The entire dental team invests time and energy into the pre-, peri-, and immediate postoperative treatment planning for an implant surgery and prosthesis. Agreeably, these steps are necessary and must be performed with great care. All of us focus on these early steps, but I would like to take this opportunity to re-enforce the need for long-term postprosthesis care.
Patients have made a substantial investment in their dental implant therapy. To maintain this investment, the Dentist and staff must motivate and educate patients on the importance of proper daily oral hygiene and consistent recall examinations with proper prophylaxis by the hygienist. If the seed for proper implant-maintenance is planted, then good oral hygiene habits will follow. The problem is when everything is going well, patients (and the dental team) can “slack off” and take the successful treatment as a given. However, each day that goes by, patients become older, develop other health issues and take more medications, which can affect their oral health. A string of missed daily oral hygiene events, or a series of missed recall and recare appointments can result in a small manageable issue becoming a larger problem. We all know how good habits can fade and bad habits can become the norm. When this happens, the successful implant may become the “ailing” or “failing” implant. When failure presents, the patient may then regret the entire process, even if it had been a successful implant for many years. As clinicians, when we see a failing implant, after many years of it being successful, we ask ourselves, “How could this happen?”
The best way of stopping failure is prevention. I clearly remember in my first year of dental school taking a course entitled, “Oral Hygiene—Maintenance of Oral Health”. We were told it was the most important course of our entire dental education. After 39 years of private practice, I now agree 100% with this teaching and the importance of maintaining good oral hygiene habits.
As time goes on and we get caught up in procedures, we tend to delegate the patient and the maintenance of the patient's oral health to our hygienist. Hygienists are well educated, highly skilled, and dedicated to our patients. As the team-leaders of the dental team we must remember how important our hygienists are, not only to our practice, but also to our patients. We need to provide our hygienists with the time, tools, continuing education, and support they need to maintain our patients' oral health.
The hygienist is the educational and motivational face of the dental office. They are often the first ones to build a relationship with the new patient and the person who conveys the care and concern for the patient of record. Hygienists impart feelings of significance to patients when they do the following:
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Take baseline blood pressure and pulse
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Review and update the medical history
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Assess and monitor the implant, particularly the presence of soft tissue inflammation and/or bone loss
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Have the proper instrumentation to clean and polish the implant and/or prosthesis
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Convey oral health care concerns and recommendations
Each of these steps requires time and helps maintain the patient's oral health, dental implant health, and retains the patient in the practice. I encourage all dentists, and in particular, those who place or restore dental implants, to assure the quality of their patient re-evaluation and recare regimens. Nothing is perfect, but we must make every attempt to keep the patient's oral health and implants as healthy as possible. Ultimately, this results in motivation for everyone.
Clinical practice guidelines have been established by the American College of Prosthodontists for the recall and maintenance of patients with implant-borne dental restorations. Recommendations are that a dental examination and prophylaxis should be performed at least every 6 months as a lifelong regimen. Patients who may be at a higher risk based on age, systemic health, periodontal health, medications, or ability to perform oral self-care, should have these treatments performed more frequently than every 6 months.1 Many recommend a 3-month maintenance schedule during the first year following the implant restoration. We must impress upon our patients that long-term implant success is dependent upon many variables, one of which is a long-term maintenance protocol.2 Implant maintenance should not be forgotten and we must remember it has the same importance as the surgical and prosthetic treatments. “Knowing these things is not enough; we must apply, and willing is not enough; we must do” (Johann Wolfgang von Goethe).
As clinicians we should appreciate and support our dental hygienists. Gratitude will be nationally recognized for the valuable role they play in the oral health of our patients during National Dental Hygienist week (April 9–15, 2016).
