No Implantology without Periodontology – #NIWOP

Some things do belong together: just as Yin needs Yang, implantology needs periodontology. With “No Implantology without Periodontology”, NIWOP for short, W&H presents a systematic and evidence-based workflow for a sound and healthy tissue situation around the implant.

The evidence-based, systematic NIWOP workflow contributes to lasting implant success.

Millions of people around the world are affected by periodontitis. This chronic disease significantly increases the incidence of biological complications in implant placement with a risk of implant loss ⁽¹⁾. Peri-implantitis and its preliminary stage mucositis also occur in a substantial proportion of patients ⁽²⁾ . The cause is frequently found in the pathological altered biofilm (dysbiosis) with its specific microflora ^{(3, 4)}.

Untreated periodontitis patients therefore have an increased risk of peri-implant inflammation through to implant loss ⁽⁵⁾. However, even patients who were treated initially and are not included in a recall program exhibit an increased risk ⁽⁶⁾. Where necessary, periodontal pre-treatment and appropriate follow-up care (supportive periodontal therapy, follow-up care in recall) is important for these patients in order to create the optimum conditions for successful implantation and retention of the implant.

Increased implant success with NIWOP

With NIWOP, W&H provides a holistic workflow that allows the best possible treatment for patients. Pre-treatment, implantation, follow-up treatment – the evidence-based, systematic NIWOP workflow and the associated W&H products can contribute to long-term implant success.

W&H for every treatment step

W&H is the only manufacturer who provides products for every single NIWOP treatment step.
During implantation, particular emphasis should be on Implantmed and Piezomed surgical devices. The functionalities of Implantmed are perfectly adapted to the requirements of implantologists when inserting implants. In addition, the W&H Osstell ISQ modul provides information on the correct time for loading an implant. With Piezomed, along with Implantmed, bones may be treated gently and effectively – for example when preparing bone blocks or lateral windows for augmentations. In addition, special instrument tips are available for the piezo surgical preparation of the implantation site.

In the field of pre-treatment and follow-up care, W&H offers many new products for professional prophylaxis. The new Proxeo Ultra Piezo Scaler is not only certified for the safe prophylaxis of patients with pacemakers, but due to the new, unique quick chucking system allows super simple changing of instruments with just one instead of six revolutions previously.

With the new Proxeo Aura air polishing handpiece W&H is expanding and completing its prophylaxis and periodontology range. For patients with pocket depths up to 4 mm, the controlled treatment is performed with a combination of subgingival powder and the setting “Perio”. For periodontal indications with pocket depths of more than 4 mm, the perio spray head is used to remove the biofilm subgingivally around teeth or implants. The professional mechanical removal of plaque and biofilm is also an integral part of the NIWOP workflow. This is where the new Proxeo TWIST LatchShort Polishing System comes into play. The working height of the system is 4 mm lower than that of standard latch systems.

The advantage for users

The evaluation of the scientific publications has shown that a treatment according to the NIWOP workflow can contribute to a significant increase in the success of the implant.
In addition, the NIWOP documentation produced by W&H may be used for patient information. This not only has a positive effect on patient compliance, but also facilitates the argumentation of additional recall costs.

1. Veitz-Keenan A, James R, Implant outcomes poorer in patients with history of periodontal disease, Evicénce-Based-Dentistry 18, 5 (2017)
2. Derks J, Schaller D, Hakansson J, Wennstrom JL, Tomasi C, Berglundh T. Effectiveness of Implant Therapy Analyzed in a Swedish Population: Prevalence of Peri-implantitis. Journal of dental research 2016;95:43-49.
3. Lafaurie GI, Sabogal MA, Castillo DM, Rincon MV, Gomez LA, Lesmes YA, et al. Microbiome and Microbial Biofilm Profiles of Peri-Implantitis: A Systematic Review. J Periodontol 2017;88:1066-1089.
4. Hajishengallis G. Immunomicrobial pathogenesis of periodontitis: keystones, pathobionts, and host response. Trends in immunology 2014;35:3-11.
5. Veitz-Keenan A, Keenan JR. Implant outcomes poorer in patients with history of periodontal disease. Evidence-based dentistry 2017;18:5
6. Tan WC, Ong MM, Lang NP. Influence of maintenance care in periodontally susceptible and non-susceptible subjects following implant therapy. Clin Oral Implants Res 2017;28:491-494