From PIP to NIWOP

First published in pip - Practical Implantology and Implant Prosthetics, 4 | 2018

Dr Karl-Ludwig Ackermann from Filderstadt has always been an uncompromising user of pre-implantological prophylaxis and stringent post-implantological follow-up care and tracks them consistently and with very good results in the PIP (perio-implant-prosthetics) protocol he developed himself. It is therefore not particularly surprising that he became one of the first proponents of the NIWOP programme created by the Austrian medical technology company W&H.

NI... what?

Dr. Ackermann:
…it has to be called something, and NIWOP stands for No Implantology WithOut Periodontology. In all of the enthusiasm about the modern-day options in dental implantology, the importance of the implant site and the periodontium has fallen by the wayside somewhat, and it needs to be brought back. W&H has committed to bringing it back, and preparation of the implant site beforehand and follow-up care to keep the implant healthy play a major role here. In principle, it is not only the implantological workflow that needs to be taken into account but also dentists who perform implants must place more emphasis on the interaction between preparation and follow-up care.

What are you doing to make sure the calls don’t quickly go unheard?

Dr. Ackermann:
NIWOP describes the workflow that can lead to the protection and long-term maintenance of the implant and also focuses on the long term, as should be the case for continuous implant prophylaxis. The entire workflow, developed by W&H and others, is based on results from evidence-based literature, so it makes a lot of sense.
I was able to give a presentation on corresponding long-term success with an observation period of over ten years during my lecture at Europerio. Of course W&H will continue to work on the dissemination and consolidation of the workflow, especially since W&H has the necessary devices and instruments for each stage of the workflow and will continue to expand the product range in relating to the workflow.

Where is the line between periodontitis and periimplantitis in NIWOP?

Dr. Ackermann:
The best kind of periimplantitis is still the kind we can prevent. There are currently no options other than significantly improving hygiene before placing the implant, from biofilm management and plaque control to an end-to-end periodontologically-supported workflow for implant therapy. Depending on the situation and patient compliance after placing the implant, appropriate close monitoring may also need to be developed so we can intervene as soon as the patient experiences initial inflammatory reactions such as mucositis rather than waiting for periimplantitis to occur.

Are you trying to use NIWOP to develop a kind of classification of perio patients in implantology?

Dr. Ackermann:
The EUROPERIO working group on the classification of periodontitis and periimplantitis has already postulated a very good definition and nomenclature.

Is NIWOP aimed at generalists, or do you also want to use it to clearly define the point at which a patient should be referred to a periodontist?

Dr. Ackermann:
NIWOP is specifically intended for all who work with implants. It is important for the patient to have a healthy or periodontally pre-treated, non-inflamed implant environment.
Otherwise they are almost certain to get periimplantitis when they have an implant. There is evidence that patients with periodontal diseases in their tissues have a significantly higher risk of periimplantitis. Anyone working with implants should be familiar with the diagnosis and treatment of periodontitis and the treatment steps associated with this.

To what extent are you planning to include disciplines associated with periodontal diseases such as cardiology, diabetology, gynaecology in NIWOP, to name but a few?

Dr. Ackermann:
There is no longer any debate about the fact that risk factors such as smoking, nutrition, diabetes and genetic factors affect the progression of periodontitis. Conversely, what are known as systemic diseases such as cardiovascular diseases can be triggered by periodontitis.
The dentist should always be aware of everything that periodontitis can affect and what it is affected by. The specialists associated with periodontitis know about the links between the transmission of periodontitis to other tissues and the effect of systemic inflammation. This means they need to work hand in hand. When a patient first presents and when the first results are collected, a targeted medical history should be taken from the patient for the known factors. Particular focus and appropriate care must go into both the explaining of the situation, including the risk factors of systemic diseases, and motivating patients. At this point I want to thank my friend and the man who supported this idea, Dr Ralf Rößler, for his expert advice. Without him, the “baby” would never have been born.

Thank you for your time, Dr Ackermann