Читать книгу Peri-Implant Therapy for the Dental Hygienist - Susan S. Wingrove - Страница 25

  Oral‐systemic health link to overall health Cardiovascular/cerebrovascular (CV/CV) disease Preterm birth/low birth weight Diabetes Respiratory disease Medical history/risk assessment Bisphosphonates, BRONJ/BON, ARONJ, MRONJ Xerostomia

  Medical history/risk assessment forms

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The terms oral health and general health should not be interpreted as separate entities. Oral health is integral to general health; this report provides important reminders that oral health means more than healthy teeth and that you cannot be healthy without oral health.

—Surgeon General Report, 2001

Over the past 30 years, implantology and periodontal medicine (periodontal and peri‐implant disease) have changed the way we think about dentistry. Dental professionals have moved away from the examination for decayed or broken teeth to a comprehensive examination of the entire mouth and overall health of the patient. The traditional dentistry resolution for missing teeth was to fabricate a bridge, partial or full removable denture or do nothing. After 15 years of wearing a full denture, patients can suffer from gastrointestinal disorders from reduced ability to chew their food and this may lead to a shorter life expectancy (1). Partial denture wearers often experience the domino effect, losing the teeth that support the partial at a rate of 44% within 10 years (2). There are even romantic consequences for edentulous patients, as they can be reluctant to start new relationships. Some edentulous patients are categorized as oral invalids unable to wear their dentures without pain (3). Today, the optimal restorative options for replacing missing teeth are implants.

It is an exciting time to be in dentistry, with the increasing use of regeneration tissue/bone procedures, and implant dentistry. Implants rank second only to bleaching procedures as the most sought after treatment in dentistry. Hygienists play an important role, recommending, assessing, maintaining, and monitoring implants. Hygienists have 50–60 minutes with patients on a regular recare basis and hold the key to many of the relationships of our patients to the practice. Often, hygienists are asked; “What should I do to replace this tooth?” and “What are my options?”

Hygienists should learn all they can about regeneration and implant therapy. What these procedures can do to benefit the lives of the patient for aesthetics and overall health. Keep in mind that many implant candidates are dental failures, periodontal disease patients, or patients with poor oral health habits. Hygienists can educate patients on implant options that can improve their oral health and might change the patient’s life!

The best candidates for implants are your existing patients of record . You have patients with missing teeth, partials, dentures, and bridges that are failing. You already have a relationship and trust with these patients. If your office wants to do more implant dentistry a key source of prospective implant candidates are referrals from your existing satisfied implant patients. Do not be afraid to ask for referrals from your satisfied patients to encourage more like‐minded patients to learn about their options for implant dentistry.

Patient selection for implants is based on a number of factors including oral‐systemic health, medical history, risk assessment, and hygiene status. Patients who are immunosuppressed or taking anticoagulants, steroids, or IV bisphosphonates can be contraindicated for implant therapy or need to be evaluated on risk levels. Heavy smokers, poorly controlled diabetics, patients with previous poor bone‐healing history, and patients with multiple systemic health problems should also be evaluated carefully. Any diseases that can directly affect the ability of osteoblasts to lay bone or interfere with wound healing of bony tissue are contraindicated for placement of implants or the dentist needs to evaluate the options with the patient’s physician.

Uncontrolled diabetics and heavy smokers are at the top of the list of contraindicated patients due to the poor vascularization of the gingival tissues as well as higher risk for infection and slower healing time. However, a controlled diabetic is an ideal implant patient due to the added benefit of implant dentistry that the implants do not decay.

A smoker can also be a good candidate for implant therapy if he or she first attends a smoking cessation program and agrees to the risks associated with possible loss of the implant. Immunosuppressed patients, such as HIV‐positive patients, who want to improve digestion can be considered for implants, but would need to be controlled and monitored.

Age, osteoporosis, and periodontal bone loss may also be an obstacle that can be hurdled. Periodontal maintenance patients who are compliant with home‐care can be excellent candidates, but should be placed on 3‐month recare for implant maintenance. The same bacteria that caused the periodontal disease will still be present in their oral cavity. If a patient enquires about having an implant, review all the options and let the patient know that the doctor will determine if he or she is a candidate for implant therapy.

An edentulous patient at any age can benefit from implant dentistry; there is no cutoff age. As a general rule, it is recommended that growth be completed prior to implant placement for children younger than 16 years of age, but younger children can be considered for implants on an individual case‐by‐case basis.

The hygienist is the ideal person to assist the dentist in the selection process to determine the patient’s motivation, dexterity for home care necessary for the selected treatment and expectations of therapy outcome, as well as to identify patients with risk factors, habits, and conditions that place patients at a higher risk for implant failure. The hygienist can talk to the patients about their needs, expectations, and questions to share with the dentist. Due to the hourly schedule that most hygienist have, if a patient is interested in implant dentistry a separate appointment can be made with the dentist to have an implant consultation.

The patient’s aesthetic and functional expectations have a direct correlation to the number of implants necessary, type of restoration to be used, time to heal, and how much the final cost of treatment will be. All of these factor into patient selection and need to be discussed with the patient prior to treatment.

A complex or larger treatment case will require a separate treatment conference and possible models or other diagnostics prior to the conference. Schedule the conference with the doctor and/or implant coordinator to walk the patient through the treatment options, time involved, and fees associated with the case. The doctor may also need to collaborate with the patient’s physician prior to proceeding with implant therapy due to the systemic health factor.

Implant treatment planning is interdisciplinary and the hygienist needs to have an understanding of oral‐systemic health, medical history, and risk factors to assist with the necessary diagnostics and questions/answers for the dentist to complete the best treatment plan for the patient.