The successful outcome of dental implant treatment is dependent on team integration and team working. The members of this team are shown in Figure 8.1. The dental hygienist/therapist is an important member of this team and plays an essential and important role in the management of patients seeking implant treatment and the value of this role should not be underestimated. The involvement of the hygienist/therapist should not be an afterthought but should be considered right at the start of the treatment discussion. This position is further exemplified in patients who are at high risk of complications. To fulfil this role, training is important for the hygienist/therapist as part of the dental team and can be obtained through manufacturer-led programmes, private providers, hospitals and universities. Online training opportunities are also available, and the hygienist/therapist should take on the responsibility of ensuring that he/she is familiar with the management of patients with dental implants. Training, ideally, should be delivered through a team approach whereby the whole dental team, including the hygienist/therapist and the dentist, dental nurse and technician can learn together to appreciate the important role each member has in providing safe and optimal implant care to the patient. Training for hygienists and therapists in implantology is limited, and these team members must ensure that they are familiar with the concepts of different implant systems and treatment modalities to be able to provide effective treatment to the patients they see and escalate issues of concern in a timely manner.

As the field of implantology continues to evolve with different procedures, techniques, materials and products emerging onto the market, continuing education and lifelong learning is an important and essential part of the hygienist/therapists professional journey. As more and more patients are undergoing implant treatment, this need for awareness and knowledge has become even more critical especially as the extent to which this is taught at pre-registration level remains limited. The need for the ongoing learning is also driven by the high emotions and expectations patients hold around their implant restorations and the ability to impart clear and accurate information is reliant on sound knowledge and awareness. This chapter aims to provide an outline of the stages during which the hygienist/therapist will be involved in managing a patient who is undergoing or has undergone implant treatment.Role as a Clinician

Role as a Clinician

The role of the hygienist/therapist in caring for patients undergoing dental implant treatment can be broken down into the following stages (Figure 8.2):

• Before treatment – preoperatively
• During treatment
• After treatment – post-operatively

To be effective in their role, the hygienist/therapist should have an awareness and understanding of the key differences associated between the various implant systems and the types of implant-retained restorations provided to patients. There should be an insight into the nuances of treating teeth and dental implants and an awareness of the consequences of the treatment they may offer to a patient with an implant-retained reconstruction. He/she should also have the confidence of raising concerns when the signs of inflammation are noted. The current litigious climate, in which patients are highly aware of implant treatment through information gained from the internet, places the hygienist /therapist at a greater risk of medicolegal litigation. Thus, the need to have a good understanding of not only their role but also the self-awareness of their own limitations when providing treatment to patients who have undergone implant treatment should not be under-estimated.

• Before Treatment – Preoperatively

The hygienist/therapist plays an essential role during this phase in helping the patient understand their role in the management and success of their implant treatment. During this phase, the patient should be guided on how to optimise their day-to-day plaque control and the aides that should be used, shown and considered in line with the situation in the mouth. This will give the opportunity of determining aides that are easy for the patient to use and those that they would struggle with. In addition to this, if the patient is a smoker, then smoking cessation advice should be given and the importance of this highlighted to the patient alongside discussing other issues present around the teeth. Other preventative measures such as using fluoride mouthrinses should be implemented if necessary. In patients with gingivitis, treatment is undertaken to stabilise the disease. In patients with periodontitis, the hygienist/therapist has the dialogue with the patient about the importance of stabilising the disease before the implant treatment and explain the effects of the unstable disease on the outcome to the implant treatment. Patient engagement and the role they play in looking after their implants should be clarified at the outset and the patient advised of the poorer outcome to the implant treatment if they fail to comply. Challenges with patient compliance should be discussed with the dentist early so that the required modifications to the planned implant treatment made to ensure a successful result for the proposed treatment. This is an important part of the patient journey into implant treatment. At the end of this phase, a dialogue between the hygienist/therapist and dentist should take place outlining any major issues encountered and the outcome to the initial treatment. A record of the periodontal health and oral hygiene status should be kept and should include the plaque and bleeding scores as well as a six point probing chart. The patients progress and compliance to advice given should be assessed against this over the coming visits. Patients may also ask hygienist/therapists about their views on the proposed implant treatment and thus coherent and clear information can only be given if the hygienist/therapist has been part of the initial dialogue with the patient.

• During Treatment

  The patient may be seen at various stages during this period. These are:

  • – Following the surgical placement of the implants

    The hygenist/therapist may be asked to undertake the one-week post-surgery review. At this visit, guidance on how to change the cleaning regime in line with the surgical intervention is undertaken. Sutures should be removed and gentle cleaning with a soft brush and Corsodyl mouthrises should be advocated. The oral hygiene in the rest of the mouth assessed and the patient gently reminded that whilst brushing, the surgical site should be avoided, the rest of the mouth should be managed as normal. At this visit, any patient concerns are listened to, heard and escalated to the dentist if necessary.

  • – During the interim period whilst the implants are healing

    The patient is given ongoing guidance and supportive care needed. If they had seen the patient prior to the start of the implant treatment, then the rapport built with the patient will help progress this phase whereby the hygienist can build on the information already given and monitor the patients performance against this. The hygienist/therapist will also be in a good position to identify untoward issues and escalate these if needed. Often they may see the patient just prior to the impression taking visit to ensure that the plaque control and gingival tissues around the implant sites are healthy so that an accurate impression can be obtained for the construction of the prosthesis.

  • – Following the fit of the prosthesis

    This visit could be immediately after the fit or within days/weeks of the appointment. At this time, guidance on how to look after the implant-retained prosthesis will be given. For a removable prosthesis advice on how to clean the prosthesis should also be given and would include the following:

    • ∘ Remove and clean the prosthesis after every meal and rinse the mouth.
    • ∘ Leave the denture out at night and clean the denture and leave it soaked in cold water or a proprietary denture-cleaning solution.
    • ∘ Clean the denture with a brush and soap and water. Toothpaste is abrasive and can wear the material which the denture is made from.
    • ∘ The implant fixtures and abutments should be cleaned and all plaque and debris removed using either interspace brushes or a combination of aides.
      Only gold members can continue reading. Log In or Register to continue