March 07, 2007
I think it is important to know the signs of healthy, successful implants, and to stress the importance of frequent examinations to the patient. Knowing that pain, discomfort, mobility, bleeding upon probing, increased probing depths, bone loss, or peri-implantitis (inflammation of tissue around implant) are all warning signs that an implant may not be successful. If patients understand the importance of frequent visits and excellent home self-care they will have a higher success rate for their implants.
March 06, 2007
IMPLANTS! YAY! :)
Implants... the new edge of dental technology, although they have been around for over 20 years. Once the patient decides to have implants placed there are some things as a dental hygienist, we should be aware of. The most important thing is to never use metal instruments on an implant, always use plastic. This is to ensure the implant would not be damange during cleaning. Secondly, we should be aware, when taking radiographs, be conscience of the bone levels around the implant to ensure the implant is secure in the mouth, and it is not loose.
Recieving an implant can be very involved procedure, that does not end after placement. Its important for the patient to understand the proper care that is needed to keep he implant in good condition and the surrounding tissue and teeth healthy.
One precaution the patient should take is to keep the area free from biofilm. Biofilm from surrounding teeth can enter the implants perio pocket and cause the same damage as a pocket of a natual tooth. A soft, rounded powerbrush would be very effective.
A precaution that should be taken by the dental hygienist involves flouride. Titanium implants can be corroded by acid flouride treatments. If a patient has implants, you should use low-concentration neutral sodium fluoride.
Ch. 30- The Patient with Oral Rehabilitation and Implants
Characteristics of the Rehabilitated Mouth- A patient that has had extensive periodontal therapy and restorative rehabilitation may have many periodontal findings which include gingival recession, exposed root surfaces, and exposed furcation areas.
Dietary Assessment- When a patient has undergone rehabilitation or has had implants it is necessary to counsel them about their diet. They must be careful to make sure that they prevent carious lesions of the exposed root surface around the restorations. They must take care of their newly rehabilitee mouth so that no further rehabilitating treatment will be necessary.
March 05, 2007
Maintenance Plan for the Rehabilitated Patient
A conscientious rehabilitated patient devotes up to an hour each day on personal care procedures. For this reason, a maintenance appointment that thoroughly evaluates the gingival tissue, the rehabilitation prostheses, and the completeness of biofilm control efforts is required and deserved.
Even the slightest amount of gingival bleeding on probing is a warning sign that an area may not be covered by present self-care procedures and needs some form of treatment. Each millimeter of gingival sulcus must be probed carefully to detect incipient changes.
Three general categories of implants...
I think it is important for us all to be able to differentiate the 3 main types of implants and a few characteristics/examples of each. Here is what I came up with:
ENDOSSEOUS/ENDOSTEAL-*most widely used*
-the implant is placed within the bone
-ex. blade, screw and cylinder types
-3 basic types of biomaterials used are metals and alloys, ceramics and carbon, and polymers
-the implant is placed over the bone, under the periosteum
-ex. a custom-fabricated framework of metal rests over the bone of the mandible or maxilla (it may be the complete arch or unilateral)
-cobalt-chromium-molybdenum (Vitallium) or titanium are used
-the implant is placed through the bone
-ex. the mandibular staple bone plate
-stainless steel, ceramic-coated materials, and titanium alloy are used
Self-care for the rehabilitated mouth
Planning the disease control program
Part One: Get basic biofilm control measures down before the surgical, restorative, and prosthodontic treatment.
Part Two: During therapy adaptations are needed for applying techniques to temporary restorations. After a while regular appointments with the dental hygienst are needed for careful monitoring of the patient's gingiva.
Part Three: When therapy is over with, new self-care procedures are needed, special devices and techniques are selected and tried until it fits the patients exact needs.
Preparation and Placement
I thought that one of the prequisites for patient selection was interesting and worth mentioning. Besides the careful screening of medical history in the beginning, the patient needs to be fully aware of the post treatment and have a sense of "desire" to go through it. To accomplish this, in some cases, a psychological examination may be requested.
Implant Biofilm and Implant Maintenance Appointment
I found it interesting to read that the biofilm microorganisms around implants are similar to those that inhabit oral tissues surrounding natural teeth. If the permucosal tisuue around the implant is healthy, the predominating bacteria will be gram-positive, nonmotile, cocci. Also, the tissues around an implant will react the same to the harmful effects caused by oral microorganisms. As with natural teeth, spirochete and motile rods increase with increased inflammation of tissues and increased pocket depths.
As it is essential to maintain our natural teeth, implants require special maintenance during hygiene appointments as well.
A. Health History Review; Vital Signs; Intraoral/Extraoral Exam- Review questions and observations are required as with all other appointments.
B. Selective Radiographs- Radiographs are required so that bone levels can be compared. The analysis of radiographs will help to indicate the stability of the implant.
C. Periodontal Assessment- Visually examine tissues surrounding implant;there should be no signs of inflammation. Use a plastic probe to check bleeding tendancy. Determine mobility of implant. Use a disclosing agent to detect the degree of dental biofilm adherence.
D. Review Personal Dental Biofilm Control Procedures- As with all prophy appointments, patient education is important. Have patient demonstrate his/her methods and offer advice for improvement as needed, and demonstrate proper techniques.
E. Instrumentation- Use plastic instruments for calculus removal. Selective stain removal is indicated using a rubber cup and a non-abrasive agent. Airpowder polishers can also be used on a light, sweeping, low-pressure application.
March 04, 2007
Accomplishment of Treatment
Before reading Chapter 30, I had little knowledge of oral rehabilitation and dental implants in general. I thought it was simple and quick, but much to my surprise it is a very lengthy preocedure and it requires a "team effort". Oral rehabilitation requires patience, persistence, and dedication of the patient, the dentist, and the dental hygienist. Some implications for the dental hygientist are to motivate the patient through the process, motivate the patient on biofilm removal, motivate the patient on the use of a fluoride dentifrice, and a fluoride rinse, and observe any changes to the habilitated areas.
For prevention of root cavities, the patient should use fluoride dentifrice, along daily with a fluoride rinse or fluoride brush-on gel. Patients with multiple sensitive teeth should use a cutom-tray application.
Factors To Teach The Patient
I think it is important for us to be able to make sure that our patients understand the responsibility and importance of care of their implants. We must make an effort at each appointment to teach these factors to our patients to assure their periodontium and surrounding tissues remain healthy. Five important factors to focus on are:
1. Importance of daily care
2. Need for concentration
3. Time requirement
4. Diligence and thoroughness
5. Importance of maintenance
I think that if these points are well understood by our patients, we can ensure continuing health of the periodontal tissues and we can trust that both the patient and we, as hygienists, are working together towards health. :)
The periodontal findings of a rehabilitated mouth may include: Gingival recession, exposed root surfaces, exposed furcation areas, alterations of gingival contour (the gingival margins may be rolled and rounded), changes in size and shape of gingival embrasures. We need to know what these are and how to maintain a low biofilm in a mouth that may have these conditions to help our patients.
Patients that have porcelain and composite restorations cannot use acidulated fluoride. This is because after repeated exposures the restorations may become pitted and rough due to the acidic pH. A neutral fluoride may be used instead.
February 27, 2007
After an implant is placed a patient should visit the dentist weekly to ensure a normal healing process. When healing is completed maintenance appointments are scheduled every 1-2 months. To me this is surprising because a stable patient usually visits the dentist every 6 months.
Something I did not know is that it is very important to use plastic instruments on an implant to remove calculus because you do not want to scratch an implant with a metal instrument. A clinician should not routinely remove stain on an implant. If a rubber cup is used to remove stain then a nonabrasive agent should be used on the implant. Also, when using an ultrasonic scaler you can cause severe abrasion on the implant. It is important to pay attention to the type of implant a patient has and to follow all the necessary precautions so it is not damaged.
Accomplishment of Treatment
For a patient who undergoes complete oral rehabilitation it may take long. It requires patience and dedication from not only the patient but the dental hygienist and dentist as well. Maintenance and supervision of the patient’s self care program are essential. We must take into consideration the specific measures for self care such as, dental biofilm removal and dental caries prevention. The dental hygienist shows the patients how to self evaluate themselves, so they can recognize the minor deviations from normal, then notify the clinician.
February 26, 2007
Chapter 30 Rehabilitation/Implants- Dietary Assessment
This section makes some good points about how it is important to prevent caries and the plan to do so. When a patient has a rehabilitated mouth you have to make sure that proper care is happening. One thing they mention is to make a plan of action for your patient from a nutritional standpoint. It is important to remember that no fixed procedure applies to every patient and that a personalized sequence must be worked out, often by trial and error. You also when presenting this plan to a patient want to avoid presenting too many procedures in one lesson. This can cause confusion and may inface discourage the patient when all you are trying to do is help. These are especially important tips for us because we are always educating and we want to do it the right way and to make it effective.
February 24, 2007
Maintenance Basic Criteria for Implant Success
The topic is direct and to the point. The long term success of an implant is assessed by routine exams frequently post surgury. The signs of healthy implants you should be looking for are: no pain/dicomfort, no signs of peri-implantitis, no bone loss in radiograph, and no increased BOP or probing depths.