Initial examination
Initial examination after implant placement
In many cases, patients are referred externally for implant placement and restoration and will return to primary care post-treatment. Details of the implant and its restoration, and post-placement radiographs should be supplied by the clinical team who carried out the treatment. The primary care team will often be responsible for implant monitoring and maintenance. When the patient is seen in primary care for the first time after implant placement and restoration, it is important that the peri-implant tissues are examined and the findings recorded to establish baseline conditions. This will allow monitoring and maintenance of the implant and its restoration in the long term.
The EFP Prevention and treatment of peri-implant diseases guideline10 recommends baseline probing within 3 months of prosthesis delivery and advises that a baseline intra-oral radiograph be obtained at the completion of physiological remodelling to document marginal bone levels.
When a patient is seen for the first time after implant placement and restoration:
Assess the cleansability of the superstructure and consider replacement or modification of the restoration if it is not readily accessible for personal and professional plaque removal.
Visually assess the soft tissue health and the presence or absence of inflammation around the implant.
Probe around the implant, and restoration if it is fixed, to determine:
- the presence of bleeding on probing and/or suppuration;
- the presence of excess residual cement;
- the presence of submucosal plaque and calculus deposits.
Note that topical or local anaesthetic can be used if probing around an implant is painful.
Measure and record peri-implant probing depths, at four to six sites around the implant where possible, using fixed landmarks.
N.B. The BPE is not appropriate for the assessment of dental implants.
Review personal oral hygiene and, where necessary, provide personalised oral hygiene advice and instruction to assist and encourage the patient to improve their oral hygiene skills as well as their understanding of the value of good self-care routines (see Oral hygiene).
Encourage the use of oral hygiene aids such as implant floss and interdental brushes. Where applicable, give smoking cessation advice (see Smoking cessation).
Ensure that a baseline periapical radiograph of the implant, aligned using the long cone paralleling technique, is obtained (e.g. at one year after superstructure connection).
- Position the x-ray head perpendicular to the long axis of the implant; this may be at a different angle to adjacent teeth.
- Identify a stable landmark, for example, the implant shoulder or implant threads, to enable comparison of bone levels over time.
Assess the patient’s risk for disease progression (see Risk assessment tool), based on their medical history, known risk factors, periodontal status along with levels of plaque control, and use this to inform future recall intervals.