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Dental Tribune Asia Pacific Edition | 11/2017 SCIENCE AND PRACTICE 11 tients developing peri-implantitis at a later date. Infection control also means that patients must have really good oral hygiene. They must have low full-mouth plaque scores, which again is strongly supported by evidence that suggests patients with poor plaque control are at a much greater risk of developing peri- implantitis. Of course, once one has achieved good infection control, one then needs to ensure that there will be good access for clean- ing the implant site once the pros- thesis has been placed. This will allow the patient to continue in- fection minimisation practices at home. If one designs a prosthesis that is inaccessible through the cleaning habits practised by the patient, it is simply more likely that he or she will contract an in- fection later on. As a practising periodontist, how have you implemented a preventa- tive approach to infection control? Having good infection control before placing implants is crucial, as it is the best way to prevent these infections occurring later on. When I am planning for im- plant procedures, I make sure that I start with a good foundation where any infection has been dealt with and that the patient has displayed good compliance and is likely to continue to do so. That is the key to prevention: to make sure that the patient has a healthy oral cavity with little plaque and no periodontal disease before one starts. A preventative approach re- quires several elements to work effectively: regular monitoring and supportive periodontal ther- apy with professional biofilm con- trol, a healthy and regular at- home oral hygiene routine, and controlling for other risk factors, such as smoking and uncontrolled diabetes. By managing these po- tential issues, dental professionals and patients can work together to help prevent the recurrence of periodontal disease and occur- rence of peri-implantitis. How important is it to properly mo- tivate a patient to engage in these preventative measures and under- stand, say, what the role of a good oral hygiene routine is? It is extremely important. Again, it is key that, right at the be- ginning of the treatment plan- ning phase, patients are informed of the risk of complications if they do not maintain good oral hy- giene supplemented with regular professional care. Recent litera- ture shows that patients with im- plants must receive check-ups and supportive care at least twice a year. For patients who have lost their teeth owing to periodontal disease, we know that they are at a higher risk of having similar prob- lems around their implants. These patients then really need to un- derstand and be informed of the importance of good oral hygiene and regular preventative, sup- portive care prior to engaging in the rather costly business of get- ting an implant. What role does regular profes- sional prophylaxis play in prevent- ing peri-implantitis? It comes back to the responsi- bilities of dental professionals: they need to identify early signs of inflammation, such as peri-im- plant mucositis, which is an in- flammation of the soft tissue, and treat that before it develops into peri-implantitis and initiates bone loss. Evidence shows that management of peri-implant mucositis is a prerequisite for the primary prevention of peri-im- plantitis. Removing the harmful bio- film from the exposed surface of an implant with peri-implantitis, though, can be very challenging. There is a different morphology to it, along with a modified surface that is often rough and tends to harbour the biofilm in a way that it is very difficult to remove. However, as with periodontal disease, it’s much easier to man- age and treat peri-implant disease before it becomes too severe. The best way to prevent it is through early detection of the signs of in- flammation so that treatment that reverses this process can take place. From a prophylactic point of view, the periodontally healthy patient is the best patient. Do you agree? Of course. It is really impor- tant that patients have good peri- odontal health so that they do not have deep periodontal pockets and reservoirs of bacteria that could lead to colonisation of bio- film around the implants. Patients need to come for check-ups on a regular basis so that the early signs of disease can be identified and dealt with. In addition, we should remem- ber that, sometimes, things can go wrong around implants; for ex- ample, if a patient has a screw-re- tained restoration and there is a mechanical problem or techni- cal issue, such as a loosened screw, then a problem with bac- terial accumulation may arise and peri-implantitis may de- velop. Though periodontal health is important, regular check-ups of the prosthesis and the patient’s overall oral health are also crucial in preventing not just peri- implantitis but other intraoral is- sues as well. Thank you very much for the inter- view. AD Brushing your teeth is fun. Exceptionally gentle with 5460 delicate Curen® filaments. #cs5460 #curaprox follow us on curaprox.com © Ocskay Mark/Shutterstock.com