Just a few years ago it was relatively unusual for a patient to arrive in your surgery with implants in situ and restorations/appliances supported upon them, but it is already becoming much more commonplace.
You may not work in a practice where implants are placed or restored, but that does not mean that you don’t need to be just as familiar with the clinical issues relating to them, as you are with natural teeth and restorations provided for them.
Indemnifiers are seeing more ‘late failure’ litigation cases, cases involving peri-implantitis, these can include clinicians who have examined or treated the patient, even when they had no part in the original treatment, and there is a growing consensus that these cases will increase, along with the risks to clinicians.
So how can we reduce the threat of litigation from cases arising from peri-implantitis? By having robust monitoring and maintenance protocols in practice.
Detailed records need to be kept to demonstrate the meticulous monitoring of the status of the implants (both hard and soft tissues) in the months and years following their placement and monitoring should include:
- 6 point probing depth measurements around implant/s
- BPE/6PPC as deemed clinically necessary for the rest of the mouth, however implant probing depth measurements are NOT included in BPE scoring
- Recording of the presence any of bleeding on probing
- Plaque accumulation with scoring when possible
- Any suppuration/exudate
- Any other signs and symptoms i.e. pain hyperplasia
- Any mobility
- Patients’ oral hygiene status
Dental Hygienists and Therapists in particular can play a key role as‘first responders’ in recognising potential complicationsand then referring patients on for appropriate treatment when necessary.
Professional plaque control measures including oral hygiene reinforcement and subgingival/mucosal instrumentation should be performed as indicated every 3-6 months with instruments specially modified for titanium surfaces, and patients made fully aware of their individual risk factors and the need for scrupulous oral hygiene measures.
A 3-4 month hygiene recall for first year is recommended, then the interval needs to be individually determined, but for patients with perio disease experience, ideally the recall should be 3 monthly long term.
Implant dentistry continues to be a dynamic and evolving field. Ensure that you keep your knowledge and skills up to date and be prepared to adjust your approach when necessary.
Author Donna Schembri
Posted by Gemma