ECPD: NSK
The Role of Powder Therapy and Ultrasonics in Implant Supportive Care Jenny Walker Dip DH/DT and Kathryn Mayo DipDH, FAETC
This CPD article discusses methods for preventing and treating peri-implant diseases, as well as the role of powder therapy and ultrasonics in implant supportive care
Learning aims and objectives • To identify the factors that lead to peri-implant disease • To recognise the two main types of peri-implant disease • To explain the role of powder therapy in implant maintenance. Learning Outcomes: C Peri-implant disease: prevalence and susceptibility Despite the reported high success rate of dental implants, it is estimated that approximately one in five implants fail, and around 43% of patients develop peri-implant mucositis. (Berglundh et al., 2019). Effective biofilm management, both professionally and at home, is crucial for preventing peri-implant diseases. Berglundh et al. (2019) also states that the soft tissues around dental implants respond to microbial biofilm in a similar way to gingival and periodontal tissues, underlining the importance of biofilm management as the foundation of implant care.
NSK’s Varios Combi Pro2 is an example of a combined ultrasonic and powder therapy device for supra and sub-gingival treatment
Understanding peri-implant disease Peri-implant disease is multifactorial, and although the soft tissue response is like that of gingival tissues, peri-implant tissues exhibit increased susceptibility to bacterial challenges due to biological, histological, and morphological differences compared to natural teeth. Moreover, Herrera et al. (2023) explained that these differences necessitate a different approach when monitoring and planning supportive care. Current guidelines indicate that the main risk factors for the development of peri-implant disease are: • A history of periodontitis • Poor oral hygiene • Irregular attendance for maintenance care. Other proposed risk factors, such as tobacco use and systemic diseases, are documented but require more substantial evidence before confirming their role. The 2017 World Workshop Classification identifies two primary peri-implant related diseases: • Peri-implant mucositis – a reversible inflammatory condition of the peri-implant mucosa characterised by bleeding on probing and erythema without bone loss. • Peri-implantitis – a biofilm-associated pathological condition involving inflammation of the peri-implant mucosa and progressive bone loss beyond initial remodelling. Importantly, it is widely accepted that perimucositis is a precursor to peri-implantitis.
Early detection and intervention W ith this in mind, early detection of periimplant disease is crucial, as failure to spot
early signs of disease may lead to irreversible bone loss. Treatment and prevention of peri-implant diseases - The EFP S3 level Clinical Practice Guideline emphasises that the detection and treatment of peri-implant mucositis are key strategies for preventing p e r i - i m p l a n t i t i s . ( H e r re r a e t a l . , 2 0 2 3 ) Dental hygienists and dental therapists play a central role in monitoring implants and delivering early, personalised interventions that prevent disease onset.
Preventing peri-implant disease The principles of prevention focus on biofilm management around implants. E ff e c t i v e re m o v a l o f p l a q u e b i o f i l m i s o f t e n complicated by the challenging morphology of implant restorations, especially in p a t i e n t s w i t h m u l t i - u n i t p ro s t h e s e s , w h e re a c c e s s f o r b o t h p a t i e n t s a n d p ro f e s s i o n a l s c a n b e d i ff i c u l t .
Plaque and biofilm removal Powder therapy combines water, compressed air, and powders to deliver a minimally invasive and comfortable method for disrupting biofilm. In clinical practice, only soft, small micron-sized powders are recommended for use around implants. This approach enables efficient supraand subgingival biofilm removal, while, if used with the correct techniques, minimises trauma to the surrounding soft tissues and prevents unnecessary surface changes to the implant. Powder therapy devices include portable units for supra- and subgingival use, which attach to the dental cart or bracket table, as well as combined ultrasonic and powder therapy brought to you by
To complete the questions and gain one hour of Enhanced CPD, visit cpd.the-probe.co.uk
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