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Developing a patient implant preservation protocol

Feb. 1, 2010
Welcome back! This month's tip involves research into the advanced technology in the use of power toothbrushes to provide our patients with better plaque removal and better gingival stimulation.

For more on this topic, go to and search using the following key words: prosthodontics, implant prosthetics, gingival health, Dr. Joe Massad.

Welcome back! This month's tip involves research into the advanced technology in the use of power toothbrushes to provide our patients with better plaque removal and better gingival stimulation. Research has shown that the new highly technical power toothbrushes can be used by our patients in various prosthetic conditions to improve gingival health, which is needed to assure long–term retention of these prostheses. All of these brushes have many brushing modes that allow the customization recommended by the dentists and hygienists to best fit any patient's dental condition.

Let's today focus on the era of implant prosthetics and the challenges our patients confront daily to maintain the impeccable hygiene we are demanding of them, especially after investing thousands of dollars to have implant prosthesis fabricated. It has been reported in the Journal of Clinical Periodontology that the long–term prevalence of peri–implant mucositis is as high as 76.6% for our implant patients. And, unfortunately left untreated on a regular basis will increase the incidence of peri–implantitis creating an atmosphere for eventual implant failure. This is serious information for all of us who place and restore implants.

Click here to enlarge image

There are many clinical studies that demonstrate the safety, gentleness and effectiveness of these brushes. Dentists, hygienists and patients can be assured by this research that these power brushes will optimize brushing performance. This convinced me to develop a patient implant prosthetic protocol taking into consideration the various types and configurations using the various head designs and brushing modes to negotiate around metal bars, various stud shapes, the fixed single or implant bridge, and the retentive receptacles associated with each.

We must set into place a protocol for all of our implant patients that will result in their successfully maintaining the healthy gingival tissue necessary for long–term retention of implants and implant prosthesis. These protocols must be easily understood by everyone concerned including all members of the practice team and our patients. The practice team must all be aware of the danger signs of implant failure and gingival inflammation and be able to help the patient understand these signs.

The first step is to get everyone on the dental team on board with the protocols. This means the business assistants, the hygienists, and the dental assistants must all buy in to the treatment of gingival tissues that you are recommending. It is imperative that the business assistant receiving the incoming calls be able to understand the patient complaints and realize the need for them to be seen on a timely basis. The dental assistant must be trained to recognize subtle changes in tissue health that may be disguising underlying implant problems. The dentist and the hygienist must be trained to help the patient with their home care so that tissue health is maintained.

Remember that our dental patients tend to be noncompliant. Since we have based our protocols on the use of a power toothbrush. It is important that the patient get one. Often when they are given a prescription or asked to buy a particular brand, they don't! I feel that it is imperative that we have the power brushes on hand in our offices. I know that many dental practices do not want to get involved in selling dental consumer products for many different reasons. Now you have a choice — either sell them or give them away (after having included it in the fee).

It is very impressive to unpack a fully charged power brush and hand it to your patient as you or your team members begin to teach them how to use the brush. I personally think it is better to give it to them because they are impressed by the gift and by the importance you place on the use of the brush. We have found that patients are much more likely to use the brush. When the patient returns for recall we ask them to bring their brush along so we can help them in any problem areas. Philips Sonicare FlexCare+® and Oral–B Professional Care SmartSeries 5000 are great suggestions for your patients.

See you next month. I hope my pleasure in dentistry will also be yours ... Joe Massad

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