By Misty Palmer, RDH
I vividly remember my first day at an implant practice. As a recent graduate from dental hygiene school, I had little experience and was new to implant dentistry. Reviewing the schedule for my first day, I saw something different next to the patient name — implant engineering adjustment. My first feeling was panic as I immediately thought, “Did I miss this in school?” The term was completely foreign to me, and the procedure was even stranger.
The implant engineering adjustment (as our practice refers to it) is a very important part of the maintenance of a dental implant. When a patient with a dental implant comes in for a routine prophylaxis and periodic examination appointment, an implant engineering adjustment is also scheduled. This can also be called an implant occlusal equilibration, which is performed during the exam. Articulating paper is used to check the patient’s bite and ensure that there is balance and that no excessive occlusal force is being placed on the implant. If the patient’s bite force is excessive, then a bite adjustment is performed to reduce the stress on the implant.
Things change in people’s lives every day. Increased stress may cause a patient to clench his or her teeth or develop a nighttime bruxism habit. Dr. Carl Misch states, “Severe bruxism is the most significant patient force factor and, on a risk scale from 1 to 10, is a 10.” It is also important to examine the patient’s other parafunctional habits. Other factors to consider are crown height, masticatory dynamics, and opposing arch.
Excessive occlusal stress from bruxism can lead to marginal implant bone loss, unretained abutments, and fatigue fractures of implants or prostheses. If a patient is found to have a bruxism or clenching habit, an occlusal night guard may be indicated to relieve nighttime stress. By performing an occlusal equilibration and evaluating parafunctional habits, we can help reduce the risk of bone loss and implant failure due to occlusal stress. It is our role as auxiliaries to help uncover factors in patient’s lives that may be detrimental to the health of their dental implant. Next time your implant patient visits you, make sure to put on your engineering cap to provide the very best in implant maintenance care.
Misty Palmer, RDH, is a dental hygienist in a general dentistry practice in Forest Grove, Ore. She is a graduate of Mt. Hood Community College Dental Hygiene Program, and will receive fellowship with the ADIA in Las Vegas in February 2011.
Stress Treatment Theorem for Implant Dentistry. Misch, CE: Contemporary Implant Dentistry 3rd Edition, St. Louis, 2008, Mosby.
By Misty Palmer, RDH