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

1 Cover

2 Title Page Peri‐Implant Therapy for the Dental Hygienist Second Edition Susan S. Wingrove, BS, RDH International Speaker, Writer, Researcher Wingrove Dynamics LLC Missoula, MT, USA

3 Copyright Page

4 Dedication

5 Foreword

6 Acknowledgments

7 About the Author

8 List of Contributors

9 About the Companion Website

10 1 Implants 101: History, Implant Design, Parts, and Pieces History Dental implant history timeline Implants Orthodontic implants/temporary anchoring devices (TADs) Implant dentistry terminology Summary References

11 2 Implant Therapy: Oral‐Systemic Health, Medical History, and Risk Assessment Oral‐systemic health link to overall health Medical history/risk assessment forms Summary References

12 3 What Lies Beneath the Surface? Natural Teeth, Bone, and Implant Surgery Natural teeth versus implants Bone: it is all about the bone! Bone regeneration Implant surgery Specialized implant placement Summary References

13 4 Setting the Stage: Adjunctive Surgical Procedures, Restorative Options, and Treatment Planning Adjunctive surgical procedures Restorative options Treatment planning for long‐term implant success Summary References

14 5 How to Talk to Patients About Implant Dentistry: Risks, Benefits, and Alternatives What are the risks, benefits, and alternatives to replacing missing teeth? Risks Benefits Alternatives Communication and motivation Summary References

15 6 AIM for Implant Success: Assess, Identify, and Monitor Assess Monitoring Summary References

16 7 Implant Complications: Peri‐Implant Disease, Biofilm, and Corrosion What is the hygienist's role in restoratively driven implant complications? Implant complications: prevention, identification, and treatmentContribution by Dr. Maria L. Geisinger DDS, MS Peri‐implant disease; mucositis and peri‐implantitis Biologic and prosthetic complications Examination, diagnosis, and treatment of peri‐implant disease The role of biofilm in peri‐implant disease The role of corrosion in peri‐implant diseaseContribution by Dr. Luciana Safioti DDS, MSD Summary References

17 8 Biofilm‐Focused Implant Home Care Postsurgical home care Single implant home care Specialized home care Summary References

18 9 Professional In‐Office Implant Maintenance and Disease Treatment Professional in‐office regimen Highlights for ACP clinical practice guidelines implant‐borne restorations Maintenance; biofilm removal, debridement, polishing, and recare Single implant maintenance Mastering the Arch© Peri‐implant disease assessment and treatments Cement residue assessment and treatment Summary References

19 Appendix: Terminology and Resources Implant dentistry terminology Resources

20 Index

21 End User License Agreement

1 Chapter 2 Table 2.1 Levels of cardiac reactive proteins (CRPs). Table 2.2 Criteria to diagnose bisphosphonate‐related osteonecrosis of the ... Table 2.3 Risk assessment for osteonecrosis.

2 Chapter 3 Table 3.1 Comparison between natural dentition/tissue and dental implants.... Table 3.2 Bone classification (5). Table 3.3 The principles behind regeneration.Table 3.4 Example of patient protocols for implant surgery.

3 Chapter 4Table 4.1 Comparison of restorative options and advantages.

4 Chapter 5Table 5.1 Comparison treatment options for missing teeth.

5 Chapter 6Table 6.1 Assessment and monitoring summary.

6 Chapter 7Table 7.1 Case definitions for peri‐implant health, peri‐implant mucositis, ...

7 Chapter 8Table 8.1 Examples of brushes to use with implants.Table 8.2 Oral hygiene home care protocol summary.

8 Chapter 9Table 9.1 Implant safe, effective hand scalers/curettes.Table 9.2 Ultrasonic implant safe tips.Table 9.3 Examples of safe pumice‐free prophy pastes.Table 9.4 Clinical applications peri‐implant therapy/note for patient’s reco...

1 Chapter 1 Figure 1.1 Discovery by Dr. and Mrs. Wilson Popenoe, Honduras, 1931. Figure 1.2 George Washington's lower denture. Figure 1.3 Professor Per‐Ingvar Brånemark, an orthopedic surgeon. Figure 1.4 Dr. Greenfield's basket design. Figure 1.5 Dr. Dahl subperiosteal design. Figure 1.6 Endosteal design. Figure 1.7 Transosteal design. Figure 1.8 Titanium and ceramic (zirconia) implant examples. Figure 1.9 SEM titanium implant surface. Figure 1.10 SEM ceramic (zirconia) implant surface. Figure 1.11 Subperiosteal implant. Reprinted from Taylor and Laney (23), wit... Figure 1.12 Transosteal implant. Figure 1.13 Blade‐form implants. Figure 1.14 Endosteal root‐form implants. Figure 1.15 Mini dental implants. Figure 1.16 Zygoma implants. Figure 1.17 Parts and pieces. Figure 1.18 Examples of cover screws. Figure 1.19 Examples of abutments.

2 Chapter 2 Figure 2.1 Inflammation process.

3 Chapter 3 Figure 3.1 How an implant attaches to bone. Figure 3.2 Cortical and cancellous bone. Figure 3.3 Ridge width lost (bone) with traditional extraction, no socket pr... Figure 3.4 What happens when bone loss continues? Patient eventually will no... Figure 3.5 Bone needs to be stimulated (Wolff’s Law). Figure 3.6 Blood clot is essential to healing. Figure 3.7 Examples of regenerative products. (A) Osteogenesis cells, OSSIF‐...Figure 3.8 Example Socket preservation case.(A) Pre‐op PA radiograph, to...Figure 3.9 Sinus augmentation.(A) Pre‐op PA radiograph. (B) Implant plac...Figure 3.10 Difference between a two‐ and one‐stage endosteal implant placem...Figure 3.11 Example of a one‐stage implant placement.(A) Implant is take...Figure 3.12 Subperiosteal framework.Figure 3.13 Transosteal implant.Figure 3.14 Zygomatic dental implants.Figures 3.15 All‐on‐4™ step‐by‐step overview.

4 Chapter 4Figure 4.1 Example of serrated periotome.Figure 4.2 Socket preservation case.(A) Initial tooth and abscess. (B) S...Figure 4.3 Alveolar ridge augmentation case.(A) Initial occlusal view of...Figure 4.4 Maxillary sinus augmentation case.(A) Initial, (B) flap eleva...Figures 4.5 Examples of bar‐supported attachment‐retained overdenture cases....Figure 4.6 Lifestyle choice of enjoying a glass of wine.Figure 4.7 Screw‐retained and cement‐retained crown differences. (A) Example...Figure 4.8 Ball implant, O‐ring attachment, and lower overdenture example....Figure 4.9 Milled bar‐supported attachment‐retained removable overdenture ex...Figure 4.10 Fixed‐removable screw‐retained hybrid final prosthesis in patien...Figure 4.11 All‐on‐4 example.Figure 4.12 Gunshot case.Figure 4.13 Example of a piezoelectric surgical unit. PIEZOSURGERY ®tou...Figure 4.14 Custom CAD milled provisional components, abutment, and BruxZuir...Figure 4.15 Digital treatment lanning, CBCT, and surgical guide fabrication....Figure 4.16 Surgical guide and flapless implant placement surgery.Figure 4.17 CBCT images for digital implant treatment planning.Figure 4.18 Digital software for implant planning with bone level CBCT.

5 Chapter 5Figure 5.1 Progressive bone loss affects appearance.Figure 5.2 Traditional three‐unit bridge; note the bone loss.Figure 5.3 Note the progression of bone loss.Figure 5.4 Communication with patients.Figure 5.5 Attend continuing education courses, Susan Wingrove presenting....

6 Chapter 6Figure 6.1 Hygienists are first responders, assessment is key!Figure 6.2 Steps for assessment and monitoring implants.Figure 6.3 (A) Normal, healthy tissue. (B) Inflammation.Figure 6.4 Probing the implant, courtesy of Wingrove Dynamics.Figure 6.5 Use a flexible probe in plastic (PDT), titanium (Brasseler) or st...Figure 6.6 Palpate for signs of infection.Figure 6.7 Signs of internal loose screw. Notice the bubbling around the cro...Figure 6.8 Testing for mobility.Figure 6.9 Dentist checks the occlusion with blue articulating paper.Figure 6.10 Notice the saucer‐like radiolucent area. This signifies cement....Figure 6.11 Line up the diagnostic radiograph of implant correctly. Threads ...