No foothold for periimplantitis -
the tool for successful prophylaxis

Source: Implantologie Journal 3 / 2015
Authors: Jenny Hoffmann, Oemus Media AG

A number of studies published in recent years show that one third to one half of all implants are subject to the danger of periimplant diseases.¹ Without adequate treatment these will generally result in loss of the implant. The risk of inflammation of the periimplant hard tissue (periimplantitis) and/or soft tissue (periimplant muscositis) is particularly high for patients with periodontitis and it significantly increases the risk of implant loss.² Therefore a suitable prophylaxis concept for the period after implantation is very important.

Consultation and compliance

While a consistent recall programme with regular check-ups is important, the active cooperation of the patient in the maintenance of oral hygiene at home is equally important for reducing the risk of periimplant disease. Because the attachment of the gum with the implant is looser than the natural attachment to the tooth, biofilm can more easily accumulate in the intermediate spaces. The patient should therefore be made aware of recommended hygiene practices for daily cleaning. Prophylaxis should also include advice in risk reduction, such as avoiding tobacco and alcohol.

Professional implant cleaning

In contrast with conventional treatment, differences in the tissue must be taken into account during professional implant cleaning and periimplantitis treatment. The use of metallic hand scalers and curettes should be avoided as much as possible to prevent scratching or roughening the surface of the implant. Even when plastic hand instruments are used, great care is required due to the increased sensitivity of the periimplant tissue.
Currently abutments and implant crowns are mostly cleaned mechanically by air-polishing with low-abrasion powder or special ultrasonic scalers. A chemical disinfectant solution and, more and more frequently, photodynamic therapy (PDT) are used as adjuvant measures for decontamination.

The W&H Tigon+ piezo scaler is equally suitable for periodontic and periimplant treatments.

Atraumatic removal of concretions

The Tigon+ (W&H) has become one of the most commonly used ultrasonic scalers, offering flexibility and atraumatic functioning. This piezo scaler can save time and offer versatility with four preset programs and one customizable program.
With its prophylaxis and periodontal settings using special implantology tips the Tigon+ is ideal for periimplantitis treatment. The adjustable power ensures atraumatic removal of deposits. In basic mode the scaler power remains constant regardless of the pressure on the tooth or implant, and in smooth mode the greater the pressure of the tip of the instrument the lower the power. In power mode the power is increased as the resistance increases. This offers the correct setting for every situation, to avoid injuries and an unpleasant feeling in the mouth of the patient.
The piezo scaler comes with a set of periodontal and prophylaxis tips. The plastic 1i Implant-Clean tip can be also be used for atraumatic and thorough cleaning of implants and the associated superstructures.
The ergonomic design of the Tigon+ and the illumination with the 5x ring LED make removal of concretions simple and efficient. The facility for heating the coolant fluid also enables treatment of sensitive areas without irritation.

Conclusion

The high sensitivity of periimplant tissue requires careful use of suitable instruments for treatment of the tissue and professional implant cleaning. Treatment with the piezo scaler used here is particularly atraumatic for the tissue and reduces stress for the patient, and at the same time the dentist can work quickly and efficiently with programs designed for specific situations. This means that the patient is more prepared to cooperate with regular check-ups and cleaning and greatly increases the chance that periimplantitis will be prevented successfully.

¹ Academy Report: Peri-Implant Mucositis and Peri-Implantitis: A Current Understanding of Their Diagnoses and Clinical Implications. Journal of Periodontology. April 2013, 84:4, 436–443.

² Sgolastra F, Petrucci A, Severino M, R Gatto, Monaco A: Parodontitis, Implantatverlust und Periimplantitis. Eine Meta-Analyse. Clin Oral Implants Res 31. Dezember 2013 doi: 10.1111/clr.12319.

Dr. Mariana Mintcheva and Dr. Christian Dan Pascu of the Düsseldorf Discover White dental practice discussed their experience with Tigon+.

Dr. Pascu, Dr. Mintcheva, what are the primary specializations of your practice? Since when have you been using Tigon+ and for what do you use it primarily?

The primary focus in our practice is on implantology and aesthetic dentistry. However, we do of course offer the complete range of services in modern dentistry. We have been using the Tigon+ since we first established our practice and it is now thoroughly integrated into our workflow as an essential instrument for our range of treatments. We use it most often for prophylaxis, which we consider a very important part of dentistry. We use the 1P attachment in periodontal treatment for removing deep concretions in inaccessible places without injuring the gingiva.

Tigon+ offers five treatment options for prophylaxis, periodontology, endodontics and restorations and there is also a user-defined program. How does the fast adjustment of parameters by pushbutton work during treatment?

Everything that has a simple and clearly laid-out design is a great advantage in dentistry. All W&H devices offer this feature. The simple and fast handling makes it easy for us and our team of assistants to optimize and simplify our treatment processes. And of course our patients also appreciate this.

Three modes of scaler power can be selected on the instrument. How important is this power regulation, for example, in the treatment of periimplantitis patients?

The different modes offer a wide range and can be very precisely adjusted for the specific requirements of the dentist. This applies not just to the treatment of periimplantitis.

Tigon+ also includes numerous universal and special tips for various indications. How would you rate the variety and functionality of the range of tips and specifically what has your experience been with the 1i implant tip?

The fine and slender tips in particular simplify atraumatic removal of deep-seated concretions without injury to the gum. Their shape allows access to areas that are very difficult to access and could only be reached with great difficulty or not at all using curettes.
The special 1i implant tip for treatment and prophylaxis of periimplantitis replaces the plastic and/or carbon curette. The special surface of this tip allows the surface of the implant to be cleaned without scratching and thus prevents the formation of a new niche for deposition of plaque.

The coolant in the tank of the scaler can be heated to three heat settings. How frequently do you use this option and how do your patients respond?

This is a very important factor. In the past many patients have stopped their prophylaxis session because the cold water on the open tooth necks was simply too painful. Patients have responded very positively to the heated fluid. Another advantage is that disinfectant solutions such as chlorhexidine 0.2% or hydrogen peroxide 1-3% can be used.

Thank you for your time!