THE DEMOGRAPHIC TREND The chance for your prophylaxis service!

Transcription

1 THE DEMOGRAPHIC TREND The chance for your prophylaxis service! Dr. Hans-Joachim Kleber A new age elder patients Dr. Sven Rinke Aftercare - The basis for successful implant-borne restorations Prof. Dr. Alexander Gutowski Prophylaxis for dentures state of the art Ideas for dental technology

2 Observations of the Dental Market: A new age - elder patients A report by: Dr. Hans-Joachim Kleber Weil im Schönbuch, Germany Do you like to use the quiet times to relax and contemplate too? I value this opportunity as it allows me to take stock and prepare for my forthcoming options. During my many years as a dentist I have experienced so much change and am aware of the diverse range of developments which lie ahead: The prominence of implantology, adhesive techniques and CAD/CAM based laboratory techniques as well as the various options which are available to us on a daily basis! Some amazing developments have also Men taken place: The number of children and teenagers suffering from caries has fallen continuously within the last few years (according to the WHO and other studies in 1973 a DMF-T-Index of 3.3 in comparison to the latest results 1.2!), and has reached values which a few years ago we thought to be utopian. At the same time there seems to be a concentration of certain high-risk groups requiring a totally new diagnostic approach and form of care. The best example of this is the demographic trend, to which there is no foreseeable end as yet, and the change in Women the age pyramid which already isn t a pyramid anymore! forces us to face new challenges: Today, the percentage of over 60-year-olds in the total population lies at 18.4 mil., for the year mil. are predicted, and this number is rising! Although the reduction of caries in children is a pleasing fact for prophylactic dentistry, treatment and supervision of our elder patients presents us with new and demanding responsibilities, particularly as more than 500,000 patients already live in residential homes for the elderly in Germany alone. Can you relate to those often frustrating situations during treatment when you are confronted with a progressing root caries, periodontal problems or poor oral hygiene on teeth and dentures which are simply impossible to cure? Thousand Age In this field there is unquestionably an urgent need for action. Dentists and laboratories will need to develop new specialised treatment procedures. The bodies responsible for institutions such as these, will need to train their personnel specifically (according to statistics more than 80% of nursing staff are presently unqualified employees) and the infrastructure can be greatly improved by Developments in the dental market the implementation of new and specialised aids and equipment. It is reassuring for me to know that new possibilities will arise for all of these challenges, not least from developments in the dental industry with new machines and equipment. So, a good reason for reorientation and approach the new tasks with optimism and dedication! Let s go for it! Demographic trend in Germany according to the Federal Office of Statistics Source: Source: Renfert Report,

3 Practice-integrated, efficient aftercare concepts as the basis for success in implant prosthetics Introduction The success of endosseous implants has been proven by comprehensive data in numerous clinical studies. Initially interest was focussed on the success rate of osseointegrated implants in different areas of indication and bone quality as well as the effect of various implant designs (Esposito et al. 1998). It was only later that implant failures, which occurred during the functional phase of the restoration, also became a focus of interest. Apart from technical complications, biological problems are an example of failure risks in the functional period of the restoration (Norowski and Bumgardner 2009). The main cause of biologically induced problems in the late phase is progressive peri-implant inflammation, which leads to destruction of the peri-implant hard tissue and consequently implant loss in the final stage (Lang et al. 2001). A report by: Dr. Sven Rinke Hanau and Alzenau, Germany Infection pattern The development of peri-implant mucositis has been proven to have a close causal relationship with bacterial plaque, despite the anatomical differences between teeth and implants (Beikler et al.2005). The microbial colonisation and formation of a multispecies biofilm follow the same pattern as on natural teeth. The submucosal biofilm accumulation is also an important aetiological factor with peri-implant diseases. The microflora associated with peri-implantitis consists of periodontal pathogen species, which resemble the spectrum of periodontitis (Luterbacher et al. 2000). It can be assumed that bacterial processes on dental implants follow the same pattern as periodontitis through translocation of bacterial germs from ecological niches in the oral cavity (back of the tongue, tonsils, buccal mucosa) as well as the supragingival and subgingival environment of the existing dentition (Klinge et al. 2002). Limits in therapy require prevention Occasionally extensive dental interventions are required with peri-implant diseases in order to maintain the function of an implant. In addition, not all current therapy options have been scientifically validated, as they only partly enable restitutio ad integrum. Effective prevention of periimplantitis is therefore in the interest of the patient and cost bearers as well as in that of the medical provider. Based on the knowledge that the aetiological infection pattern on the teeth and implants progresses in a similar manner the basic diagnostic methods used in periodontology can be applied with implant patients (Beikler et al. 2005). To ensure early diagnosis of peri-implant complications, it is highly recommended that patients with implants are included in an integrated aftercare concept (Esposito et al. 1999). Recall intervals of 3 months have proven successful in the case of partially edentulous patients and patients treated with implants. The recall interval should be 3 to 5 months (depending on the individual status of oral hygiene) for edentulous patients who have been treated with an implant-supported restoration (Lang et al. 2000). The peri-implant probe depth should be recorded regularly at six-month intervals using the clinical parameter bleeding on probing. To ensure optimal aftercare, these values should be compared with the initial findings when the implant was first loaded. Recording the pocket probing depth at implants using special plastic periodontal probes, which was a requirement for many years, is now no longer considered necessary. Conventional metal periodontal probes not only just alter the rough implant surface to an insignificant degree but also ensure more reliable and reproducible diagnoses due to their more slender diameter and greater inherent rigidity in comparison with plastic probes. The radiological check of the peri-implant bone site is also given greater significance; a radiological check is recommended after 1, 3, and 5 years of prosthetic loading and if there is normal clinical progress, it should be completed every 5 years (Zitzmann el. 2006). Peri-implant aftercare concept At this present point in time there are no generally accepted guidelines for cleaning implant surfaces. The use of a combined mechanical anti-infective therapy similar to periodontitis therapy seems practical (Beikler et al. 2005, Esposito et al. 1999, Before cleaning After cleaning with SYMPRO 3

4 Before cleaning After cleaning with SYMPRO Zitzmann et al. 2006). Mechanical removal of the bacterial biofilm is mainly used in the routine aftercare of implant patients. Air-powder-water sprays with a minimally abrasive blasting agent and also silicone cups with polishing paste or specially developed sonic scalers with silicone tips are suitable for subgingival cleaning of the polished surfaces of implant shoulders and superstructures (Mombelli & Lang 2000). With peri-implant bone loss any cleaning of the predominantly rough implant surface that is necessary can also be performed using conventional sonic scalers, as instrumentation only alters the property of the implant surface to an insignificant degree (Lang et al. 1999). At present, the minimally abrasive air polishing technique using a glycine-based agent seems to be the most efficient and gentle method for conditioning submucosal implant surfaces. Adjuvant procedures in the aftercare concept Operator-removable superstructures should be removed, if possible, during implantological aftercare. This not only creates better access to the individual implants but also enables the superstructure to be cleaned separately. In the case of implantretained overdentures separate cleaning of the attachments and overdenture is particularly important, as there could be accretion, discoloration or calculus on these units. In the majority of cases the use of ultrasonic cleaners alone is not adequate for producing a satisfactory result. Generally in these instances further cleaning is required using rotary instruments and drills a procedure that is very time consuming and that is not sufficiently cost-effective in terms of business management. Efficient, effective cleaning Needle-cleaning techniques have been recommended for cleaning dentures for some years. The term needle cleaning is derived from the metal pins, which are used as a second component in combination with liquid during cleaning. A rotary magnetic field sets the pins in motion, which then produce gentle mechanical removal of the surface accretion. The rotating needles heat up the cleaning solution to approx. 45 C and so accelerate the chemical reaction. This technique allows dentures that have been in situ to be cleaned fully automatically. Stubborn discoloration and calculus can be eliminated without removing any material, even on areas that are difficult to access. Many years of clinical experience with these systems indicate that interdental spaces, fissures and complex structures of precision attachments and retentive elements are also effectively cleaned using this technique. Needle cleaning can be provided as a practical additional service within the parameters of a structured prophylaxis programme. Generally patients who undergo implant prosthetic treatment are more compliant than patients who undergo conventional prosthetic treatment. The primary target group for additional services in a prophylaxis programme is therefore to be found in this segment: these patients attend the practice regularly and they have already exhibited their willingness to pay by opting for a high-quality restoration. A newly developed unit (SYMPRO, Renfert) based on the needle cleaning technique was recently introduced to the market. This unit is much more efficient than previously available units, as it is possible to clean a denture effectively within 15 to 20 minutes. This means that the full cleaning cycle for the restoration can be completed parallel to the prophylaxis appointment when the peri-implant aftercare is complete, the removable restoration has also been cleaned. Integration in the practice This service can be invoiced as a practice laboratory position according to BEB (standardised price list for German laboratories). BEB 8123 or 8124 can be used for the denture cleaning procedure; accordingly an amount of euros can be achieved (with ongoing material costs of approx. 2.5 euros and an initial investment of approx. 700 euros) for each cleaning cycle depending on the capacity. Even in the case of practices with small or medium prophylaxis areas the option of automatic denture cleaning using the SYMPRO system produces a cost-effective increase in the efficiency of prophylaxis and ensures greater customer loyalty. Source: DZW, Issue 26/10 4

5 Clean dental restorations quickly and effectively Wearers of partial or full prosthetic restorations have always had high demands in terms of prophylaxis, aesthetics and oral comfort or wellbeing. And more and more patients would like their»false teeth«to be treated in the same way as their»natural teeth«. Professional cleaning of restorations is therefore an important component in individual prophylaxis A report by: Prof. Dr. Alexander Gutowski Schwäbisch Gmünd, Germany Prof. Gutowski, what in your experience are the consequences of inadequate denture care? The formation of bacteria, plaque and calculus with their known effects. There is also inflammation at the denture base, impairment of taste and taste sensitivity, incidentally this also happens if the denture is not completely clean. It is therefore particularly important to ensure complete cleanliness. Further spreading to other organs also occurs, though this is very rare. While going to the hairdressers or inspection of the car is regarded as normal, it is still very difficult to convince many patients about the necessity of increased prophylaxis and cleaning. This was still very pronounced a few years ago. Nowadays, however, the situation has changed significantly. Not everyone responds to the undoubtedly sound medical reasons given by the dentist. Often the very positive effect on their normal life and living environment simply has to be explained to the patients. It has never been attractive to go around with bad breath or an unsightly restoration, especially not nowadays. Many patients find it easier to understand the need to improve acceptance, attractiveness and quality of life. Which types of equipment do you normally use for cleaning dentures? We have been using the SYMPRO highperformance cleaning unit for some time. Why do you use this unit in particular? It has proved to be effective at cleaning dentures. Extensive tests have convinced us of its advantages. Our dental assistants are very happy with the unit and they have to clean the dentures and know what they are talking about. The unit is also very easy to operate. What more can you ask for. What exactly does quicker mean? Denture cleaning only takes a maximum of 20 to 30 minutes in our practice, the patient can then go home again with a clean denture. How do your patients react to this? They are pleased of course, who likes to wait for a long time. In addition, those patients who get their denture back after the first cleaning notice that they could never have cleaned the denture so well themselves and always come back at certain intervals to get their denture cleaned again. What do you expect from effective denture cleaning? Medically: cleaning in regions that are difficult to access. Technically: smooth surfaces. After the cleaning procedure the denture must be perfectly clean! All accretion must be removed, as it could irritate the mucosa and cause inflammation and even distorted taste perception. It is also important to clean the mucosa, as otherwise it could lead to the ping-pong effect. How often do your patients attend the practice for denture cleaning? Wearers of fixed-removable and full dentures visit the practice regularly, approximately every 6 months. The denture is then cleaned professionally in the practice. Testimonial at Products Equipment Cleaning units SYMPRO 5

6 Service in only one visit: SYMPRO, the clever idea for dental clinic, laboratory and patient! In future, let SYMPRO carry out the professional cleaning of removable dental restorations and orthodontic appliances. This fully automatic and highly efficient cleaning process doesn t take up any of your valuable resources for this unprofitable and unpleasant task. Conventional cleaning methods are time consuming and costly. These and other disadvantages were taken aboard by our development department and eliminated with this innovative system. The SYMPRO takes on the important task of denture cleaning at your service and subsequently contributes to the value of your practice and laboratory. Plaque AND tartar are removed in only approx. 15 mins! At last, a fast and above all hygienic denture cleaning process with the SYMPRO system! 6

7 Use in only three steps: 1 2 Filling-up Add needles, SYMPROfluid Universal cleaning liquid and object, e.g. one patient s upper and lower dentures. Start Set the desidered cleaning time and start the unit. 3 Remove Rinse the object thoroughly with water before bringing it into contact with the patient and disinfect as prescribed by the hygiene regulations. SYMPROfluid Nicoclean is used wherever posttreatment is necessary to remove stubborn nicotine stains. 7

8 Advantages for the patient ffimproved oral hygiene and well-being ffthe patient feels looked after and regularly cared for ffbetter quality of life without fear of bad breath Advantages for the clinic fflow capacity commitment ffhigh hygiene standards ffpotential high return ffcustomer loyalty Support for your success in the practice Together with the SYMPRO, you will receive the patient s information brochure»well-being through Oral Hygiene«, as well as a waiting room poster, for ongoing success with your new SYMPRO-system. Improve your quality of life! Your smile is your most attractive piece of jewelery. Well-being through oral hygiene You regularly take your car for a service and feel safe? You visit the hairdresser regularly and take care of your looks? You treat yourself to a massage or wellness treatment and thus improve your well-being? Pay a little attention also to your denture! You will feel better and more confident if: your dentures do not cause bad breath you can laugh without feeling insecure you prevent illness Have your denture cleaned regularly and professionally at your dental clinic. A small step for more well-being. +J A EN 8