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Implant Tribune Asia Pacific Edition

22 SCIENCE AND PRACTICE Implant Tribune Asia Pacific Edition | 11/2017 The role of prevention in implantology Increasing patient compliance and treatment outcomes through saliva diagnostics Dr Peter van der Schoor has placed more than 30,000 implants in his professional career and is an avid lecturer in the field. By Dr Peter van der Schoor, Netherlands In October last year, I had the honour 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 pro- iling” approach using saliva and aMMP-8 diagnostic 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, every- one can get periodontitis, but my younger patients visit my dental practice less frequently, which means they are at a higher risk of developing periodontal diseases. Interestingly, we have always had dificulty achieving the necessary compliance from patients in this younger age group to obtain good AD Sign up FREE – weekly e-news delivered to your inbox – latest industry developments – event specials – exclusive interviews with key opinion leaders – product information – clinical cases – job adverts Sign up to the fi nest e-read in dentistry www.dental-tribune.com number of dental hygiene proce- dures for 40 per cent of the patients in your practice. I have done over 30,000 im- plants in my life and about ten per cent of those have failed. The over- whelming majority of failures were due to patients developing peri- implantitis. For patients who would like to have implants, we irst have to determine what has gone wrong with their natural dentition. Which is why, prior to implant place- ment, we use the PerioSafe test to evaluate whether there is silent in- lammation that might need atten- tion. After the implant surgery, we use the ImplantSafe test for regular monitoring to prevent peri-im- plantitis. The patient has to test negative for aMMP-8 to guaran- tee tissue stability and since our strategy is sustainability, aMMP-8 is the most effective diagnos- tic tool available to date. Looking forward, we now have to step into the world of dig- ital saliva diagnostics that is per- formed as a chair-side, aMMP-8 quantiication with the ORALyzer, which is one of the biggest inven- tions in dentistry, because it al- lows us to precisely look at the pa- tient’s immune response system and print out an analysis report within a couple of seconds. This tool is exactly what we need to ight peri-implantitis and perio- dontitis. With the ORALyzer can even measure the success of our treatment by seeing a reduction of aMMP-8 concentration in the saliva, measured in ng/ml. Some dentists think they can- not earn money with prevention, but I want every dentist to under- stand that 40 to 50 per cent of all patients will need two to four den- tal hygiene procedures per year to prevent deterioration. aMMP-8 saliva diagnostics open the door to much needed “patient target- ing” and “compliance” and there is nothing else available that can compare to it at this point in time. It is a prevention-need-indicator and a patient motivator. Simply do the calcula- tion for yourself, it is a win-win for the dentist and the patient. 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, inally, we have found a way to do this. The well-documented collagen destruction indicator, aMMP-8 can be measured in the saliva (with PerioSafe) and is, for us, the new gold standard for predictive analysis in preventive dentistry. It helps us identify the patients with the great- est 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 rec- ognised the “predictive value” and solid scientiic data of aMMP-8 diagnostic methods and is going to fully reimburse the cost of the diagnostic treatment for every patient by 2018. This de- cision 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 old. Each patient received a free PerioSafe test. Inter- estingly, 40 per cent of these partic- ipants tested positive for the pres- ence of aMMP-8. All of these pa- tients wanted to stay at our practice for an oral hygiene treatment. Of the other 60 per cent who had a negative result, around ten per cent still asked for an oral hygiene treatment. This means that only one test is necessary to triple the © Monika Wisniewska/shutterstock.com

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