Providing Implant Patients With All the Tools to Succeed
Appropriate products and clear instructions improve the likelihood of home care compliance
Lynn Pencek, RDH, MS
While helping out in a dental office the other day, I had a patient in my schedule who had returned to the practice for her first maintenance appointment after receiving an implant-supported removable full denture. When I asked the patient to remove the denture, I observed copious plaque biofilm and red, inflamed gingiva. The amount of inflammation was concerning.
I asked the patient which home care tools she used and how often she removed the denture to brush around her implants. Her response gave me great concern: She said that she had never removed the denture to brush the implants underneath. I am not sure what happened between the placement of the dental implants and the delivery of the removable denture with locators, but an essential communication step regarding who was responsible for educating the patient about home care was missed. The office was a small dental support organization (DSO) practice where a surgeon visited the office once a month to place implants. It appeared this vital step of home care education was not agreed upon between the surgeon and the restoring dentist, and both parties possibly thought that the other was responsible for providing the home care instructions.
With this scenario in mind, let's review what postsurgical care should be discussed with the patient. After receiving implants, the patient should be instructed to use an anti-microbial mouth rinse and not brush the surgical site or dental implants while the area is healing. The patient should then return for an evaluation a week to 10 days after implant placement; the sutures may be removed at that point, and an ultra-soft postsurgical brush and water flosser should be introduced as appropriate home care tools. Water flossers have been clinically shown to be safe for gingival tissue and epithelial attachment at all pressure settings.1 Some specialists recommend not using an electric toothbrush for up to three months after implant placement when osseointegration success is confirmed. This needs to be communicated and agreed upon between referring offices.
Written instructions should be reviewed with the patient on what to expect on the day of the surgery and the week of healing. Special instructions regarding regeneration materials, when to return for suture removal, and home care instructions should be included. Instructions on changing home care regimens, including specialty brushes, follow-up visits, and maintenance protocols should be clear between the surgeon and the restoring dentist.
Sometimes there is a disconnect when patients are advised to go and buy home care aids themselves after surgery. Think about it: Patients are busy with their lives and can get confused. What if the patient does not have an Amazon account? What if the recommended water flosser is not on sale? What if Walmart or Target does not have the recommended water flosser model in stock when the patient stops in?
Patients should focus on taking it easy and healing after surgery, not shopping for home care supplies. Be a five-star service provider and supply the home care tools at the postsurgical evaluation visit. During the visit, the hygienist should use disclosing agent to show biofilm and advise the patient about proper home care techniques. If the patient has not used a water flosser before, this visit is the ideal time to open the box, show the patient how to fill the basin, how the power is turned on, how to direct the pulsating water around their implants, and how to position themselves for water flow in the sink to prevent making a mess while irrigating.
If thousands of dollars are being billed for the placement of an implant, home care supplies—including a water flosser and an electric toothbrush—should be included as part of the implant package.
Reference
1. Goyal CR, Qaqish JG, Schuller R, Lyle DM. Evaluation of the safety of a water flosser on gingival and epithelial tissue at different pressure settings. Compend Contin Educ Dent. 2018;39(Suppl 2):8-13.
Key Points
• After receiving implants, the patient should be given clear instructions for home care.
• Have the patient return for an evaluation a week to 10 days after implant placement.
• Make sure the patient has the appropriate home care products, and consider providing them if necessary.
Lynn Pencek, RDH, MS
Founder
Practice At Your Best, LLC
practiceatyourbest.com
lynn@practiceatyourbest.com
