Biofilm-focused care protocols for natural teeth, implants, and restorations

Susan Wingrove, BS, RDH

 New biofilm-focused care protocols and innovative products elimnate inflammation that can initiate the inflammatory cascade. From peri-implantitis

expert Susan Wingrove, here's how you can take your practice into biofilm-focused care.

Susan Wingrove, BS, RDH

Mar 1st, 2020

It’s an exciting time to be in dentistry, with new products to restore natural dentition and implants to replace missing teeth. Dental and medical professionals have joined together as first responders to focus on biofilm and its role in inflammation and oral-systemic disease.

Protecting our patients’ health, dentition, and restorations by addressing biofilm and non-biofilm induced inflammation starts with a paradigm shift in hygiene protocols, technology, and products. To address this challenge, new guidelines for maintenance and recare for tooth- and implant-borne restorations have been developed, as well as a new classification for disease treatment.

The American College of Prosthodontists (ACP) developed a set of clinical practice guidelines for recall and maintenance of patients with tooth-borne and implant-borne restorations.1 This is a good place to start with modifications to our maintenance protocols and recommendation that all patients of record be advised to present for in-office maintenance at least every six months to protect their restorations, and most importantly, their overall health.1

The ACP guidelines include the use of low-abrasion powder-streaming technology at the beginning of the maintenance visit to remove biofilm prior to probing or assessment. Monitoring occlusion is especially important for implant-borne restoration patients. If grinding or clenching is detected, adjustment to the occlusion is recommended, and a prescribed occlusal device may be needed to protect fixed restorations. At-home care maintenance for the patient should include the use of oral hygiene aids to disrupt the biofilm (e.g., dental floss, water flosser, interdental cleaners, electric toothbrushes).1

The American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) developed a new classification of periodontal and peri-implant disease and conditions. The classification follows a medical model that allows clinicians to explain treatment to patients based on stage, extent, and progression. The 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions provided 19 review papers and four consensus reports that outline classification and conditions affecting the periodontium and biofilm-induced and nonbiofilm-induced inflammation.2-4

By focusing on biofilm, this classification and its guidelines change how dental professionals approach maintenance and home-care recommendations. New protocols, technology, and products are now available to remove biofilm, prevent biofilm formation, and protect teeth and implants.

Detect, diagnose, and treat

Detection and diagnosis begin with a comprehensive dental exam, an up-to-date medical history, and full-mouth probing (FMP) that includes a new focus on bleeding points for inflammation identification. Below are some possible additions to your recare maintenance and disease treatment protocol for patients with natural teeth, restorations, implants, or all three.5

Test patients’ saliva to identify pH and risk factors for disease and other conditions affecting the periodontium. Use products to identify plaque and biofilm and use powder-streaming technology with erythritol and glycine powder to remove the biofilm. Another consideration is to routinely use fluoride or antimicrobial varnishes to protect natural teeth and implants. Recommend neutral pH home-care products for all patients with tooth-borne and implant-borne restorations.

Biofilm-focused care should include the use of fluoride varnishes, and any products used should be of a neutral pH, especially if implants are present. Examples of varnishes that are neutral and safe to use around teeth and implants include Fluor Protector (Ivoclar Vivadent), MI Varnish (GC America), and Vella (Preventech). Fluoride varnishes are recommended for caries prevention and sensitivity on natural dentition

As dental professionals, this is a vital time to protect our patients’ teeth, implants, restorations, and most importantly, overall health. Our goal with new biofilm-focused care protocols and innovative products is to eliminate inflammation that can initiate the inflammatory cascade. The inflammatory cascade starts with tissue breakdown and can lead to bone loss in teeth and around implants.

The ACP’s “Clinical practice guidelines for recall and maintenance of patients with tooth-borne and implant-borne dental restorations” and the AAP/EFP periodontal and peri-implant disease classification information are a good place to begin. Gather the guidelines, classification, protocols, and products to take your practice into biofilm-focused care.

Editor's note:View Susan Wingrove's companion treatment protocol reference to this article here.


Read more: Are you compromising your patient’s implant?


References

  1. Bidra AS, Daubert DM, Garcia LT, et al. Clinical practice guidelines for recall and maintenance of patients with tooth-borne and implant-borne dental restorations. J Prosthodont. 2016;25 Suppl 1:S32-S40. doi:10.1111/jopr.12416
  2. Caton G, Armitage G, Berglundh T, et al. A new classification scheme for periodontal and peri‐implant diseases and conditions – Introduction and key changes from the 1999 classification. J Clin Periodontol. 2018;45 Suppl 20:S1-S8. doi:10.1111/jcpe.12935
  3. Froum S. The new classification of periodontal disease that you, your patient, and your insurance company can understand. Perio-Implant Advisory website. https://www.perioimplantadvisory.com/clinical-tips/article/16412257/the-.... Published August 30, 2018.
  4. Wingrove S. Clinical applications for the 2018 classification of peri-implant diseases and conditions. Perio-Implant Advisory website. https://www.perioimplantadvisory.com/clinical-tips/hygiene-techniques/ar.... Published November 6, 2018.
  5. Wingrove S. Peri-Implant Therapy for the Dental Hygienist: Clinical Guide to Implant Maintenance and Disease Complications. Oxford: Wiley Blackwell; 2013.
  6. George AM, Kalangi SK, Vasudevan M, Krishnaswamy NR. Chlorhexidine varnishes effectively inhibit Porphyromonas gingivalis and Streptococcus mutans - an in vivo study. J Indian Soc Periodontol. 2010;14(3):178-180. doi:10.4103/0972-124X.75913
  7. Anand V, Govila V, Gulati M, Anand B, Jhingaran R, Rastogi P. Chlorhexidine-thymol varnish as an adjunct to scaling and root planing: A clinical observation. J Oral Biol Craniofac Res. 2012;2(2):83-89. doi:10.1016/j.jobcr.2012.05.006

Susan Wingrove, BS, RDH, is an international speaker, author, researcher, instrument designer, and a 2016 Sunstar/RDH Award of Distinction recipient. She is a member of the American Dental Hygienists’ Association, the International Federation of Dental Hygienists, the Oral-B Global Implant Board, and the Western Society of Periodontology. She is an author of multiple journal articles and the textbook Peri-Implant Therapy for the Dental Hygienist: Clinical Guide to Maintenance and Disease Complications, and a scientific panel member for the American College of Prosthodontists Clinical Practice Guidelines. Contact her at sswinrdh@gmail.com and wingrovedynamics.com.

Latest in Patient Care

بروتوكولات العناية التي تركز على ازالة  ا لصفيحهالجرثومية   المتوضعة على   الأسنان الطبيعية ، والغرسات ، والترميمات .

 

سوزان وينجروف ، BS ، RDH

 

  تستند بروتوكولات الرعاية الجديدة   على  ازالة البيوفيلم والمنتجات  المصاحبة للالتهاب الذي يمكن أن  يستمر ويتطور.

 

   سوزان وينجروف

   الخبيرة في  امراض التهاب الأنسجة  المحيطه بالزرعات مارس 2020

 

إنه  من المثيرحاليا  اس في خدام   استخدام مواد الأسنان كمنتجات جديدة  لترميمالأسنان الطبيعية والغرسات لتحل محل الأسنان المفقودة. اجتمع المتخصصون في طب الأسنان والأطباء الذين استجابوا  لدراسة البيوفيلم ودوره في الالتهابات وأمراض   الفم.

تبدأ حماية صحة مرضى الأسنان ، وأسنانهم ، وترميمهم من خلال معالجة الالتهاب الناجم عن الالتهاب العضوي المتعلق  بالبيوفيلم وغير بيوفيلم مع تحول  نظامي في بروتوكولات النظافة والتكنولوجيا والمنتجات. لمواجهة هذا التحدي ، تم وضع مبادئ توجيهية جديدة للصيانة والعودة للترميم المنقولة بالأسنان والغرسات ، بالإضافة إلى تصنيف جديد لعلاج الأمراض.

قامت الكلية الأمريكية لأطباء الأسنان (ACP) بتطوير مجموعة من إرشادات الممارسة السريرية  لعلاج وصيانة ترميم نسج المحيطة بالزرعات  .   

 إنه حقل جديد  جيد للكلية  للبدء بتعديلات على طرق الصيانة الخاصة  بها والتوصية بأن  يتلقى جميع المرضى علاج وقائي في عيادة طبيب الأسنان  كل ستة أشهر على الأقل لحماية  الترميمات في الفم  والمجافظة على سلامتها العامة.

تتضمن إرشادات كلية ACPاستخدام تقنية تدفق مسحوق منخفض التآكل في بداية زيارة الصيانة الإزالة البيوفيلم قبل الفحص أو التقييم.

مراقبة الانسداد مهم بشكل خاص لمرضى الاستعادة المنقولة بالزرع. إذا تم الكشف عن الطحن أو الثقب ، يوصى بتعديل الإطباق ، وقد تكون هناك حاجة إلى جهاز الإطباق المحدد لحماية الترميمات الثابتة. يجب أن تشمل صيانة الرعاية المنزلية في المنزل استخدام أدوات نظافة الفم لتعطيل الأغشية الحيوية (على سبيل المثال ، خيط تنظيف الأسنان ، خيط الماء ، منظفات ما بين الأسنان ، فرش الأسنان الكهربائية) .1

قامت الأكاديمية الأمريكية لطب وجراحة اللثة والاتحاد الأوروبي لطب اللثة (EFP) بتطوير تصنيف جديد لأمراض اللثة وأمراض الغرسة المحيطة بها. يتبع التصنيف نموذجًا طبيًا يسمح للأطباء بشرح العلاج للمرضى بناءً على المرحلة والمدى والتقدم. قدمت ورشة العمل العالمية لعام 2017 حول تصنيف أمراض وحالات دواعم السن واللثة 19 ورقة مراجعة وأربعة تقارير إجماعية تحدد التصنيف والظروف التي تؤثر على اللثة والالتهاب الناجم عن اللبيوفيلم والالتهاب الناجم عن البيوفيلم.

 

https://www.rdhmag.com/patient-care/article/14169538/biofilmfocused-care-protocols-for-natural-teeth-implants-and-restorations