"Don't probe implants with a metal probe or you'll scratch it!" - and so for years I was afraid to check the gingival health around implants. Crazy right? Dr Pav Khaira is here to bust that myth - but like with everything, it's not a simple answer - it has some interesting anatomical considerations. His answer is so eloquent, check it out!

https://youtu.be/pLDfqe8liLE

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Need to Read it? Check out the Full Episode Transcript below!

“If you can get to the neck of the implant, you SHOULD be probing to the neck of the implant...but you don't want to do it too aggressively, it should just be very gentle pressure.” Dr Pav Khaira

In this group function we discussed:

Can you probe implants? 5:33Screening Periodontal Health of Implants 11:14Referring patients with Peri-implantitis 16:22

Check out The Dental Implant Podcast!

If you liked this episode, you will love revisiting Implant Assessment for GDPs: from Space Requirement to Ridge Preservation

Click below for full episode transcript:

Opening Snippet: You just got into the cuff just sweeping it backwards and forwards and you seeing whether that triggers any bleeding because that's a sign of inflammation...

Jaz' Introduction:Hello, Protruserati. I'm Jaz Gulati and welcome to this group function. Now if you're new to the podcast, welcome, great to have you. A group function is where we work together as a team to find out a solution to a common problem. And the problem I'm presenting today and I'm hoping to get a good answer from Pav today is 'Can you probe around implants?' And what I mean by that is, I was fed a lie or a semi lie at dental school, like someone told me, I don't know who it was. But if you use a metal probe, to do a periodontal probing chart of an implant, you will scratch that implant and therefore that will harbor bacteria. And therefore you should not be probing around implants. So for the longest time, I didn't check the periodontal health of implants and it sounds really bad. But as a GDP who doesn't place implants, not much to do with implants. I thought that was the right thing to do. I thought I was doing less harm by not inserting my Williams or WHO or CPITN probe in the sulcus to check for the periodontal health because I didn't want to scratch the implant. I was scared of scratching the implant if you like. So I was expecting this to be a really quick group function. And I thought Pav was saying Yeah, you totally can. It's all good. But Pav of being Pav, an amazing guy he is. The only does he give us a really good definitive answer at the end, where he talks about the rationale of what the concerns are maybe and how each actually look a little bit deeper than Can you probe? Can you not? Because there's some anatomical variation, so I'm not going to spoil it for you. Let's join this group function with Dr. Pav Khaira. That man again. Pav Khaira.

Main Interview:[Jaz] Dr. Pav Khaira, welcome back to the podcast, my friend. How are you?

[Pav]I'm very good right now. How you doing?

[Jaz]Yeah, great. So it is Pav Khaira from The Dental Implant Podcast. And I'm gonna just pick your brains. You need to teach us something today. You need to speak to me like I'm five years old. Because this, the following questions I'm gonna ask you on this group function today is very much basic things that you're probably gonna laugh at me like Jaz, why you asked me these basic questions? But I'm sure with the referring dentist that you've met and your colleagues, like when it comes to implants we come out in dental school, like a lot of other topics. And we're like, where do we even begin? So just before we dive into that, just reminder on people who perhaps didn't listen to our episode on finding your niche. I think it was episode 76 from memory. Do listen to finding your niche, it's a cool one where we discover what is like your calling in dentistry. So do check that one out. But just remind us what is it that you do other than these amazing transformations that you posted on our telegram group.

[Pav]So thank you very much for having me on Jaz, I'm going to be cheeky and just upload this as the next dental implant podcast episode as well as your record. We have the same video editor. So it's an easy way. Firstly, I just wanted to say that there's no such thing as a silly question. This is something that I learned really quite early on, either you know, or you don't know, it's really that simple. And I think anybody who doesn't know who's asking questions at that point that then they shouldn't feel embarrassed or anything along those lines. So if I am being overly complicated with my answers, please feel free to remind me because obviously, for me, this is fairly straightforward stuff. And you know, when I get excited about implants, that's it, mouth starts. Okay? We all know.

[Jaz]We're going to start talking about at the cellular level, biological level. No, we're gonna go way simpler than that today. I know the kind of stuff that you talk about you love that you absolutely love that. And that's amazing to see though your passion is so..

[Pav]I'm gonna make it really tangible for you guys as well. So a little bit about me. I graduated in 2002. I did loads of different things. You know, I ended up getting bored quite quickly. It was one point I was doing endo for smile makeovers. And ironically, I just didn't make surgery. I didn't make implants. And then I ended up getting into implants. And I was like, Oh, actually, I really love this a lot. I'm now at a position where I am fortunate to be at EVA dental four days a week, and I mentor other dentists and I started working at another practice one day a week as well. And I placed approximately 1800 to 2000 implants a year. So that's actually quite a big number. And yes, you know, when you when you place big numbers, you learn to prevent a lot of mistakes, but you still see them, you know, anybody turn around and say you have 100% success rate. This is something that I've alluded to before, they are either lying or they're only placing one or two implants per year because if you place one or two implants per year, it's quite easy to have 100% success rate. So yeah, I mean, that's just a little bit about myself, I do the surgical aspects of it. I also undertake the restorative, because you can't separate them. You know, it's that intrinsically linked together. So that, you know, that's just a little bit about me.

[Jaz]Amazing. I mean, it's crazy. That number you mentioned, you probably do more implants than I do checkups. You probably do more implants than I do composites. You do. You do more implanst than any procedure. That's pretty spectacular. So you're totally the right man for this. So question number one of three in this group function is m, can I probe that implant? Now to give you some background behind this question, it's something that you may have heard before. Now, I don't know whether it is a myth or not. And I think it is, but let's just find out the whole thing about if you use a metal like a Hu probe, or a CPITN, a metal probe, or an implant, you will scratch the implant, which will then harbor bacteria, and it'll be a never ending spiral of peri-implantitis in future. And therefore, dentists all over the world. I'm sure they are. I'm sure they are, are doing their BP and they skip the implant and they carry on. Tell us about this.

[Pav]So the question that I understand is can you probe around implants?

[Jaz]Can you probe with a metal probe aroung implant? Or is it a myth that you shouldn't, you can't, or just tell us generally about how to check the periodontal health of an implant in a safe way.

[Pav]Okay. Do you want me to be really unhelpful now? Because you know, what I'm like, it's one of those. Okay, so the answer to your question is, yes, you can, and no, you can't at the same time, I'm going to expand on that right now. Okay?

[Jaz]Sure.

[Pav]I think we need to take half a step back and understand what's happening a little bit. Okay. So when you receive the final outcome of or, let's just say, restored single implant crown, okay? So there's a number of ways that it can be done. The way to get the best outcome isn't done very often, because it's more time consuming, it's more difficult to do, okay? So the kind of the standard way that most people out there do it, which is kind of accepted is you have quite a narrow implant in relation to your ridge, which is the same height as the alveolar crest. And then radiographically, it looks like a lollipop, tomato on a stick is what it's called. So you get this sudden, you get this sudden, really, really extreme what we call emergence profile, okay? Now, so probing around implants is different to probing around teeth, okay? Because when you're probing around teeth, you're immediately going into the periodontal ligament. If you imagine you've got this really wide implant, sorry, really narrow implant, or really wide crown. If you're probing straight down the side, you're not actually going to do anything, you almost want to be at 90 degrees, and it ends up being really difficult. Okay, so in those instances, when you've got an internal connection, the implant actually needs to be deeper. So you've got running room to have a natural emergence, but then you need to condition the soft tissue with a, instead of just a standard healing abutment out of the pocket, you can make custom healing abutments so you get a really nice smooth transition. Okay? Now, the reason why that is important, is because when you've got a very acute and sudden emergence angle A) it becomes virtually impossible to probe to the neck of the implant, but it actually answers the bio flora, the biofilm next to the implant neck itself, unfavorably, it becomes anaerobic as opposed to aerobic. Okay? So you've actually snookered yourself.