in this video we'll be covering what every dentist should know when it comes to giving
your patients the option of getting implants how to deal with patients who present with
implants and periumplantitis and we'll finish off by discussing the different
journeys a dentist can take to being able to provide implants for their
patients hi everyone and welcome back today i am honored to be joined by the amazing award-winning
dentist dr anushivaran aryakis who is the director of the award-winning practice white rose dental
studio and he has over 25 years of clinical experience with a master's in period ontology and
a special interest in the diagnosis and treatment of perium plantitis thank you for having me i
think this is a topic that many people can benefit from and i look forward to sharing my knowledge
we're going to be doing this in the form of a q a so let's get started my first question to
you is what are the advantages of replacing a gap with an implant dental implants allow the missing
tooth gap to be restored without any attachments to the adjacent teeth therefore facilitating a
more improved hygiene when compared to dental bridges or dentures in addition an appropriately
placed dental implant leads to less bone loss in the missing tooth space when compared to dentures
gentle implants can be placed without any involvement with the surrounding teeth
eliminating the need for unnecessary tooth preparation immediate to the gaps implants
are fixed titanium screws that face with the bone hence they become permanent fixtures as long as
their health is maintained so that sounds like a great option is there a minimum or a maximum age
for getting implants there's no maximum age as long as the patient is fit unhealthy and
the surgical procedure is justifiable based on clinical guidelines in terms of a minimum age
this is different for male and female patients for a male patient it is advisable not to place
implants below the age of 22 or 23 and for the female patient not below the age of 24 or 25
as the facial skeleton still undergoing the growth process okay let's say a patient was a
good candidate for an implant how many sessions does it take to complete an implant treatment
in general we need six sessions the first session is the initial consultation and case assessment
based on patients wishes and expectations the assessment of the patient suitability for implant
treatment would be carried out and a detailed discussion about these risks and benefits of
dental implant treatment and all available alternatives would take place impressions
are then taken to manufacture models of the patient's upper and lower jaw for further planning
and creation of a surgical guide patients are then referred internally or externally for cbct
imaging the second session is about presenting the treatment plan to the patient having a detailed
discussion about clinicians thoughts and patients expectations and the final decision making the
third session is the surgical day when implants are placed this is usually the longest appointment
the fourth session is a short review appointment at one two or three weeks after the surgery
this is to reassess the healing the fifth and sixth sessions are generally three months after
the surgical implant placement this is when the clinician reassesses the implant and starts
the process of crowning the implants this phase normally takes between two to four weeks and is
usually over two short appointments so in general six appointments one of which is the two three
hours long surgical implant placement now when you look at the detail of this implant treatment
process one would question the credibility of some adverts on newspapers claiming implants in
one day oversimplifying and somewhat misleading the patients our next question is how long does
the healing process take after an implant surgery in general patients feel well and do not have pain
after the surgery full healing of the soft tissues or the implants takes between four to six weeks
and it takes approximately three months for the implant itself to achieve a biological connection
with the surrounding bone and this process is called osteointegration and my next question is
which cases or scenarios are not suitable for an implant those that are not suitable usually
present with underlying medical conditions that exist at the time of implant treatment conditions
like uncontrolled diabetes unstable periodontitis cancer treatment radiation therapy to their jaw
area medication history such as bisphosphonates or chemotherapy a recent heart attack and that is
just to name a few but the clinician must take a full medical history and liaise with the patient's
doctor also contraindications to implant treatment includes patients with poor oral hygiene and those
who do not comply with oral hygiene instructions given by the clinician smoking is also a risk
factor for implant health although smoking itself is not a contraindication for placement of dental
implants patients must be warned that they would be at higher risk of implant failure now we know
from literature that smoking and diabetes are risk factors for periodontitis however we do not yet
have conclusive evidence to know whether these are also risk factors for peri-implantitis presence or
lack of sufficient space for implantation also is an issue this needs to be fully assessed during
clinical examination and measurement of the spaces by means of study models and help of cbct scans
if you imagine that the diameter of an implant on average would be four millimeters then that means
that we need a space of almost eight millimeters to be able to place one implant now let's talk
about a patient who presents to a general dentist with implants already how should that general
dentist assess those implants well we start with history taking and we should find out when the
implants were placed as well as the full details about the implant like the brand name material
and surface characteristics of the implant arrangements to obtain a previous radiograph
is desirable and a good practice we should ask the patients if they have any symptoms in
relation to the implants we then visually inspect the soft tissues around the implants for signs of
inflammation such as red and swollen gingival margins further on we should have two types
of periodontal probes plastic and metal available to measure the peri-implant probing depths around
the implant which should not be more than five millimeters at the same time there should not be
any bleeding on probing at six points around and implants and how do we deal with scaling
around an implant scaling around an implant should be performed with care not to breach
the tissue attachments to the neck of the implant on a healthy implant for implants made of titanium
titanium hand scalers should be used systems using a mixture of air and abrasive particles
have also been found effective you should not be using your usual skaters made of stainless steel
on a surface of an implant in addition to that the usual ultrasonic scalers should not be used
on dental implants because they will cause surface damage and make implants more prone to peritonitis
and when should we be referring a patient with an implant and who should we be referring to
as soon as you detect a peri implant probing depth of more than five millimeters and radiographic
evidence of bone loss around an implant a referral to periodontist for a second opinion and treatment
planning is a wise approach this is also extremely important from a medical legal aspect
later on if this condition worsens or if indeed it stays the same but a diagnosis of pre-implantation
established by another colleague you may find yourself responsible and criticized for failing
to diagnose this important condition in addition to failing to treat it okay let's talk a bit
about peri-implantitis first of all what is it peri-implantatives is a bacterial inflammatory
condition of the tissues surrounding a dental implant with loss of bone it is important to note
that in the presence of inflammation but absence of bone loss we are talking about peri-implant
mucositis which precedes perineplantitis it is important to be able to differentiate between
peri-implant mucositis and perineplantitis the latter is the same inflammation but with loss of
bone okay and what can cause peri-implantitis there are different causes this could be a
patient's poor oral hygiene incorrect placement of dental implants poor design of the prosthetic
aspect such as the bridge or crown supported by the implant pre-existing and unstable periodontal
disease and most commonly it is a patient who is non-compliant with the implant maintenance regime
such as three monthly hygienist visits and how can we diagnose it so clinically the signs are
peri-implant probing depths of five millimeter and more in addition to bleeding on probing
radiographically we would compare the baseline radiographs with the current radiographs and look
for bone loss and in the absence of the baseline radiograph we would look for bone loss of three
millimeters or more to reach our diagnosis what are the symptoms of peri-implantitis most patients
will not complain of any symptoms occasionally a patient might observe a superation which is a
discharge often white or yellow in color from the gingival margin surrounding an implant in case of
a mobile dental implanted diagnosis of implant failure is definitive in which case the implant
must be removed as soon as possible and what are the outcomes of treatment of periumplantitis
good question this is something that experts are still talking about to reach a consensus
obviously the outcome is long-term survival of an osteointegrated implant this is what we call
an endpoint outcome however often we have to wait some years to find out about the outcomes
of the treatment in the case of dental implants we need to look at surrogate outcomes which are
markers such as resolution of inflammation such as marginal bleeding and reduction of
the pre-implant probing depth radiographic bone fill of the implant bony defect is also desirable
outcome but i must emphasize that clinicians must focus on patients aesthetic expectations to
the clinician reduction of the pocket depth and radiographic bone may be a successful treatment
outcome however sight of a few millimeters of an implant metallic body above the gum level
in the mouth may not necessarily meet a patient's expectations of a successful outcome
the aesthetic criteria is commonly missed by many clinicians and finally the last question i have
today is what are the different routes that we can take to becoming an implant provider now
this ranges from self-training by means of private mentorship arrangements with an experienced local
mentor to participating in formal implant surgery training such as postgraduate certificate and
diploma courses that can lead to mscs and other qualifications you can also enroll on part-time
or full-time msc or m-clinton's periodontology programs available in various universities
establishing a good professional relationship with a local mentor is of paramount importance
you will need a lot of support from case selection and early treatment planning to
troubleshooting when things don't go in line with the treatment plan it is very important to choose
the right mentor you need to meet them you need to observe their work you need to be comfortable
with what they do placing thousands of implants otherwise said titanium screws in jaw bones does
not mean that someone is qualified enough to teach you how to place implants thank you very
much dr aryakis for answering all our questions with regards to implants and peri-implantitis
if you guys found that useful which i'm sure you did you might also enjoy some of the other videos
that we have on our channel so feel free to check out some of the suggestions here if you guys have
any other questions regarding implants feel free to message me on instagram at white rose dental
studio and i will get back to you i would like to congratulate you guys for this innovative
incentive in digital education thank you so much and thank you everyone for watching thank you