Reports on the ADI Team Congress 2011
Thursday 14 - Friday 15 April
Manchester Central Convention Complex
Petersfield, Manchester M2 3GX

The role of the dental hygienist in implant treatment
Speaker: Anita Daniels

Reported by Nicola McPherson

Anita Daniels' lecture entitled "The role of the dental hygienist in implant treatment" gave a very interesting and informative insight into the essential role that a hygienist can play in dental implant care.  She covered everything from the aetiology of dental disease and suitable patients for implant therapy, to maintenance care for the implant patient from the hygienist's perspective.

It is interesting to know that 65% of all disease in the body is a result of an imbalance in the biofilm.  This is significant in the case of the implant patient, as studies demonstrate that periodontal bacteria can seed in implant sites, risking bone and tissue damage.

There are two forms in which dental disease can present associated with the implant patient.  Peri-implant mucositis, like gingivitis in the natural dentition, is reversible through periodontal therapy and good home care.  Peri-implantitis on the other hand, is more like periodontitis, as it involves bone and / or attachment loss around the implant site.

We learned that the earlier types of implant had a "hydroxyapatite" coating which was prone to breaking down and leaving a roughened surface on the implant.  This may give rise to the above-mentioned conditions due to inability to keep the area clean.

It is of the utmost importance in the implant patient to see the hygienist regularly, as with an implant, there is no periodontal ligament there to act as a shock absorber.  This means that bone loss can occur due to traumatic occlusion.  Furthermore, peri-implantitis occurs commonly with poor oral hygiene and lack of maintenance visits - hence the importance of hygienist treatment.

The role of the hygienist during the maintenance phase of treatment is to monitor the health of the tissues and identify any potential for peri-implant mucositis and peri-implantitis.  We do this by superficially scaling and probing, usually with plastic instruments and selectively polishing with a non-abrasive paste.  The patient's oral hygiene status is reviewed at each appointment.  Radiographs are a good indicator of bone loss, more so than probing which is controversial due to the risk of damaging any attachment that may be present.

Recall maintenance (or "recare", as described by Anita) appointments are tailored to the needs of each individual and at these visits, appropriate oral hygiene advice can be given and an assessment made as to what recall interval is best for the patient.