today EAO Madrid October 05, 2017

science & practice abutments4life esthetics simplified + predictable D A prosthetic.line The role of prevention in implantology By Dr Peter van der Schoor, The Netherlands (cid:132) In October last year, I had the hon- our of speaking in front of a medical and dental audience to explain my ap- proach to prevention. In my lecture, I talked about our new “perio profiling” approach using saliva and aMMP-8 di- agnostic methods. The thing is, we need to treat patients between the ages of 20 and 40 differently to those who are 40 years and older. Certainly, everyone can get periodontitis, but my younger patients visit my dental prac- tice less frequently, which means they are at a higher risk of developing per- iodontal diseases. Interestingly, we have always had difficulty achieving the necessary compliance from pa- tients in this younger age group to ob- tain good dental hygiene in order to prevent periodontitis. Also, we have found that well- known diagnostic methods, such as PSI or BOP, do not necessarily “look ahead”, nor are they predictive—which is exactly what we need to make sure we are not always too late with our treatment. Now, finally, we have found a way to do this. The well-documented collagen de- struction indicator, aMMP-8 can be measured in the saliva (with PerioSafe) and is, for us, the new gold standard for predictive analysis in pre- ventive dentistry. It helps us identify the patients with the greatest need for preventive treatment and at the right point in time, which is when the sub-clinical collagen destruction of periodontal tissue has started, but it is not yet visible. Fortunately, the Dutch public health insurance system has recog- nised the “predictive value” and solid scientific data of aMMP-8 diagnostic methods and is going to fully reim- burse the cost of the diagnostic treat- ment for every patient by 2018. This decision is a breakthrough for tar- geted healthcare in dentistry. A proven concept At my practice, we ran a study with over 200 periodontally-healthy patients, between the ages of 20 and 40 years. Each patient received a free PerioSafe test. Interestingly, 40 per cent of these participants tested positive for the presence of aMMP-8. All of these patients wanted to stay at our practice for an oral hy- giene treatment. Of the other 60 per cent who had a negative result, around ten per cent still asked for an oral hy- giene treatment. This means that only one test is necessary to triple the num- ber of dental hygiene procedures for 40 per cent of the patients in your practice. I have done over 30,000 implants in my life and about ten per cent of those have failed. The overwhelming majority of failures were due to pa- tients developing peri-implantitis. For patients who would like to have im- plants, we first have to determine what has gone wrong with their natural dentition. Which is why, prior to implant placement, we use the PerioSafe test to evaluate whether there is silent inflammation that might need attention. After the implant sur- gery, we use the Implant Safe test for regular monitoring to prevent peri-im- plantitis. The patient has to test nega- tive for aMMP-8 to guarantee tissue stability and since our strategy is sus- tainability, aMMP-8 is the most effec- tive diagnostic tool avail- able to date. Looking forward, we now have to step into the world of digital saliva di- agnostics that is per- formed as a chairside, aMMP-8 quantification with the ORALyzer, which is one of the big- gest inventions in den- tistry, because it allows us to precisely look at the patient’s immune re- sponse system and print out an analysis report within a couple of seconds. This tool is exactly what we need to fight peri-im- plantitis and periodontitis. With the ORALyzer can even measure the suc- cess of our treatment by seeing a re- duction of aMMP-8 concentration in the saliva, measured in ng/ml. Some dentists think they cannot earn money with prevention, but I want every dentist to understand that 40–50 per cent of all patients will need two to four dental hygiene proce- dures per year to prevent deteriora- tion. aMMP-8 saliva diagnostics open the door to much needed “patient tar- geting” and “compliance” and there is nothing else available that can com- pare to it at this point in time. It is a prevention-need-indicator and a pa- tient motivator. Simply do the calcula- tion for yourself, it is a win-win for the dentist and the patient. (cid:26) Editorial note: This article was origi- nally published in Prevention – Inter- national Magazine for Oral Health 1/2017. Author Dr Peter van der Schoor is director of Implacademy in Garde- ren in the Netherlands. + Time to Teeth. Implantology has never been easier. Cendres+Métaux SA Rue de Boujean 122 CH-2501 Biel/Bienne Phone +41 58 360 20 00 info@cmsa.ch www.cmsa.ch/dental

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