Date Added: 17/08/2008
Viewed: 2776 times
You have a new patient in your surgery, you have a look at the charting and see that they have some implants present. You have not treated a patient with implants before, how will you procede?
Assuming all other factors are normal and that they are there for your care and professional advice:
1. Ensure that you have all radiographs of the implant sites to hand, obtaining copies from the previous dentist or oral surgeon so that you have a baseline to work from.
2. Only use a plastic probe (I prefer the PDT Sensor Probe) and carry out a thorough probing in the peri-implant pocket. You will generally find this to be around 3mm, making sure that excess pressure is not used as there is no periodontal ligament. As with natural teeth there should be no bleeding.
3. Should you find any calculus or plaque on the implant do not be tempted to reach for your ultrasonic or your H6/7. The normal metal instruments have no place in implant care. You must use plastic/carbon/Gold instrument specifically designed for implants. The material the instrument is made from has to be softer than the titanium so as not to scratch it and increase the plaque retention. Sometimes i will just use an interspace brush and the deposits will come off.
4. Once deposits have been removed the surfaces should then be polished, again normal prophy pastes cannot be used, 3i have a polishing paste for implants or use normal toothpaste lots of water and a rubber cup taking care not to heat the implant. The idea is to return it to its high lustre.
5. any areas of bleeding may be treated by irrigating the pocket with corsodyl gel, here i will use a syringe with a plastic canula (ultradent have some UP341) so as not to scratch the surface of the implant
6. Now show the patient where the areas of inflammation are and show them how to clean each of the areas, they can use corsodyl on a cotton bud to help in the areas of inflammation. A regimen of zero tolerance to plaque should be instilled in the care of the implants.
7. Radiographs should be taken initially on a 6 monthly basis and once all is stable, annually.
8. Any changes to the soft tissues or bone levels should be noted, if the pocket depth has increased taking into account any superficial swelling, the patient should be referred back to the dentist who may then refer on to the implantologist. In many cases, if caught early enough, disaster may be avoided.