The healthy patient with early periodontal disease*
The 68-year-old patient has no general health conditions and is not taking any medication that may be relevant to her oral health, and her lifestyle does not pose any particular risk. The patient has two dental implants (3rd quadrant, for five years) and a previous case of periodontal disease (stage IV, grade B periodontitis) with tooth loss. Currently the periodontal conditions are stable. However, periodontitis significantly increases the biological complications of implantations and there is a risk of implant loss (21). Four recommendations can be determined for the prophylaxis session.
As the patient does not have any particular risk factors with specific dental implications, the requirements determined from her current state of oral health are crucial. Here, it is recommended that a thorough assessment of periodontal condition be carried out once a year. This will ensure that any potential progression of the previous periodontal disease or development of peri-implantitis can be responded to in good time.
Despite the stable conditions, it is also crucial for the instructive/motivational discussion to be conducted with this patient. Particular attention should be paid to teaching the patient how to care for the implants correctly. Here in particular, good at-home maintenance can have a significant impact on the long-term stability of oral and implant health.
In terms of instruments, specific procedures are required for use with implants. In order to preserve the surface of the implant while cleaning it effectively, it is essential to choose suitable powders and instruments such as the targeted use of air polishing devices with special periodontal tips. Which powder is most suitable can be determined according to the needs and risk. For example, in addition to the appropriate degree of abrasion, dietary requirements (including sugar-free, low-salt) may also be taken into account.
Because the patient has implants and a history of periodontal disease, she is at risk of developing peri-implantitis. It is therefore recommended that she attend a recall session every three to four months.
* with the kind permission of Dr G. Schmalz and Dr D. Ziebolz MSc.
Individual Prophy Cycle – The patient-oriented prevention concept
Priv-Doz Dr Gerhard Schmalz is a senior physician at the Oral Health Medicine, Polyclinic for Dental Preservation and Periodontology, University Hospital Leipzig, Leipzig (Director: Prof Dr Rainer Haak).
Prof Dr Dirk Ziebolz MSc is a senior physician at the Polyclinic for Dental Preservation and Periodontology, Leipzig University Medical Centre (Director: Prof Dr R. Haak); with focus on interdisciplinary dental preservation and health services research.
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