Peri-Implant Therapy for the Dental Hygienist. Susan S. Wingrove

Parts and pieces for implants

Today, the FDA regulates and requires data on all oral and dental implants being placed with controlled studies under medical devices to gain full approval. It is not necessary for hygienists to know all the ins and outs of implant metals and designs, since the choice of implant to use will be in the hands of the surgeon. However, the biomechanics of implants or component parts of an implant are important to know and understand. The three main component parts of an implant are the implant body, with different designs, lengths, shapes, diameters, and surfaces; secondly, the abutment, which comes in many different types and materials, and even custom abutments are available, all screw directly into the implant to connect with the restoration/prosthesis. The final stage is the prosthesis; crown, bridge, fixed prosthesis, or removable overdenture (see Figure 1.17).

Figure 1.16 Zygoma implants.

      Courtesy of Nobel Biocare.

After the implant is placed into the bone, a cover screw or healing abutment (Figure 1.18) is placed directly into the implant to prevent bone and/or soft tissue from infiltrating the internal aspect of the implant during osseointegration. The healing abutment extends through the gingival tissue, forming the tissue contour/emergence profile to receive the final abutment and restoration (Figure 1.19).

At this time, well over half a million dental implants are being surgically placed annually. Implants are being properly planned and executed with success rates well over 90%. And yet, as rapidly as this field of dentistry is growing, the majority of potential dental implant patients are unaware that this treatment exists. To address this, dental hygienist can take the lead and talk with his or her patients about tooth replacement and implant dentistry. As hygienists, we need to plant the seeds with our patients that the technology exists today to better their quality of life. The knowledge of key implantology terms will allow hygienists the opportunity to talk with their patients about implants and these quality of life issues. See the Appendix for more implant dentistry terminology.

Figure 1.17 Parts and pieces.

Figure 1.18 Examples of cover screws.

      Courtesy of BioHorizons.

Figure 1.19 Examples of abutments.

      Courtesy of BioHorizons.

Implant dentistry terminology

      Connecting bar: System between two or more implants to be utilized for stability for implant prosthesis.

      Dental implant: A biocompatible device placed in the bone to replace the root lost, preserve the bone level, and support the prosthesis.

      Dental implant abutment: The component part that screws directly into the implant to retain the crown, bridge, and/or overdenture prosthesis in place.

      Implant thread: The screw‐like component part of the body of the endosteal, root‐form implant.

      Osseointegration: The firm, direct, and lasting biological attachment of an implant to vital bone with no intervening connective tissue.

      Peri‐implant diseases: Collective term for inflammatory lesions that may affect the peri‐implant area, mucositis, and peri‐implantitis.

      Peri‐implant mucositis: A pathological condition occurring in the tissue around dental implants, inflammation similar to gingivitis, reversible, caused by bacteria, biofilm, or residue. Manifests in the form of redness and inflammation, in the peri‐mucosa, with no additional bone loss.

      Peri‐implantitis: A pathological condition occurring in tissue around dental implants, characterized by inflammation in the peri‐mucosa and progressive loss of supporting bone that can be irreversible.

      Periosteum: Fibrous vascular membrane that fits tightly on the outer surface of the bone.

      Permucosal seal: The tissue seal that separates the connective tissues from the outside environment around a dental implant.

      Prosthesis: The removable or nonremovable restoration that attaches to the implant to replace the teeth.

      TADs: Titanium mini‐screws used primarily by Orthodontists in the facilitation of moving teeth or anchoring an orthodontic appliance.

Summary

The 21st century is an important and critical time to be a hygienist! History has shown us that implants are not new and are definitely here to stay. An understanding of the evolution of implants, implant design, and the key terminology will allow you to talk to patients about the background of implantology. The relationship between periodontal health and diseases involving other organs and physiological systems (i.e., cardiovascular disease, preterm birth, diabetes, and respiratory disease) has been clearly documented (15–19). Hygienists need to be trained in the long‐term prevention of peri‐implant complications.

      According to Dr. Nogueira‐Filho et al., writing in 2010 (1), “There is no reason to believe that mucosal inflammation affecting endosseous implant (i.e., peri‐implant mucosal inflammation) would have fewer effects on general health than similar levels of inflammation affecting teeth (i.e., periodontitis, gingivitis).” Therefore, it is imperative that hygienists are trained in identifying and treating peri‐implant mucosal inflammation that could affect overall body health. The explosion of dental implants over the next decade will change the way we practice dental hygiene.

References

      1 1. Nogueira‐Filho G, Iacopino AM, Tenenbaum HC, Perio D Prognosis in implant dentistry: a system for classifying the degree of peri‐implant mucosal inflammation. J Can Dent Assoc. 2010; 77: b8.

      2 2. Froum SJ. My patient’s implant is bleeding; what do I do? DentistryIQ, 2011.

      3 3. Greenfield EJ Implantation of artificial crown and bridge abutments. Dent Cosmos. 1913; 55: 364–369, 430–439.

      4 4. Research, Science and Therapy Committee of the American Academy Position paper dental implants in periodontal therapy. J Periodontol. 2000; 71: 1934–1942.

      5 5. Simon RL Single implant‐supported molar and premolar crowns: a ten‐year retrospective clinical report. J Prosthet Dent. 2003; 90: 517–521.

      6 6. Jivraj S, Chee W Treatment planning of implants in posterior quadrants. Br Dent J. 2006; 201: 13–23.

      7 7. Lemmerman KJ, Lemmerman NE Osseointegrated