Ep. 26: The Patient's Guide to Full-Arch Maintenance (Part 1)

Part 10:00

This is Beyond the Arches, where full-arch dentistry meets real talk. Let's get into it. Hello and welcome to Beyond the Arches. I'm your host, Dr. Daniel Noorthoek. With me today, I have Erica and Dr. Hauer from our Boca team. Good afternoon. Welcome, folks. Today, we have an exciting and cool topic. We're going to be talking about full-arch maintenance, interval, professional cleanings, how you take care of it at home, all of the nitty-gritty of the industry and why we do things a certain way.

And so we're going to sort of break it down and give opinion pieces both on what the research says and what we believe, but also some recommendations on how we approach it and what we're thinking about and what kind of items are going to be addressed in your regularly scheduled maintenance and what kind of items that a patient might need to take care of in their day-to-day life, sort of breaking up responsibilities, if you will, and why each one is important.

And so today, what we're going to be talking about is what we're going to be talking about really the theme of it is, it's not just set it and forget it. When I first started doing these procedures, a lot of the attitude towards it was set it and forget it. A lot of it was not really pushed as, hey, here's a long-term relationship. This is why it's important for you to select the right people. ▶It was, hey, here's how expensive this is. If you want the Cadillac, you can do it and it's fail-safe and it's ironclad and it's bulletproof. So never think about anything long-term.

And of course, that doesn't apply for everyone. But in terms of my experience and what I saw of the industry, that was sort of the way that it was a little bit pitched. You kind of had to get away with not talking about the nitty-gritty after because you really wanted to sell on the expense of this procedure, et cetera. And so part of this podcast, part of this is to get the data out there to start pushing the industry into a niche of, listen, we got to tell people this needs to be cleaned. This needs to be looked at.

This needs the patient's role to play a part, and that's something that we've really been pushing from a protocol and from a corporate standpoint, but also as an opinion piece or beyond the arches, that's something that we've kind of pushed. So in general, let's talk about caring for a full arch. Let's talk about daily maintenance because that's the stuff that patients are going to get bogged down in day to day. And I'm going to let Erica talk about that.

Like, how do we talk to a patient in terms of how they need to take care of it? What do they need to expect? If I'm a patient, prospective patient, et cetera, what is my cleaning routine going to look like? So if I was a patient, what I would expect to do on my end, basically, it would consist of just brushing and water picking. So thankfully, it's nothing too, too crazy, nothing too insane or out of this world.

You're just brushing. Once in the morning, once at night, soft bristle toothbrush, kind of just some regular toothpaste, nothing fancy, nothing special or expensive. And then water picking just twice daily. So, well, some actually I take that back. Some patients like to do it after every meal. So we at least advise twice daily morning and night. But some patients might have a preference to just kind of do that a little bit more frequently to find a big.

So some patients may like to do that a little bit more frequently to. Kind of get that minty taste, minty flavor and just feel kind of fresh overall. And if a patient's kind of in a awkward scenario, maybe like in a restaurant, but they can jump off to a restroom.

▶If there is something stuck in there, a lot of times just a simple rinse with some water and spit into a sink will work, too. And I don't have a water pick scenario. Absolutely. I have heard this is a little bizarre, but I have actually heard one of our patients say you wouldn't believe the amount of suction that you can do with. Yeah. Yeah. Just. Like a sip full of water that you had at the table. Take yourself to the restroom and just kind of figure it out from there.

But it's not impossible.

Part 24:09

It's all about just keeping the surface clean, doing it from the underside and from the outside. And like we've talked about before, you know, toothpaste is important. The toothbrush is important. I think that, you know, in terms of electric versus manual, certainly for all the studies. An electric is much better and far superior to a manual for a person with regular dentition for a hybrid. My opinion is that it doesn't matter as much because we're not cleaning out the surface, the cuticle, if you will, like the difference between the nail and the cuticle.

That's what you're cleaning when you're brushing teeth, actual teeth. You're cleaning that connection, that junction there. You don't want anything to get lodged underneath there. And with a hybrid, you don't have all of those connections. And they're more or less kind of hidden away underneath the fake gums, if you will. And so it's not as important for manual versus electric. What is important is that it's thoroughly cleaning the surface so that it doesn't continue to stain and so that you're kind of removing some of the bacteria that's in there.

And the rest of it is just mechanical debridement with flushing it out with a water pick. And, you know, don't pressure wash the side of a house. Don't overly put. Too much pressure in and you're not trying to overwork the system. It's just good, clean, thorough massage and lavage through daily habits. I have a good amount of friends and family that have had this done over the years. And whenever I can, I have taken a couple of them aside and said, listen, I want you to give me like the nitty gritty.

What is this like to clean? Because I don't have this. And I would really like to know what I'm pitching to the patient is essentially what it is. Absolutely. And so I've asked them, like, what is it compared to original cleaning your own teeth? And the best way it was described as Jamie, Jamie told me that it's the exact same amount of work, just completely different. So she said, it's not easier. It's not harder. It's just a different order of operation.

It's just a different way to clean. It's just a different feeling and experience. So effort wise, same. It's not like it's. Yeah. More painful or more difficult or. No added steps or anything like that. Yeah. She said it's the same amount of difficulty. It's just the exact same effort and the same amount of inconvenience, if you will. Probably effort that was potentially maybe never there. Yeah. Yeah. Potentially. Yeah. Maybe. Blake, anything to add? Um, I, I think I agree with you on, on the maintenance.

I know we talked in the past about, you know, types of toothpaste and my opinion here is. Using something in a very, you know, moderate amount, you're not using toothpaste like you are on a tooth. There's no enamel, there's no remineralization of a tooth structure, but you just need to find a strategy that works for you, that you're consistent on, that you can keep plaque and food away from the implants. Yeah. Yeah. And using something that ideally it's not abrasive.

So the big buzz ones are the easiest ones to point towards are anything. That's a sensitivity toothpaste. When you use a whitening tooth. Toothpaste is going to have essentially some sand in it. Some pumice that abrasiveness is what brightens and removes stains from the surface of our enamel, but not needed in the zirconia. The zirconia is the color that it needs to be. It's just keeping it clean. And so we want something that doesn't have a ton.

If, if the preference, if, if I'm asked preference, how do I put this? It's not entirely important to the point that you shove it down somebody's throat. But if I'm asked preference. I want something that's slimy or in the hands and something that's less likely to have that pumice because it's not as needed, uh, as in a, in a normal tooth situation, the in, in gum or in a regular cleaning, when, when you're doing your daily maintenance on a typical tooth inside of gums scenario, I think all of us have our teeth.

So when we're cleaning our teeth, it's a matter. Of removing the tooth or the, the food material, which can have sugars in it, that sugars, the bacteria takes those sugars and attaches to the tooth. It uses it to ha to help attach to the tooth and can use it to make acid, which will break down the tooth. And that acid can cause what we think of as cavities and cause sort of a bacterial infection. And that can get bad enough to get into the.

Root and cause a need for a root canal, et cetera, that, that sort of infection. So you're preventing cavities with your normal cleaning. You also are with fluoride. You're trying to, if there is an invasion of acid, you're trying to build up the structure of that tooth so that it is preventing further attack or further lost ground, if you will. Right. And, um, additionally, you're trying to clean the surface. That's sort of underneath the gums. We're. Stuff.

Can, can collect and create irritation that over a long period of time can cause bone loss and what we call as, as periodontitis. And so that's the intention of regular daily cleaning in a tooth to gum tissue relationship in an implant, whether it be a single implant or for full arch, your, your intention is to remove the irritant from getting to the connection between the implant and the tooth. And the bone, so that you don't have that bone loss, like periodontitis, the implant version of.

Um, periodontitis is called. Her implant Titus. Peri implant Titus, instead of gingivitis. Her implant mucositis. There you go. Um, they're just fancy terms for essentially the exact same thing happening around implants and we don't have cavities. So remineralization of teeth is not as important because that's, what's important for cavities. And of course we're not going to have. Here's your Connie break down and have a cavity. So in some ways you're getting sort of protected. If you're a person that got a lot of cavities, that's generally the bacteria that you have stuck in your mouth.

That is something that you will be pretty protected from in the hybrid. But when you get a hybrid and you've lost it for a period on Titus, one of the risk factors for peri peri implant Titus is. History of predom disease, uh, bruxism diabetes. So. So the, the bugs that are in the bacteria that is in your mouth just generally are there and they're going to be there forever. They were established from the beginning. It's not a genetic thing.

It's an actual bacteria that colonizes your mouth and it will essentially be there. And the difference in general between let's say that you have periodontal disease, sorry to be the example. And I don't, your bacteria is more angry than mine. So we have very similar types of bacteria, but your bacteria is just very pissed off and mine. Isn't. And so if I do a hybrid in you versus me, you're going to have a tendency to still see that happen because your bacteria just are still very angry.

And so we need to make sure one of the things that we're making sure in a cleaning is making sure that we don't get that bone loss. We don't have that same thing happen. So if you have a tendency towards cavities, generally, you're going to be a little bit more protected because that's your tendency. And we took that all away. You have a tendency towards bone loss and peri implant or, uh, periodontitis, you still are going to have that tendency.

And that's one of the things that we really want to keep touch base with because those bacteria are still angry. There's no calming them down. Is that a fair, easy way to explain everything? Yeah. And I think one thing to add is, you know, we all strive for excellence, but you know, that your surgeon, wherever it may be is a season.

▶If they're open about what are the complications and what are the limitations of implants? And the reality is that implants can have peri implantitis, whereas teeth can have peri. I'm sorry. Yeah. Let me rewind teeth can have periodontitis, whereas implants can have peri implantitis and teeth can have gingivitis and implants can have peri implant mucositis. It's all about prevention and understanding from our, our end, the biological process of an implant having disease is more of a rapid process.

And that's really important for us to catch it early in the phase before bone loss, which goes into why we remove the prosthetic and want to see what's going on under the hood per se, so we can help. Our patients and not lead to any catastrophic problems. This is an excellent point. And yeah, like you said, that, that can advance very rapidly. The, the complex, the interface between the implant and the bone doesn't have as much protection.

It doesn't have as much blood supply. ▶It doesn't have as much life, if you will, as your own teeth. And so it's a little bit less resistant to having those issues. And so we want to make sure that that stays long-term another important point is that. When we take out teeth with bone loss and periodontitis and cavities and all of that, you essentially get this like real big reduction. You're, you're essentially winning the world war five on your teeth and it goes to quiet stage, right?

Part 313:45

It goes to total peace. And then over time it can build back up. So you're still at risk. It's a reset button. It's a chance. It's a second chance of sorts. So we want to capitalize on that second chance and keep. Everything at bay so that you don't end up losing that battle again. Okay. So the purpose of the cleaning is really for two things. A to keep your zirconia are just clean, free of debris and build up things like that.

But really more importantly, it's kind of still focusing on the periodontal side of things. So you're not having all of these. Infections are sure. Removing the risk factors towards that progression diagnosis is going on. Okay. Yeah. ▶And that's where, when you're in the chair for a maintenance appointment. We can diagnose something that's mechanical, whether it's a chippage of the teeth, whether it's an issue between the actual zirconia and the, uh, the gum tissue or it's biological, something that's going on at the implant level as discussed, like peri-implantitis.

Yeah. You could think of it as you're the daily to, to go into a war example as well. Again, you know, your daily cleaning is like that. You're just kind of holding your own ground on this biological warfare. And then when you bring in and you come in once a year, you're getting it looked at from both a biological warfare and a mechanical warfare standpoint. There's two things at play. There's the biology of the implant to the gum tissue and how that's being taken care of.

And what does the bacteria load look like? But then there's also the mechanical stress and the mechanical factors that come into play. The screws being loose and the screws being broken, uh, prosthesis, having a chip, the prosthesis being stress fractured. All of those things need to be looked at from a perspective of, we don't intend on them happening. It doesn't happen often, but let's put our eyes on it to make sure that everyone keeps peace. Okay. So in talking about that, the, the protocols can be widely varied across all, all centers that do this.

And, um, I guess we can kind of pitch it from our perspective at Dun & One. Uh, Blake, why don't you? Kind of give the, the consensus on frequency in terms of too much, too little, too infrequent. So I'll say that it's all across the board in the industry. Um, it's gone from more frequent to less frequent to more than less, but the most obvious and recent consensus we have is from the American college of prosthodontics. So they're a specialty group that deals with mostly teeth.

And they made a statement recently on full arch. And what they said is that the removal of a screw. And implant prosthetic is not needed at all. And they only recommend this when there's signs of implant bone loss, peri-implantitis, there's an inability of the patient to clean properly, or there's a mechanical complication that requires removal. So I think when you take into that aspect, we have to understand with our protocol, do we disagree? Do we agree? And maybe this is a good segue into why we do what we do.

Right. And, and go ahead and give that piece on the. Why we do what we do. So we have a firm understanding that, you know, we're on your team and we want to be able to see everything. And the reality is that when we take an x-ray once a year, which is part of our protocol, as well as maintenance, we can't see everything. So we firmly believe that taking the prosthetic off every three months or six months is way too much for many reasons.

But once a year is the, is a good time point to not only remove the prosthetic. And clean the prosthetic nail. And clean the gums, but also properly evaluate your implants and gum tissue. Um, x-rays are 2d or even 3d from a CBCT, uh, scan, but there's always scattered because in the metal of abutments and the prosthetics, and it's not the only way to see things. So to properly diagnose you, we need to look at the bone x-rays gum tissues, and it allows us to have an opportunity to, um, intervene if necessary.

Um, and sometimes intervention is, is, can be minimal if we see that your implants. Are healthy and coral pink. Great. If we see something is maybe a little inflamed, Perry implant, mucositis, we can provide some adjunctive care, but we can't provide these recommendations if we don't see what's under the hood. And a lot of people may listen to this and say, well, if an x-ray doesn't work, why do we have an x-ray or how does that work?

Part 418:19

Where, you know, I thought that they are gold and I was thinking about this last night. So we just got done with our pumpkin carving. Yes. And, uh, unfortunately. So I wasn't able to carve a pumpkin cause I had family in town, but I always get the pumpkin seeds and I always make them. And so I've been doing those. And if you've ever baked or done pumpkin seeds or roasted them, if you will, you would know that it's sort of obscure in terms of like when you, when you turn the oven off and how long you keep them in the oven.

And so you kind of have to keep a really close eye and I promise this relates to the x-rays. So I was thinking about this. So. It's very hard. It's very hard to tell. I, you know, I have an oven with a, with a window in it, right? So turn the light on and I'm watching through the window periodically and I couldn't tell anything about whether or not it's fully done. Couldn't tell exactly how brown they were, exactly if they were the right crisp and the right moisture content was gone.

But what I could tell is it's definitely not burning and they're definitely not, um, raw like they were when I first started. And that's a little bit like an x-ray. Okay. You can tell by the smell and you, and the look that they're not burning or they're not undercooked, right? But when you look in there, you can't tell, like, is it perfect? And that's like an x-ray and x-ray will tell us, holy crap, those are bad. Holy crap.

Those are perfect and fine, but it doesn't tell us a lot about the inside in terms of exactly where we stand. And so sometimes physically gathering that information and putting our eyes to. And our instruments to the test to look at it is very important. It's a good test. It's a good window. It's great that we have the window to look, but sometimes to be able to get that perfect pumpkin seed, if you will, you really need more than just the x-ray.

This might be silly too, but what about the, um, the sound test when patients come in for cleaning? Sometimes they do also get that tap. What is that for? So there's, there's actually, um, the, the easiest, cheapest way is to, to do what's called a percussion test. There are other instrumentation that you can buy that will, you remove a piece of the implant so that you then a firm in it. It essentially throws, is it radio waves or ultrasonic waves?

It's some sort of frequency that resonates for like a turning tuning fork. And it resonates in a certain way that tells the machine and gives it a reading of how integrated and how incorporated into the bonus for that. That requires a little bit more involved for removing. And essentially gives you the information that we would be able to get from a percussion test and sort of my opinion and the way that we function. Implants are very on or off.

They're either really healed and perfect or they're not. And so, um, when you tap on the implant and it gives you a dead feel or it doesn't give you a sound, I know that the implant surface is not properly or fully adhered to that bone in a good health. The way, meaning that there is some connection that's a little bit off or held in by gum tissue and therefore it's probably not any good when you get a very crisp sound, you know, that that connection, just like if you were to tap a piece of, uh, or a screw that's inside of a solid piece of wood, you would get this like sort of sharp noise.

That's what we get with tapping on the implants is that sort of positive feedback that re that percussion sound. That is. Oh, wow. These are connected versus if you took that same screw and you put it into loose soil and tap that you wouldn't get any sort of ting, if you will. That's, that's what the percussion test is. And it's largely a very like off and on scenario. It's often it's dead and some screw or it's not tight in bone.

Some screw is loose or it's not tight in bone or wow. This is solid and doesn't need anything. Yeah. I think, you know, what really makes sense to me that we're saying is that. There's not one only way to look at the health of something X-rays can tell us implant, um, health, um, torque test can help us. ▶Meaning you put an instrument in the actual implant and you see by hand what it feels like tapping on the implant.

There's devices that look at friction of the implant that we talked about. So there's so many reasons and ways that we can look at things, but X-rays don't tell us everything.

Part 522:51

Yeah. And putting those pieces together is a little bit provider based. It's a little bit in terms of. It's a little bit in terms of what's going on in the patient's quality of experience and kind of going off of these opinion pieces and these, these research papers and such, and you're trying to find what's going to be best for your quality of life and the patient's quality of life. So we don't want to. Overly evaluate to the point that it's a four hour cleaning.

We don't want to make it a painful experience, but we also want to get enough information. So finding the ways that we have is what makes us happy to feel good about the results that we have. We get in the long-term care for that patient. And so likewise, you know, every six month cleaning is too excessive. It's too much pressure in and out of this on the screws. It's too much damage mechanically, if you will. It's too much encumbrance on a patient's life.

It's too much financial burden on them. And so for us, we found that once a year was, was a good steady point to be able to get enough information that we know mechanically and biologically. Things aren't going south to, to Blake's, uh, to Blake's, uh, point, the, these things can go south faster than say a tooth. So we want to be able to see it. Um, and we don't feel comfortable with just letting our patients go for on forever and ever.

And if you look at our pricing, we've tried to represent that in a way that doesn't make it so that it's a turnoff. It's not a $1,500 in arch cleaning that says, uh, that very clearly communicates that. We don't. We don't want you here. It's something that's a little bit more expensive than a regular tooth, a regular set of teeth cleaning. It's less frequent, but it's something that is important to us because we want to make sure just as much as a patient wants their investment protected.

We also want to be protected and know that we've done what we can to help fix things and address them in a timely manner. Because if we don't get to address them in a timely manner, things can go real south real quick for almost no reason at all. We could have just seen. And maybe made it so that it wasn't a big deal to begin with. And so like, as we're walking through this, you know, lifetime warranty and two year warranty kind of comes up.

The, the longevity of a set of these teeth and the health of, uh, of these implants healing is very straightforward. It's a very reliable procedure. You see it all the time. It works. You know, only occasionally do we have an implant go bad or, uh, an issue that arises. But long-term, what we noticed is that we wanted to reward patients that came back frequently for cleaning. And we've talked about this in our lifetime warranty discussion, but we wanted to reward those that were going to be responsible to it.

And we wanted to be responsible to them in a similar fashion. And so one of the ways that we do that is we offer a cleaning program. It's not actually, I just totally messed it up. It's not a cleaning program. ▶It's a warranty program that includes a cleaning. And the reason why we do. That is we want that patient to be looked at once a year so we can jump on and fix things in our own safety.

And, uh, it renews once a year because we want that to be a shared relationship. It's not that we don't believe in our product. It's that we believe in things getting addressed quickly and efficiently in a very healthy way. And for us, it's that one year, not encumbering the cost, et cetera, but also making it so that it's a peace of mind for that patient. So not only when they come in. If we see a problem, does it get addressed quickly, but it gets addressed in a way that doesn't, um, cost them a lot financially.

And so if they stay responsible to us, we stay responsible to them. And if a person wants to take it into their own hands and then that's fine as well, it's not that those people are on the outside and they should be concerned that it won't work. It's just a matter of staying responsible to each other is really why we kind of came up with that. Right.

Part 626:56

So I guess we can kind of go into maybe what our goals are. What are our protocols and, you know, what does it look like in the office? Um, you know, coming in once a year involves, you know, speaking with one of the doctors and also, um, working with our restorative team. So from the most basic level, we're going to diagnose your implants. Are they healthy? Are they not? What are your changes in medical history? We need, we're on your team.

We want to know if anything changed with your health, you have maybe a change in medications, you have diabetes, something that is maybe altering. Your bone metabolism. That way we can have the best recommendations. Um, from there, we remove the prosthetic and we want to look at the health of the abutments, health of the screws, um, x-ray health, um, on the implants, looking at the gum tissue, um, looking at the actual prosthetic. And then we look at, um, it, what is the actual integrity of the zirconia?

Are there problems? Do we need to do a real line there? So there's so many things that go into it from a simple to complex level that having you in the chair is just. Okay. Very critical. Yeah. And for the, maybe for the majority, you could say they could go every two years and they used to tell patients, listen, we're going to extend as we get along and more comfortable with how the longevity of your processes is.

We're going to start extending that timeline. And the, the problem with that is that you get too many patients that are maybe have an issue that sort of fall through the cracks. So that's the problem with making it an inconsistent timeline. And so for us, it's important that if. ▶Let's say 10% of people are going to have an issue over 10 years that we catch that one person a year for that 10 years at the expense or the peace of mind for everybody to know that they're doing okay.

Um, so now that you, um, are aware, cause we've discussed it before, what's, um, what is the big reason why we're okay with patients going to other centers to get cleaned? What was the difference? What would have, what has changed over time with hybrid? Yeah. Dentistry. Yeah. So we're okay with patients going local due to the fact that there's zirconia is so strong that we were talking about in our other episode. Um, it's kind of. I put you on the spot a little.

Um, and I was kind of thrown off by your response cause it wasn't anything that I'm throwing it back to you. Um, so the reason why we feel comfortable with patients going like, um, out of state or local to their provider to have a cleaning done is that we. We are essentially just not really nervous about what's going to happen to the zirconia just because the integrity of it is so strong. Um, that usually one of the biggest problems that, uh, I, someone who's not familiar with it would have is like actually disengaging the zirconia from the mouth would be taking it out.

Um, but due to those like access hole, those screw channels, like things. So, um, the rigidness of the material, the rigidness of the material of the zirconia. Um, they can kind of get through there and take it off easily. Yeah. So the old materials used to be really soft, almost softer than the access fillings. And so when we used to go into them, it took a real steady hand and you wanted to make sure that you were the person to do it because you could cause some serious or somebody else could cause some serious damage to where that, uh, implant was.

And also a side thing, uh, is as those holes would get bigger. In an acrylic or a nano ceramic or some other material, as those holes would get bigger over time. Not only does that suck for the patient's integrity of their prosthesis and long-term longevity and, and sort of daily comfort, cause that access hole is slowly getting bigger over time. You also would, um, start to be able to find that screw worse in a harder and harder fashion.

It would blend in sort of more with the teeth cause it got to be bigger and bigger and bigger. And so finding the screw holes. It was even more difficult because you were then damaging some portion of that bigger pothole. And so now with zirconia, because it's so strong and it's so resistant to abrasion, we can go in there with a burr and, uh, clean that out without causing a lot of that damage and that widening and the problems that come out with it.

So for us personally, we're a lot more comfortable with letting somebody else do it because there's a lot less, a lot less damage that they can create to it. One thing that we haven't mentioned really a lot before is part of keeping things clean is selection of your implant brand and selection of the design of the brand and sort of going soup to nuts from a soft tissue standpoint, et cetera.

▶So just as an example, we're very intentional about the brands that we work with, the implant brand that we currently work with, they have the circle. If you think about the cone that's holding onto the teeth. That cone has a platform, like a disc that's holding onto the base of the teeth and that cone, that circle does not have any screws that go through it. And so when you put the teeth on, it creates a good seal all the way around.

There are other brands that have screws that go through that circle and create areas of plaque and things to build up in. So it isn't just a daily cleaning scenario. It isn't just a yearly cleaning. There's an end to end selection process. It's very important to the longevity and the health of a person's implant. So even if you took me as a periodontist that's going to do your surgery with one brand versus the other implant wise, on paper or in theory, you're going to have more issues with selecting a brand that doesn't necessarily do that.

You're going to have more nooks and crannies that bacteria can get into. So that's part of it. The other part too is when you have...

Part 732:59

When you have the access holes, you want those to be sealed because that is kind of a pocket where bacteria could build up. Is it okay for them to be open for a period of time? Like, I don't want anyone listening to this to freak out because they had an access hole open for a year. Sure, because it's not sealed off. You're able to clean it. You just need to be intentional with keeping it irrigated and clean.

But sealing it off is important. Well, there's a screw underneath there. And so that screw that's at the bottom... The bottom that you need to get to needs to have something that's very removable and in between that doesn't hold and collect a lot of bacteria that creates essentially like a safety zone that we don't hurt and damage. So when you look at a screw hole, if you were to watch us take it apart or build it back together, the common and accepted standard now is to fill that hole first with Teflon tape because it's very easy to work with.

It's pretty clean. It doesn't hold a lot. We used to use cotton pellets and cotton pellets used to get real stinky with bacteria and such. But now the current protocol is that we use Teflon tape. And then on top of that Teflon tape, we use a regular filling material to create as good of a bond against the circle of the screw access hole, the channel as we can. And so all of that, soup to nuts, that's why it's important to protect and keep a protocol in place.

It's implant longevity inside. The implant or inside the bone. How well does that hold the bone? How well is that going to hold up long term? Did the people look at it often enough? Is is their thought going into where the bacteria could collect? There's a lot of stuff that goes into the underside design. What does that look like? Is it easily flushable? All of that goes into selecting, but it also goes into long term care, daily care.

Things could be difficult if they're not created correctly. They also can create. They can create problems that need to be looked at, and we're not fail safe. We're not without flaw. We're human. And so we want to double check and cross all those T's and dot all those I's. And so that's why we really have kind of set in on once a year because, you know, it's not too encumbering, but allows us to check a lot of those things.

So it's kind of up to the patients to keep everything clean at home. But when they come back for that one year mark, it's important for us to check on all those parts and just make sure everything's doing what it's supposed to be doing. Make sure the design is kind of allowing for that space to get in there. Check everything out. Yeah. I think of, you know, our patients have the job of selecting a center, paying for it, being on a soft diet so that the implants heal properly, and taking care of it daily.

Our responsibility is putting in good stuff, selecting the right materials, selecting the right team to take care of them and identify it. And so that's one of the issues from a from a phone call all the way to a treatment standpoint, selecting the right materials and machinery to accomplish it in the best way possible, but also to look at it and make sure and double check and assure them and certify, if you will, that they are going to continue to be good long term.

So it's very, very shared. There's four almost I just counted out. There's like four big major categories of responsibility on each side. And that's. Kind of it's soup to nuts, I think. I think so, too. Yeah, I think it's a cooperative responsibility. Like you said, you know, we want to create something that's cleansable. ▶You know, we have a duty as surgeons to do our best to put the best implants in the best bone and give you the best results surgically.

Our restorative team gives you the best contours, the best ability to keep it clean. But we're a team. And without your, you know, as a patient, your ability and interest in keeping it clean. You can't have that. So we're all together to get where you want to be.

Part 837:03

I had Blake here compile a list of a couple of things. And just looking at this, there's a note that you wrote that's impact of maintenance therapy and the prevention of peri implant diseases, a systematic review and meta analysis. And the take home bullet point that you put on here, I think, is a really good sort of pre closing type statement. And it's implant therapy must not be limited to the. Placement and restoration of dental implants, but to the implementation of P I M T, which I would assume is preventative maintenance therapy of implants to potentially prevent biologic complications and hence to heighten the long term success rate.

So to summarize, you know, it's not that it has to be looked at every day because there's a problem every day. It's that long term, it's better to be taken care of and to have it looked at. And so. That opinion to me speaks volumes on making sure that that awareness is out there and the positive part about this. And one of the main reasons why we're here is not necessarily to shove done in one in our theories and our protocol down anyone's throat, but to bring to light the information that dental hybrids aren't necessarily completely maintenance free, that there are aspects that need to be looked at and thought about all the way through.

And like we've talked about a little bit before already today. One thing that I'm very excited for in this niche of dentistry is that when I started this there 10 years ago, only there was, and I said only there, Blake, not that old. 10 years ago, only it. I saw a lot more cases, even in my own offices, but a lot more cases being sold as the end all be all golden arrow. Not. Not really covering maintenance.

And now we see this sort of public understanding of this public knowledge or this sort of campaign to educate the public on what they're actually getting. And this is hopefully if this is not necessarily done in one, isn't your cup of tea. You don't want to travel for it. We're out of your location, whatever it is. Hopefully, at least this can be some data and some information that can be used so that the public understands that there is a two way street and that it needs to be taken.

Care of this isn't set it and forget it. Implants don't come without and free of complications. They need to be looked at by a professional. The frequency and the cost with which is is up to you. But they there are aspects to it that are very important and can go very in depth with issues and things that are thought of. Full arch maintenance isn't hard. It's important. Exactly right. It's very simple. Very straightforward. It's not. It's not hard.

It just needs to be done. Very cool. Well, I appreciate you guys taking the time. We will move on from here into part two, which we've already recorded. If you couldn't tell, we started with part two, which is frequently asked questions about the nuances of cleanings and maintenance and what the patient's responsibility, all the kind of nitty gritty of the daily, et cetera. So where we go a little bit more into depth into some of this stuff.

But pay attention to part two. We appreciate you paying attention to part one on our series here on implant maintenance and hybrid care, both daily and long term. Thanks, guys, for having this discussion. Thank you. Thank you. Appreciate it.