Implant Assessment: Fear Not, Your Guide Is Here!

You're listening to the Phil Klein Dental Podcast Assessing dental implant health is different than assessing the health of a natural tooth. So when it comes to implants and the surrounding tissue and bone, what do we look for and how do we proceed with our hygiene treatment and our recommendations to the patient regarding a feasible home care strategy? To tell us more about it is our guest, Michelle Strange, a registered dental hygienist with a master's in dental hygiene education. She brings over 20 years of experience to her numerous roles in dentistry. You can get more information at levelupip.com. Michelle will be joining us in a moment, but first, if you're looking to make teeth whitening a successful part of your practice, then you need a system that not only dramatically whitens teeth fast, but also ensures little to no sensitivity. Philips Zoom Whitespeed does both. Whitespeed's light-accelerated technology speeds up the whitening process, clinically proven to whiten up to eight shades in one visit. And what's really impressive is that 99% of patients surveyed experienced little to no sensitivity with Philips Zoom. Philips offers two professional whitening solutions, in-office whitening using Philips Zoom Whitespeed, and take-home whitening, with a range of whitening gels for either daytime or nighttime use with custom trays. For a comprehensive, tried-and-true, state-of-the-art whitening solution for your practice, check out Philips Zoom Whitespeed. To learn more, visit philipsoralhealthcare.com. Michelle, it's a pleasure to have you on the show. Thank you. I appreciate being here. So with three and a half million implants placed annually, and that's in the US alone, if you do the math, in a period of a decade... and hygienists are looking at 30 to 50 million implants in our patients' mouths. So it's certainly pretty clear how important it is, especially for the hygienist, to really understand how to assess the health of an implant. So that takes me to my first question, Michelle. How should we examine the patient in our assessment of dental implant health? Yeah, so you're so correct. And I do truly believe that hygienists and also assistants, I think the auxiliary team, are just so vital to the long-term success of these dental implants. Because when you think about the percentage of time that an implant spends in its life, a small percentage is the surgical. placement and the restorative phase, the rest of it hopefully is all maintenance and never the surgery side of it. So I do think that we should all be very well versed in how to assess a dental implant. I think first and foremost, that research does support the importance of probing those dental implants, but I think it's more important to understand the baseline numbers. So like, what is that probing depth telling us the moment it was placed with that superstructure on top? it. And sometimes that is a four millimeter pocket. So if I assess and I get a four millimeter, I'm not going to run screaming from the room that, you know, it has peri-implantitis because that is its baseline. But also I think understanding that probing is only a part of the big picture, you know, it's only a piece of that puzzle that probing in addition to visual assessment, checking, is it red? Is it inflamed? Is it irritated? Taking those radiographs on a regular basis, depending. on that patient's level of health and previous history of disease and just palpating actually like putting your fingers on either side of that alveolar ridge and kind of starting at what would be the apathy of that implant and working your way down has actually showed me more exudate and inflammation, mostly exudate, more than probing. So I think that is a very important part of the assessment phase that not a lot of people actually perform. So Michelle, tell us what the goals are in your mind of proper implant assessment. So, like I said, all of those things are part of the puzzle that will tell us the big picture. And that is, is it healthy? Is there a mucositis? Is there peri-implantitis? That helps us to understand how are we going to approach this patient, not only in how we are going to treat them in our office with, is it, I don't know, debridement? Is there cement? Is there calculus, something like that happening? Or is it just poor biofilm management at home? Because when I'm doing that visual assessment, that is a part of that whole assessment phase. I am looking for home care as well. Is there a lot of biofilm? Is there debris? Is there open contacts that are catching food and stuff like that? So my goal is to define it properly. Is this health? Is this mucositis? Is this health on a reduced periodontium? Or is this... And all of those will help guide me to what I need to do. And maybe that's in the office or maybe that's referring out. And then how do I guide my patient at home with their products and therapeutics? Yeah. And also when you assess this entire environment, is it important for the hygienist to say, hey, we're looking at something that's happening on the implant, but the rest of the teeth look pretty healthy. So this seems to be an isolated situation with perhaps mucoside. related to a particular implant. Is that something that's seen and should be noted for the dentist to understand that and be aware of that versus generalized periodontitis in the entire dentition, including the implant? For sure. I mean, I think calling it what it is, making sure you document properly, and then you have that conversation with the patient and in the handoff from, you know, me and the doctor sitting down and having that, you know. assessing like this is what i am seeing let me you know let me know your thoughts whatever that conversation looks like when you do that handoff to the doctor because i do tell patients a lot of times these are very sophisticated medical devices implanted in your jaw i i don't let I don't let inflammation sit too long. You know, like at the moment I see any early signs of that redness and increase in probing that's bleeding on probing, especially I get after it pretty quickly. And usually the doctors that I've worked with in the past have been very on board with that as well. Yeah. So it's obviously very important for the hygienist to do a good assessment and then get this information over to the dentist on the handoff. That leads me to the next question. Once the assessment is complete, what's next? So for me, when I do the assessment and I, I don't know, determine if it's health, let's say, let's call it health. How do I choose the instruments that I'm going to then use or the tools I have or will use on this patient. And, you know, if you're temping, that sometimes is what is available to you. But for me on a healthy patient with very little biofilm, definitely no hard deposits. I very rarely pick up a titanium scaler. I just do biofilm management. Most of the time that's with my airflow and erythritol powder machine that I have. or it's a pumice with a super, super fine paste. Now, if it is early mucositis, you know, then you can get a little more, I don't know, involved in that assessment of like, is it calculus? Is it some kind of foreign debris, you know, seeds or cement potentially? And then I will pick up scalars depending on what I find. I have a hard time saying pick up a scaler and put it to every single implant without ever doing that proper assessment. And then determining, is there even something I need to go after on this implant? I just kind of like to properly assess and do biofilm management. And if I can't do a proper assessment, then I can't decide the tools that I will pick up. We'll be returning to Michelle in a moment, but first, when it comes to fighting dental disease, we all understand the importance of an effective prevention strategy. This includes patient home care compliance, regular hygiene visits, and using the best prevention products available. That's why so many dental practices rely on VOCO's award-winning preventive care product line. Recommended by top dental clinicians, Remin Pro, Proflorid Varnish, Admira Protect, and Grandiose Seal are tried and true products. are effective, easy to apply, and result in successful clinical outcomes with high patient satisfaction. Whether it's for fluoride treatment to seal pits and fissures or to treat hypersensitive teeth, VOCO's premium preventive care products help you win the battle against tooth decay and sensitivity. So when you're thinking prevention, think VOCO. Request your free sample today at vocoamerica.com. And how does using digital radiography fit into your assessment? So if you follow the literature, it says about within the first year of placement, taking a PA or a bite wing every six months and then about every year, depending on the patient's level of health. And I personally like to discuss this with the doctor and the team that. I like to see a PA on the implant every year. And that's just from my history of being in perio for 13 years in a very heavy implant office. We just found some very interesting things when we would do, you know, a yearly PA. Now, if this was a healthy single implant, literally in a...-something, 30-something-year-old has never shown a sign of inflammation, redness. It is just, you know, doing its thing in there with no problems. I would probably maybe lean a little bit more following those ADA guidelines and say maybe once. every 18 months to two years. But I definitely encourage everybody, well, anytime I give my courses, I tell, you know, I'm giving you literature, I'm giving you my experience, but I do think you should take that back as a team and discuss what are the proper protocols for your practice. So during your interaction with the patient, how much patient education takes place? I mean, for instance, the patient might say to you, Michelle, it's an implant. In actuality, the tooth isn't even real. So why am I having any health problems with it? Why should I be so worried about this tooth? It's artificial. Absolutely. So I think education, if you have the ability to do this, of course, starts before that implant is ever placed. I think we have to have these important conversations about the patient's level of responsibility. If they have any ambivalence towards this, are they just kind of like, I don't do what I, you know, I don't even like coming to see you every six months now. I'm not going to come in any more frequently than that. I like to have real honest conversations with my patients so that they understand their level of accountability and this. When it is an issue with biofilm management, and I am starting to see those early signs of mucositis. You know, I try to give my patients some grace because life happens. In-laws come in towns. You know, kids happen. Holidays happen. You know, so I really kind of explain to them that I know they can get it healthy. They've done it once. They used to do such a great job. It's just more of encouraging them. I see a problem. You know what to do. Let me know if I can help aid you in that. If it is somebody that is finally going to get on board with this, they're like, yep, you're right. too much money i'm willing to do it then it's more i take actually um about 30 minutes i charge out for this. I call it an OHI appointment and I have a plethora of items that I will work with the patient to decide like what is actually going to fit that implant and its superstructure and its anatomy and what is going to fit in that patient's hands as far as their dexterity and their level of skill, but also their socioeconomic status and their lifestyle. Like could they use an oral irrigator? But you know, I travel a ton. I'm probably not traveling with my portable. oral irrigator. So like, what are the other options for this patient? So I'm always trying to ask open-ended questions with them. And I really kind of set aside that time so that we can elevate the importance of that education and the tools that we are going to choose together for the lifelong success of that implant. Yeah. And I was going to ask you about home care. Is there any specific formulary that you have in your mind when you... to a patient where they kind of get the same story about how to take care of that implant, or as you're suggesting now, you kind of tailor it to the patient's lifestyle. So can you tell us about how you specifically make these recommendations to each patient individually regarding home care? Yeah, and that definitely is a complicated answer for me, at least, because I feel... It depends on the implant and the superstructure. Are we talking a single unit, a bridge support, you know, splinted implant structure, hybrids, you know, all on X's, over dentures? I have a handful of tools that I'll kind of break out for each one of those situations. But what I really try to do is always find a way to integrate what they're already using. and make sure it works around that new implant and superstructure. Because we're all humans. The likelihood of us picking up new things and creating that new skill and working to get those new neural pathways to create that fine motor skill. You know, it's a little difficult. So I always first start with what are they using at home? Could we adapt that for this new prosthetic in their mouth? Your main goal, obviously, is compliance. And by working with something they're already comfortable with, the odds that you're going to get a high compliant patient is much greater than completely changing their behavior abruptly. So as we wrap up this podcast, it's been very interesting. What is one of your findings that not many people really think about during the assessment of a dental implant? Oh, that's so good. And the one that always comes to mind is lack of attached tissue. So that's not the killer of implants. It's not a risk factor per se. However, I have found in the last 15 years of working with implants and imperio and stuff like that, that people tend to baby. those implants with less attached tissue. It's just a little bit more sensitive. I'm somebody that's had a tissue graft on, you know, 24, 25 and didn't realize how much I babied it before that graft. And so I would say when you're looking at somebody and you're doing that visual assessment, look and see how much attached tissue is there. And if you see also a level of biofilm or debris, I would kind of coach them through that and confirm that when you touch it with. the toothbrush or the items, that it's not too sensitive and that's how they should be feeling it. I just find that most people with that either thin biotype or lack of attached tissue, baby it. They just do. Michelle, another excellent podcast. Thank you so much for your insight. We look forward to having you on future podcasts soon. I know we have some scheduled. Until then, have a great evening. Thank you for having me. If you're enjoying our podcast, please leave a review or follow us on your favorite podcast platform. it's a great way to support our program and spread the word to others thanks so much for listening see you in the next episode