdental brush.[x]

The impact of the clinician appears most notably in the all-important check-ups and dental hygienist appointments that patients should attend. The latter are best every six months, perhaps more often for those at a greater risk of oral health problems, but a regular yearly appointment to focus on the implant itself should also be encouraged.

A keen, clinical eye

An annual implant-focused visit could address issues in the greater dentition, but clinicians should prioritise this time to address the healing and patient-led maintenance of the restoration and, most importantly, identify and act on any signs of peri-implant complications. But just as the natural dentition and dental implants react differently to the oral microbiome, clinicians should react differently to each structure.

For example, periodontal indices are viewed by many as inappropriate indicators for treatment needs around dental implants, arguing it is no more effective than the visual inspection of mucosa redness.[xi] The risk of damaging fragile peri-implant scar tissue is another significant concern. Bleeding on probing and periodontal pocket depth measurements need to be associated with radiographic assessments of crestal bone loss for confident diagnosis and treatment plans – some would argue it is as effective, and safer, to avoid probing entirely and instead use visual cues, palpation and radiography as the basis for post-placement assessments.[xii]

To be able to effectively manage patients in their implant durability, dental professionals must, above all else, be appropriately trained and knowledgeable about these care provisions, from planning and placement to long-term assessments. Clinicians could choose to grow their skill-set, and provide exceptionally informed patient care, with the Postgraduate Diploma in Implant Dentistry from One To One Implant Education. The course covers the entirety of the treatment journey, transforming budding implantologists into confident clinicians. Delegates learn from dedicated tutors in a peer mentor system, for ease of communication and exceptional guidance throughout the process.

With the right knowledge in place, clinicians can achieve long-lasting restorations that receive brilliant upkeep. Implants must be thought of differently from the natural dentition, but by establishing regular patient visits, the dental team has the greatest opportunity to cease and prevent the common soft-tissue challenges that have long plagued survival rates.

To reserve your place or to find out more, please visit
https://121implanteducation.co.uk or call 020 7486 0000.

Dr Fazeela Bio

Author bio:

Dr Fazeela Khan-Osborne is the founding clinician of the FACE dental implant multi-disciplinary team for the One To One Dental Clinic based on Harley Street, London. She has always had a passion and special interest in implant dentistry, particularly in surgical and restorative full arch rehabilitation of the maxilla. She has been involved in developing treatment modalities for peri-implantitis within clinical practice.

Dr Khan-Osborne is also the Founding Course Lead for the One To One Education Programme, now in its 20^thyear. As a former Lead Tutor on the Diploma in Implant Dentistry course at the Royal College of Surgeons (England), she lectures worldwide on implant dentistry and is an active full member of the Association of Dental Implantology, the British Academy of Aesthetic Dentistry and the International Congress of Oral Implantologists.

[i] Bandiaky, O. N., Lokossou, D. L., Soueidan, A., Le Bars, P., Gueye, M., Mbodj, E. B., & Le Guéhennec, L. (2022). Implant‐supported removable partial dentures compared to conventional dentures: A systematic review and meta‐analysis of quality of life, patient satisfaction, and biomechanical complications. Clinical and Experimental Dental Research, 8(1), 294-312.

[ii] Gulati, M., Govila, V., Anand, V., & Anand, B. (2014). Implant maintenance: a clinical update. International scholarly research notices, 2014.

[iii] Nilsson, B. O. (2021). Mechanisms involved in regulation of periodontal ligament cell production of pro‐inflammatory cytokines: Implications in periodontitis. Journal of periodontal research, 56(2), 249-255.

[iv] Jäger, A., Setiawan, M., Beins, E., Schmidt-Wolf, I., & Konermann, A. (2020). Analogous modulation of inflammatory responses by the endocannabinoid system in periodontal ligament cells and microglia. Head & Face Medicine, 16, 1-12.

[v] Gulati, M., Govila, V., Anand, V., & Anand, B. (2014). Implant maintenance: a clinical update. International scholarly research notices, 2014.

[vi] Dhir, S. (2013). Biofilm and dental implant: The microbial link. Journal of Indian Society of Periodontology, 17(1), 5-11.

[vii] Giannelli, M., Landini, G., Materassi, F., Chellini, F., Antonelli, A., Tani, A., … & Bani, D. (2016). The effects of diode laser on Staphylococcus aureus biofilm and Escherichia coli lipopolysaccharide adherent to titanium oxide surface of dental implants. An in vitro study. Lasers in medical science, 31, 1613-1619.

[viii] Lauritano, D., Moreo, G., Lucchese, A., Viganoni, C., Limongelli, L., & Carinci, F. (2020). The impact of implant–abutment connection on clinical outcomes and microbial colonization: A narrative review. Materials, 13(5), 1131.

[ix] Cortellini, S., Favril, C., De Nutte, M., Teughels, W., & Quirynen, M. (2019). Patient compliance as a risk factor for the outcome of implant treatment. Periodontology 2000, 81(1), 209-225.

[x] Luz, M., Klingbeil, M. F. G., Henriques, P. S. G., & Lewgoy, H. R. (2016). Comparison between interdental brush and dental floss controlling interproximal biofilm in teeth and implants. Dent. Health Curr. Res, 2.

[xi] Coli, P., & Sennerby, L. (2019). Is peri-implant probing causing over-diagnosis and over-treatment of dental implants?. Journal of clinical medicine, 8(8), 1123.

[xii] Coli, P., & Sennerby, L. (2019). Is peri-implant probing causing over-diagnosis and over-treatment of dental implants?. Journal of clinical medicine, 8(8), 1123.