The role of the dental hygienist begins at the initial consultation
Dental implant treatment is a collaborative effort between all members of the dental team. Dental hygienists, in their roles as oral health educators and clinicians, participate in implant therapy from the initial treatment planning stage, all the way through ongoing maintenance. The hygienist is in a unique position to initiate discussions regarding treatment options for missing teeth during the initial oral and periodontal health evaluation or at a continuing care appointment. The dental hygienist, who is educated in the surgical as well as restorative processes, is a valuable resource to patients considering implants and plays a key role in building the implant practice.
Continuing education is the key
Whether you are a new graduate or an experienced hygienist, a continuing education course on implant therapy is an excellent way to become familiar with all of the treatment options available for the replacement of missing teeth. Attending an implant course designed for dentists is an excellent way to learn more about the latest surgical and restorative techniques that are available. It is also an excellent way to appreciate the complexities of the treatment, in order to address patients’ concerns regarding the procedures and the associated costs. The International Congress of Oral Implantologists welcomes dental hygienists to attend their symposia and have an association specifically for dental implant auxiliaries (ADIA) as part of their organization. Go to www.icoi.org for information on their upcoming symposium and ADIA membership.
Implant Maintenance Procedures
Maintenance of optimal oral health and prevention of peri-implant disease is the goal of continuing dental hygiene care appointments for patients with implants. Maintenance appointments should begin at the time of the initial assessments before beginning the surgical process. Implant patients should not only understand the importance of good oral health as it relates to systemic health but also the importance of good oral hygiene and regular continuing care as they relate to the success or failure of the implant supported restorations. It is often easy to lose sight of the importance of ongoing dental hygiene care while the patient is involved in the surgical phases of implant therapy. A coordinated approach involving the surgeon placing the implants, the restorative dentist and the dental hygienist is key in ensuring optimal patient care and a successful treatment outcome.
Dental Hygiene Assessments
After the implant or implants have integrated into the bone and the restorations have been placed, the soft tissues should be evaluated for the following:
- Quality of the peri-implant tissue – healthy versus inflamed
- Presence of plaque and calculus
- Radiographic appearance of implant
- Presence of suppuration in the peri-implant tissue
- Presence of salivary percolation
- Mobility of the implant or prosthesis
Patient comfort and function is also an important factor to consider. Patients are the best judges of how their implant supported teeth feel and can often be the first to notice any subtle changes indicating a potential problem with either the implant or the restoration.
The continuing care schedule should be made in consultation with the dentist and be based on the complexity of the implant restoration, the overall periodontal condition and the patient’s self care abilities. Reversible mucositis is the precursor to peri-implantitis, the implant equivalent of periodontitis. Peri-implant infections can progress more rapidly than in a natural dentition leading to the recommendation that a three-month continuing care interval be initiated in the first year following implant placement. Radiographs should be taken according to the schedule determined in consultation with the treating dentist. Many clinicians may request more frequent radiographs in the first year. It is important that the x-ray technique used be replicable in order to accurately compare the bone height around the implant.
In the absence of bleeding and inflammation, the benefits of periodontal probing are questionable. Radiographs are often a more predictable indicator of implant health.
Instrumentation Techniques
Implants are becoming very common in the general dental practice. While many clinicians may only associate implant therapy with full-mouth reconstruction or as a means to support a removable denture, many patients are now choosing implants for single tooth replacement options rather than a fixed bridge. Whether the hygienist is maintaining a lingual bar for a mandibular denture or an implant abutment for a single crown, the following points should be kept in mind:
- Calculus formation on implant surfaces is less tenacious than on natural teeth.
- Metal instruments have been shown to scratch titanium implant surfaces.
- Plastic, graphite and gold tipped instruments are appropriate for implants.
- Plastic probes are available for probing peri-implant tissue when necessary.
- Rubber tips and plastic interdental brushes may also be effective for deplaquing implant surfaces.
- Specially designed, plastic coated ultrasonic scaler tips, may be safely used on dental implants.
- Implant dental floss is often effective for deplaquing implant abutments, especially on single unit restorations.
- Low abrasive polishing pastes and cleaning agents can be used safely when polishing is indicated for stain removal.
Actual instrumentation techniques around implant-supported restorations will vary greatly depending upon the restoration. By using the principles outlined above, the clinician has a variety of instruments and devices to effectively deplaque and maintain dental implants.