INTRODUCTION:

Dental implant treatment has been used as a gold standard for the replacement of missing tooth for over the past few decades.[1] [2] Since its first use around the year 1940s,[3, 4] there has been immense advancements in the design and surface characteristics of dental implants. The long term studies showing high survival rates of dental implants [5-7] coupled with increased patient awareness over the years [8-11] has also contributed in the increased market share of many dental implant systems. [12-14]

The patients’ maintenance of dental implants post treatment plays an important role in its survival rate. [15] Determination of the patients’ gingival health changes help in controlling the harmful effects of plaque accumulation by incorporation of patient education or motivation into dental practice.[16]

Long term evaluation of dental implants are very important in order to assess its survival as well as the rates of complication or failure. [17, 18] This also helps in the determination of factors affecting the success and to identify the specific problems faced by the patients. [17, 19]

In the First European Workshop on Periodontology in Ittingen, Switzerland in 1993, the phrase peri-implant disease, peri-implant mucositis and peri-implantatis were given the scientific meaning. [20-22] Peri-implant disease is a collective term for inflammatory processes in the tissues surrounding an implant.[23] Peri-implant mucositis was defined as a reversible inflammatory process in the soft tissues surrounding a functioning implant, whereas peri-implantitis is an inflammatory process additionally characterized by loss of peri-implant bone. [21]

There are many methods to determine gingival health around teeth such as Gingival Index [24-26], Plaque Index [26] and others. Mombelli indices are used to assess the marginal mucosal condition around the oral implants.[21] [27] Assessment of Mombelli indices clinical signs has been considered important in the diagnosis of several periodontic disease. [28] It is generally recommended that the patients who had undergone the implant treatment are reviewed at yearly intervals. [29] The gingival index is measured based on the observation of oral implant area.

This study aims to determine the gingival health of patients around dental implants. This helps in assessing the patients’ oral hygiene status and thus helps the practitioner to formulate a module to educate them.

MATERIALS AND METHODS:

40 patients, both males and females were assessed for their gingival health post dental implant treatment at Oral Implantology department of Saveetha Dental College and Hospital, Chennai, India during the year 2015.

An autoclavable plastic probe was used to check the gingival health. Apart from the redness and swelling of the marginal tissues, bleeding on probe (BOP) can also be a result from peri-implant infections. BOP was notated as BOP+ in clinical record elicited after a probe insertion into the sulcus by using light pressure approximately 0.25 N. The absence of bleeding on probing is marked as BOP-.

Mombelli Indices are used to assess the marginal mucosal condition. These scores are mentioned in table 1.

Table 1: Indices for Marginal mucosa conditions around oral Implants [4]

Score	Mombelli (Mpi)
0	No bleeding when a periodontal probe is passed along the mucosal margin adjacent to the implant
1	Isolated bleeding spots visible
2	Blood forms a confluent red line on mucosal margin
3	Heavy or profuse bleeding

OBSERVATION AND RESULTS:

40 patients, both male and female were assessed for their gingival health post dental implant treatment at Oral Implantology clinic, Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India during the year of 2015. Of the total of number patients, 11 male patients are assessed after 1 year of implant therapy, 18 male patients after 2 year of implant therapy, 6 female patients after 1 year implant therapy and 5 female patients after 2 years of therapy. The mean age of the patients were 45 years and 50 years for men and female respectively.

In this study, most of the patients (39 patients including male and female patients) have shown Mombelli score 0 which mean that no bleeding when a periodontal probe is passed along the mucosal margin adjacent to the implant. However, only one male patient showed Mombelli score 1 which indicates that isolated bleeding spots were visible. There are no score 2 and 3 shown in the observation for first and second years follow-ups. Table 2 and Figue 1 showing the number of patients, male and female, and their marginal mucosa condition after follow-ups period based on Mombelli score.

Table 2: The number of patients, Male and Female, and their Marginal mucosa condition after follow-ups period based on Mombelli score

Mombelli score	0	1	2	3
Male, follow-ups after 1 year	10	1	0	0
Male, follow-ups after 2 year	18	0	0	0
Female, follow-ups after 1 year	6	0	0	0
Female, follow-ups after 2 year	5	0	0	0

DISCUSSION:

In this study, 39 patients including male and female patients which are age range between 20 years old to 73 years old are taken as the study subject. The correlation between the Mombelli score of mucosa condition and their dental hygiene after implant therapy are taken into consideration in result and conclusion of this study.

The present study on the Mombelli score of mucosa condition in the male and female patients indicates that approximately most of them scoring 0 which mean no bleeding when a periodontal probe is passed along the mucosal margin adjacent to the implant. However, one male patient during his first year follow-up give score of 1 which mean isolated bleeding spots visible.

From the result, 97.4% of patients did a correct dental hygiene suggested by dentist after their implant therapy. Only 2.6% of patients did not cope with the correct dental hygiene. Overall data indicates all females patients have excellent dental hygiene after their therapy meanwhile there have small percentage of 0.03% of male patients got score 1.

The result indicates that even more patients are having better awareness on their dental hygiene, however there are still some group of patients that still do not know how to maintain their dental hygiene after the treatment. There some guidelines needed by dental implant practitioner to plan the module for education purposes on patients’ dental hygiene. A new physiological patients’ environment can be built through the module.

Assess motive

A dental implant practitioner need to provide some motivation for their patients after the treatment. This can be done by a motivational interviewing. Motivational interviewing is “a client-centred, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence” (Rollnick and Miller 1991). [30]

There are three components in the motivational stage which are strategy, principle and spirit.[31] In a ‘strategy’ component, a dentist should suggest a good motivation based on their gender, occupation and obstacle that they might have after their implant therapy. Based on the result in this study, male patient have less awareness on their dental hygiene due to some factors that practitioner might be do not know. Therefore, history taking procedure is very important before assessing a motivation. [32]

In a ‘principle’ component, there 4 different things that should be hold by dental implant practitioner during their motivational stages which are express empathy, support self-efficacy, roll with resistance and develop discrepancy.

Meanwhile in a ‘spirit’ component, is also known as ‘clinical way of being’. The spirit is based on 3 element which are collaboration between the dental practitioner and the patients, evoking or drawing out the patients’ ideas about change and the autonomy emphasizing of the patients.

Raise awareness

A dental practitioner always confused between raise awareness and giving information to the patients. Based on Cambridge dictionary, awareness is “knowledge that something exists, or understanding of a situation or subject at the present time based on information or experience”. Meanwhile, ‘giving information’ in medical is “experienced with feelings of worthlessness, relief, confusion or confidence and coping” (Kilkkun N., Munnuka T. and Lehtinen K. 2003). [33]

Patients are taught to use the dental aid such as oral irrigator, flossing aid, interproximal toothbrush, electrical toothbrush and manual toothbrush. Awareness can be raising by educating the patients on choosing the correct products that will help them in maintaining their dental health and hygienic after therapy.

Support change

A dental implant practitioner can support a patient change by encouraging a patient problem solving, offering a set of strategies of options and help in planning steps for the change. Support change can be aided by ‘change talk’ between the practitioner and patients which are consisting 3 stages.

First stage is ‘Elicit-Provide-Elicit’ stage. Second stage is ‘roll with resistance’ and third stage is ‘a brief intervention’. The change talk between patients and implant practitioner should consists of preparatory change talk and implementing change talk.

In the preparatory change talk, the elements needed to be reached are DARN which are Desire (I want to change), Ability (I can change), Reason (It is important to change), and Need (I should change).

In the implementing change talk, the elements needed to achieve are CAT which are Commitment (I will make changes), Activation (I am ready, prepared, willing to change) and Taking Steps (I am taking specific actions to change). [34]

CONCLUSION:

The maintenance and condition of dental implants post treatment plays an important role in survival rate and controlling the harmful effects. The study of mucosa condition after post implant therapy can help the dental practitioner to build new physiological environment in order to educate and motivate the patients on their dental hygiene. Based on recent study, 97.4% of patients did a correct dental hygiene suggested by their dental practitioner after their implant therapy. Only 2.6% of patients did not cope with the correct dental hygiene and overall data indicates that all female patients have excellent dental hygiene compared to male. The module that suggested by writer are assess motive, raise awareness and support change to the patients after their implant treatment.

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Received on 31.03.2016 Modified on 22.04.2016

Research J. Pharm. and Tech 2016; 9(9):1333-1336.

DOI: 10.5958/0974-360X.2016.00254.7