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Research Assessment and Maintenance of Dental Implants: Clinical and Knowledge– Seeking Practices of Dental Hygienists

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Research Assessment and Maintenance of Dental Implants: Clinical and Knowledge– Seeking Practices of Dental Hygienists Research Assessment and Maintenance of Dental Implants: Clinical and Knowledge– Seeking Practices of Dental Hygienists Sue Tucker Ward, RDH, MEd; Charlene A. Czuszak, DDS, MS; Ana Luz Thompson, RDH, MHE; Mary C. Downey, RDH, MS; Marie A. Collins, RDH, MS, EdD Introduction Abstract Dental implants have become the Purpose: This study surveyed dental hygienists in order to treatment of choice for replacing assess their routine approach for dental implant maintenance missing teeth, and the frequency and to determine if a relationship exists between the formal of placement has rapidly increased education of dental hygienists and their previous attendance since the mid–1960s.1 Varying re- and interest in future implant related continuing education sults have been reported in studies courses. related to assessing dental implants, identifying signs of failure, planning Methods A survey was distributed to dental hygienists at- continued care, implementing treat- tending an annual national continuing education course. Par- ment and evaluating outcomes.2–5 ticipants voluntarily completed and submitted their survey Researchers have expounded on before the end of the first day of the 3 day course. various protocols for the assessment Results: The results indicate that there is a statistically sig- of dental implants, which include nificant relationship between the level of formal education obtaining radiographs and assessing and implant related continuing education course attendance. periodontal health (probing depths, Dental hygienists whose formal education did not include mobility, bleeding on probing and dental implant care were more likely to attend implant re- inflammation).6,7 After systematic lated continuing education courses than those whose formal reviews of randomized controlled education included this content. The majority of the dental trials, Faggion et al developed an hygienists expressed interest in continuing education courses evidence–based algorithm for the on dental implants. Results of chi–square analysis show a treatment of peri–implantitis.4 statistically significant relationship between the type of edu- cation and interest in attending implant related continuing It is widely known that bleeding education courses. There was no statistically significant dif- on probing is an indicator of inflam- ference in continuing education interest between dental hy- mation of soft tissue whether around gienists whose formal education did or did not include dental natural teeth or implants. However, implants. there is controversy regarding the Conclusion: Additional continuing education courses have frequency of probing around den- been completed by most dental hygienists whose curricula tal implants due to risk of damag- did not include formal training on dental implant care. Most 5 ing delicate peri–implant tissues. dental hygienists are interested in gaining additional knowl- Another concern is introducing bac- edge whether or not their dental hygiene curriculum con- teria into peri–implant tissues from tained content on dental implants. surrounding teeth for which Terra- ciano suggests avoiding cross con- Keywords: Dental implants, dental hygienists, oral examina- tamination by probing and scaling tion, instrumentation, dental continuing education dental implants first.2 Overall, re- This study supports the NDHRA priority area, Clinical Dental searchers agree that gentle probing Hygiene: Assess the use of evidence–based treatment rec- is an important part of the implant ommendations in dental hygiene practice. recall.2,5,7,8 The use of plastic probes is recommended to provide more flexibility when positioning it parallel produce less damage to the implant surface and to to the long axis of the abutment.2,9 For the most 104 The Journal of Dental Hygiene Vol. 86 • No. 2 • Spring 2012 gentle probing around dental implants, a plastic scores improved in both groups, with no effects controlled–force probe is recommended.10 on probing depths15 • Resin tipped scalers versus gold coated or Heitz–Mayfield described best practices for de- graphite instruments: resin tipped scalers do tecting implant failure using mobility tests and ra- not create scratches and performed better than diographic findings.11 Radiographs are deemed an gold coated/graphite instruments16 integral component of implant maintenance and • Plastic scalers versus ultrasonic device: plastic the most important assessment tool for evaluat- scalers produced less alteration of titanium sur- ing implant status.6,12 The literature varies as to faces than ultrasonic device17 the recommended interval for taking radiographs. • Curettes versus ultrasonic device: no group dif- Recommended maintenance protocols distinguish ferences in the ability to reduce the microbiota necessary care during and after the first year of in peri–implantitis3 implant placement. A few of the various protocols • Ultrasonic scalers covered with a plastic sheath suggested are: and Ultrasonic scalers with carbon tips versus metal scalers: carbon and plastic tipped ultra- • Initial placement: 6 months, 12 months and sonics produced smooth implant surfaces while every 2 years12,13 metal tips resulted in damaged implant surfac- • Initial placement: 1, 3 and 5 years if no pathol- es18 ogy present5 • Initial placement: 6 and 12 months, annually Dental hygienists are routinely responsible for if no pathology present – if pathology present, the continuity of patient education and maintenance every 6 months until resolution14 of dental implants, years beyond initial placement. This care is referred to as the “first line” therapy Panoramic radiographs are most valuable when or the nonsurgical approach.4 However, there is a determining potential implant candidates.2 Radio- paucity of evidence based research regarding the graphs can be used to determine bone loss over best practices for implant maintenance, specifically time, to identify areas of radiolucency that could by the dental hygienist. Graduates prior to the late indicate implant failure, and to confirm adequate 1990s may have had little to no formal education seating of the abutment or prosthesis.2,5,8,9,11,12 Pe- on implant care, yet they are treating patients with riapical radiographs using the paralleling technique dental implants. Dentists are encouraged to active- have been recommended to assess bone loss and ly seek standardized and comprehensive training implant components.5 When evaluating dental im- via professional–centered education.4 Professional plants after placement, panoramic radiographs continuing education may similarly fulfill this need are considered helpful tools by some while others for dental hygienists. question their value.5,13 In this current study, authors surveyed dental The dental hygiene appointment may include de- hygienists from diverse educational and practice bridement of hard and soft deposits using hand and backgrounds in order to assess their routine ap- power instruments designed specifically to protect proach for dental implant maintenance. This study the delicate implant surface. Recare intervals of 3, also sought to determine if a relationship exists 4 or 6 months are recommended for careful evalu- between the formal education of dental hygienists ation of peri–implant tissues by the dental hygien- and their previous attendance and interest in fu- ist and dentist.8 ture continuing education courses about implants. Persson pointed out that it is likely that the in- Methods and Materials struments available for debridement around im- After an extensive review of the literature, fac- plants are not properly designed to reach affected ulty at the Medical College of Georgia Department areas.3 This limitation is mentioned because im- of Dental Hygiene developed a 24–item paper plant design, location and clinical conditions make survey specifically for this study. All items on the it difficult to provide adequate debridement of survey reflected content found in publications that dental implants. While searching for ideal implant addressed maintenance of dental implants. Only tools, researchers have studied the effect of sev- the faculty considered the questions and content eral debridement instruments on implant surfaces. validity of the survey. The protocol for this study Summaries of their findings include: was submitted to the institution’s Human Assur- ance Committee. Upon review of the proposal, it • Titanium hand instruments versus ultrasonic was determined that this study was not considered scalers: no group differences were found in human subjects research as defined by the federal the treatment outcomes. Plaque and bleeding regulations because the data obtained was restrict- Vol. 86 • No. 2 • Spring 2012 The Journal of Dental Hygiene 105 ed to assessing the practices of dental hygienists. Table I: States Where Participants Practice Dental Hygiene Upon arrival to an annual national continuing education course, the instrument Dental Hygiene State Number % Care of Implants–Survey of Dental Hygienists was GA 277 75 distributed to all attendees (n=370). All course SC 43 12 attendees were female and the states they rep- NC 19 5.1 resented are shown in Table I. Participants were conveniently sampled and volunteered to submit FL 17 4.6 their survey before the end of the first day of the VA 2 0.5 3 day course. Surveys submitted after the first day KY 2 0.5 of the symposium were not included in this study because lectures on implant maintenance were MD 1 0.3 scheduled for the second day. Completed surveys NJ 1
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