My Guided Biofilm Therapy Journey
By Tabitha Acret
When I graduated university, I was excited to finally “treat” patients. After being a student for 3 years, I eagerly anticipated completing each step of my studies as I just wanted to begin treating my patients. When I finally arrived at my clinical practice, it became very obvious that the learning had not stopped and there was still so much that I needed to learn in regards to some of the complex cases that were sitting in my chair. At university, my exposure to patients with single tooth implants was very limited, let alone patients with full mouth reconstructions and All-On-Four™ upper and lower fixed appliances.
After graduation, I began working full time in private practice and at least once a day, I would see patients with dental implants. I then started working at a practice where the principal dentist had a strong interest in implant dentistry and would block off a full day once a week to place implants. This instantly gave me anxiety as I didn’t feel prepared to confidently look after the maintenance of these patients, let alone any complications. I knew that I couldn’t stick my head in the sand and I also wanted to treat my patients with the best, most up-to-date evidence-based dentistry.
This is when I started a journey to educate myself in implant maintenance so that I could treat my patients confidently and with the best care possible. I started with cornering the implant sales reps whenever they would come to visit the dentists but sadly, while the implant companies offer many courses on placing implants or dealing with post-surgery complications, there was a huge gap in the preventive care model to avoid the complications. So, I started going to implant conferences, sometimes attending for 2 days to hear 20 minutes of information on implant maintenance. I started Googling any implant maintenance information I could find. I travelled to America and Switzerland to attend courses discussing implant maintenance and spent days shadowing the local specialist periodontists to see what they did for implant maintenance. There was consensus through all the different education that I was doing and it was AIRFLOW® technology.
It was at this point that I attended the Swiss Dental Academy training course on using AIRFLOW® for both general maintenance, periodontal therapy and implant care. Armed with this information, studies and a business plan, I set up a meeting with my employer to discuss the benefits for patient outcomes and the financial benefits of introducing AIRFLOW® technology to the business. I explained the scientific evidence behind AIRFLOW® technology, the reduction of wear on the clinician’s body as well as the patient’s teeth and supporting structures. The increased comfort for the patient and the reduction in sensitivity not only helps make the experience pleasant for the patient, but it helps with patient compliance and it’s a practice builder. Happy patients talk and happy patients refer more patients to your practice. By embracing AIRFLOW® technology and the GUIDED BIOFILM THERAPY protocol into the practice, we would also be able to reduce my 1 hour appointment times to 45 minutes and this also meant that I would be able to increase the number of patients I see per day by two; that equates to an extra 8 patients a week and that’s an extra 384 patients a year. When you put that into dollar value, that’s a massive benefit for any practice.
I presented my employer with a business plan. The extra two patients a day would pay off the new AIRFLOW® device in 4 and a half months and after that, the extra two patients a day would be pure profit for the practice. Each year that profit would continue. We also discussed the ethics of placing implants and then taking care of those patients. If the practice was going to place implants in our patients’ mouths and then continue to see them for the care, then we needed to provide the best care possible for these implants and we were currently not providing that. It was our job to help our patients maintain the implants for as long as possible. My employer was excited about this new technology and enthusiastically agreed.
I loved it from day one, but what I also loved was the concept of GBT. It’s actually quite a simple concept, bringing us back to the basics of what we learnt at university but quickly forgotten as we enter the workforce. It’s essentially back to the basics of plaque disclosing and then motivating all of our patients to obtain better long term results. By ditching the messy prophy cups and using AIRFLOW® first to remove biofilm and stains, I was able to reduce the use of my ultrasonic. My patients are happier and their teeth receive less intervention which long term, reduces periodontal pocket depths from intervention and root modification.
I also noticed how much better the clean was. By plaque disclosing first and then letting it guide my cleaning, I learnt my blind spots. I found out that I was often missing the distal interproximal area of the 24 and when I went to recheck areas, I would see pink plaque. I still feel there are probably about 10,000 patients from my pre-GBT days that probably left with plaque in the 24/25 inter proximal space (sorry!).
Probably the biggest success was 100% biofilm removal. We all know biofilm is the enemy in periodontal therapy and I was now able to access difficult to reach areas such as orthodontic brackets and distal of upper 8’s.
My job satisfaction increased; I was now able to remove that once impossible staining, reach difficult areas, achieve better results and I felt happier. Not only were my patients feeling more motivated by the GBT protocol, but so was I! The other thing that was becoming obvious was the improvement in the periodontal status of my patients. Patients that I could only hand scale because they couldn’t tolerate the water in the ultrasonic could now have biofilm removal with AIRFLOW® and they could also tolerate the ultrasonic for spot removal.
GBT has made me a more passionate clinician which in turn enables me to motivate my patients and improve their oral and general health. Through this passion, I was asked by EMS to work with them as a Clinical Educator. At first, my answer was no. How could I possibly get up in front of people and start telling them how to maintain implants and treat periodontal disease? After some convincing, I travelled to Switzerland with EMS for further training in their head office and I started my journey as an EMS Clinical Educator. It’s been an amazing experience. I have had the pleasure to present both nationally and internationally and I feel so honoured to be able to represent EMS on many occasions. Not only do EMS make a great device that improves patient comfort, health and outcomes, they are also passionate about education.
EMS invests heavily in educating clinicians all over the world on the latest research on non-surgical periodontal therapy and implant maintenance. EMS has provided me with so many career opportunities, all whilst supporting my further education and they have helped increase my passion for dentistry. I am forever thankful for my GBT journey as I truly believe it has increased my clinical life and enhanced my personal experiences within the dental field.
Fast forward to the present day, I now work in an implant dental practice. EMS has helped me take my fear of implants and turn it into a passion. I now routinely and confidently treat complex zygomatic implant patients and full mouth implant rehabilitations. I give advice in implant forums and provide mentorship to other clinicians. GBT has changed my life in a way I could have never anticipated. I am a happier, more confident clinician and my patients are healthier and also happier.
Thank you EMS for always supporting, championing and helping not only myself, but clinicians all over the world. I feel honoured to be part of the EMS family and to be able to share my passion for implant maintenance with the world. My GBT journey has been such a fun experience and it’s only the beginning!