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prevention International magazine for oral health No. 1, 2018

peri-implantitis | So, you argue that implants should be avoided as much as possible? Reuss: Well, implants are a great treatment modality and we are very thankful for this invention. However, im- plants should be delayed as far as possible. If we can preserve the tooth for ten more years and then place the implant, that is the way forward. Patients should not have their teeth removed and replaced with implants in- stead. After implant treatment, patients need to be twice as careful with their mouths. There is no way to go back to another solution. The dentist needs to communicate this as far as possible. Llorente: An implant is the best solution for a missing tooth, but it is not an alternative for a tooth that can still be saved. An implant is more expensive than maintaining the natural tooth, so we try to preserve the tooth if we still can. Do you think that implantology and prevention of implants can work side by side? Reuss: Prevention is the best thing one can do for one’s patient in the long run. If we can get our patients to believe in prevention and therefore come to the dentist more regularly, it will be beneficial for all of us. However, this is a long and bumpy road, as the patient’s oral care mindset cannot be changed easily. Llorente: Prophylaxis is the main way that conditions like peri-implantitis can be prevented. We know that im- plant treatment requires follow-up; implants need to be taken care of continuously, so it is very important to in- struct and motivate patients to have regular check-ups that are complemented by a good home oral hygiene routine. As a periodontist and implantologist, how do you work together? Reuss: In cases of severe periodontal disease, such as aggressive periodontitis, we try to delay the implant placement as far as possible. I am not talking about weeks or months, but even years. If we need ten years for a patient with periodontitis to have the necessary oral health for implant placement, then we wait. Sometimes, it depends on the patient; sometimes, it is the wrong ap- proach to oral hygiene; sometimes, it is genetics. At the same time, we have seen implant failure without any clear reason. Llorente: The major risk factors include bacterial con- tamination, a history of periodontitis and habits such as smoking. This means that we need to look at the patient’s habits and anatomy and the surgical protocol. These fac- tors are more related to early loss. Another factor is the prosthetic design. Reuss: When we see a patient with very poor oral hy- giene, we do not place the implants. We are that radical. We tell our patients that the periodontal tissue needs to be strong. In the case of poor oral hygiene, the implant will fall out eventually. We need to make sure that the patient has good oral health habits. Edentulous patients with a lack of good oral hygiene are not good candidates for implants. We have to do several hygiene appoint- ments first before continuing with implant placement. How can we motivate the patient to use oral care products more effectively and regularly? Reuss: First of all, we have a growing awareness of oral health among our patients. That helps a lot in the general predisposition of patients. When they come to our prac- tice, they have changed their dietary attitude and work out more. They are starting to believe more in prevention. They also come in every six months, while we only saw them every two years in the past. Llorente: In Spain, we still have this mindset that pa- tients only come when they are in pain. Now, we are mov- ing in this direction of coming at least every year. From a periodontal perspective, I would like to see my patients every three to six months, especially during maintenance therapy. During the dental appointment, they already look forward to the next appointment. Reuss: We understand now that we have to work with patients as a team. We can no longer simply pro- vide treatment. We have to spend extra time educating them, motivating them on how they can maintain and preserve their oral health, which is ultimately their respon- sibility. Do you also instruct your patients on how to use toothbrushes, interdental cleaning tools and tooth- paste? Reuss: Our dental hygienists focus more on oral care instructions. Their role in prevention is crucial. They es- tablish a close relationship with the patient and make sure that every patient gets the individual tools he or she needs, be it toothbrushes, interdental brushes or floss. Everything in our office is teamwork. Llorente: Every patient is different, no doubt, but every- one needs interdental brushes, for example. I brush in- terdentally every day. As dentists, we need to make sure that we reinforce oral hygiene measures every time the patient visits. With improving oral health habits comes greater satisfaction for the patient. The best thing in den- tistry is that we can see the change. We can see how the bleeding stops. And the patient feels it. What do you think about CURAPROX products? What role does poor oral hygiene play in terms of im- plant success? Reuss: Products that are easy to use help us progress in our treatments quicker and provide patients with the m o c . k c o t s r e t t u h S / s e y t s n o c i e v l i t a e r C © prevention 1 2018 39

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