FeatureFeature

The Fonthill Implant Care Protocol: AThe Fonthill Implant Care Protocol: ACritical UpdateCritical UpdateOctober 8, 2019

by Peter C. Fritz; Donna M. Lavoie; Roxanne More; Linda M. Dakin; Angie Nahli; Amanda B. Longoby Peter C. Fritz; Donna M. Lavoie; Roxanne More; Linda M. Dakin; Angie Nahli; Amanda B. Longo

It has been eight years since we published our Supportive Periodontal Implant Maintenance Protocol

which has been shared and implemented in dental practices and hygiene colleges across the globe.

With the exciting new periodontal and peri-implant classifications published simultaneously by the

American Academy of Periodontology and European Federation of Periodontology, we felt it was

necessary to revisit our implant maintenance protocol to better reflect the new information and

technologies available today. This article is focused on the best evidence to prevent peri-implant

mucositis and peri-implantitis using a systematic approach which is personalized for the patient. This

critical update has eliminated several steps from our former algorithm and replaced them with

innovative approaches generated from new concepts of peri-implant health.

It is impossible to separate the health of the implant from the periodontal health of the natural

dentition and that is why a more comprehensive approach is now suggested. Implantology is a

collaborative art involving many stakeholders including the patient, surgeon, restorative dentist,

dental hygienist, denturist, lab technician and implant company. Everyone is completely aligned in

that they do not want any complications with the final result. However, many complications can occur

with implants and many of these do not emerge until the implant has been in function for three to

eight years which should be regarded as the “danger zone.” Fortunately, many of the complications

are preventable by following proper implant maintenance guidelines and working cooperatively as a

team in the best interest of the patient.

Implants should be regarded as high maintenance dental devices and it is clearly dangerous to

consider implantology in the absence of periodontology. Roccuzzo and colleagues compared implant

health in patients with a healthy periodontium to those with moderate and severe periodontal

disease. Less than every tenth implant in the periodontally healthy group but every third implant in

the moderate group and every second implant in the severe (periodontal) group had probing depths 6

mm or greater at implant sites. Regular periodontal maintenance was a predictor for implant health

despite a standardized approach for implant maintenance.

In a systemic review of epidemiological literature, the reported mean prevalence of peri-implant

mucositis is 43% and peri-implantitis is 22% of implant patients. Statistically, a peri-implantitis is

found at every tenth implant and in every fifth implant patient after a five to 10-year period. Because

peri-implantitis is most often associated with a bacterial biofilm induced infection, a lifetime of biofilm

management is required to ensure implant survival. Dental implants are different from any other

implanted devices in humans because once placed, they are never sterile. Only 30 to 120 minutes after

implant placement, the peri-implant sulcus takes on the nearly identical microbiological profile as the

neighbouring teeth underscoring the inextricable links between periodontal and implant health.

A useful analogy is to compare a bacterial biofilm to a large metropolitan community. There is a power

grid, waste channels, food stores, communication lines, security services and delivery pipelines. It’s a

complex, diverse, three-dimensional, resilient community or consortium trying to grow and thrive

without being disrupted by external influences. Biofilms are found everywhere including on rocks in

streams, airline tray tables, aquarium glass, on the surface of plants and on the hull of canoes. Given

that on a microscopic level, implants are pitted like the surface of the moon, it is no wonder biofilms

develop so readily around implants and are capable of causing inflammation and bone loss to the

susceptible surrounding tissues.

The supportive periodontal therapy “recall hour” consists of 5:

1

This video file cannot be played.(Error Code: 102404)

2

2

3

4

1. Examination, re-evaluation and diagnosis.2. Motivation, re-instruction and instrumentation.3. Treatment of re-infected sites.4. Polishing of the entire dentition, application of fluorides and determination of future supporting

periodontal therapy.

The Fonthill Implant Care Protocol adapts the “recall hour” into six stages outlined in Figure 1Figure 1. The

six stages of Implant Care are to assess, disclose, motivate and empower, instrument, check and

document, and recall. These six stages are adapted from the Guided Biofilm Therapy protocol for

dental biofilm management as proposed by EMS (Nyon, Switzerland). Our evolving supportive implant

maintenance protocol continues to successfully maintain more than 8000 implants in a private

specialty practice (Fonthill, ON, Canada). The protocol is useful for all implant designs and for implants

not having had previous implant care. This protocol allows the early identification of peri-implant

mucositis and peri-implantitis and has recently been tailored to reflect the disruptions in biofilm

management strategies.

Fig. 1Fig. 1

The Fonthill Implant Care Protocol.

ArmamentariumArmamentarium

The following instruments and devices are required to deliver contemporary implant care.

1. Metal periodontal probe. A metal probe is recommended because it is difficult to reproduceprobing depths with accuracy with a plastic periodontal probe.

2. Mirror.3. Explorer.4. Lip retraction mechanism (OptraGate by Ivoclar Vivadent, Schaan, Liechtenstein).5. Plaque disclosing solution.6. Air polishing system capable of supra- and sub-gingival polishing (AIRFLOW by EMS, Nyon,

Switzerland).7. Erythritol powder (AirFLOW PLUS Powder by EMS, Nyon, Switzerland).8. High-volume suction (Double-sided mirror suction by Hagar Worldwide, Hickory, North Carolina,

USA).9. Titanium scaler or curette (PDT, Missoula, Montana, USA). Plastic and Teflon scalers are

ineffective for implant therapy and metal scalers and curettes will damage the implant surface.

The Fonthill Implant Care ProtocolThe Fonthill Implant Care Protocol

1. Assess1. Assess

The assessment stage requires a review of the patient’s full medical and dental history as well as

clinical and radiographic examination.

A review of the patient’s medical history should always be undertaken at every dental visit. Changes in

the patient’s glycemic control, smoking status, medications contributing to hypo-salivation and

immune health are of particular relevance to implant health.

The negative and serious effect of cigarette smoking is well established on implant health. The effect

of smoking is cumulative and impairs the natural healing process. For example, the periodontal

healing capacity of a 50-year old smoker is the same as that of an 86-year-old non-smoker and

tissues can take over a decade to recover after quitting.

6,7

The effect of cannabis and vaping is presently unclear on the health of dental implants, however,

given the toxicity of one joint being greater than or equal to two and a half to five cigarettes due to its

higher level of combustion , we would speculate cannabis may be as deleterious to implant health as

cigarette smoke. With the recent legalization of marijuana, Canadian research will likely be on the

cutting edge as its consumption and the link to health and disease is a research question being asked

by many in the dental and medical fields, alike. The effect of vaping is less clear at this time however is

likely to have the same if not greater deleterious effects on implant health.

A comprehensive dental history is also imperative to collect in the assessment stage. Poor oral

hygiene and compliance, a history of periodontitis and cigarette smoking were found to be pivotal risk

indicators for development of implant complications and are summarized in Figure 2.Figure 2.

Fig. 2Fig. 2

Odds ratio of risk indicators for the development of peri-implant disease.

Clinical assessment:Clinical assessment:

The 10-point clinical examination to be used in the assessment of peri-implant health and disease is

presented below and has been summarized in Table 1Table 1.

Table 1Table 1

Ten-point inspection for clinical examination in the assessment of peri-implant health and disease.

1. Probing Depth:1. Probing Depth: In addition to probing the entire mouth, six sites around the dental implant

should be probed with a metal probe with a pressure no greater than 22 grams (Fig. 3Fig. 3). This probing

should be compared to the probing measurements at the time the superstructure was delivered.

Relative changes between appointments are more important than absolute changes and ideally there

should be no variation from the measurements taken at baseline.

Fig. 3Fig. 3

8

9,10

Probing with a metal periodontal probe.

Unlike around natural teeth, the probing depth around implants may be more than 5mm and still be

healthy due to the placement depth of the implant as well as the physiology of the mucosal seal

around the implant. As a general rule, if the probing depth does not increase over baseline

measurements, the peri-implant tissues can be considered healthy. An increase of 2 mm or more in

probing depth is considered a potential biological complication and may suggest progression from

peri-implant health toward disease. A referral to the surgeon who placed the implant is indicated as

peri-implant mucositis or peri-implantitis management may be necessary. A systemic antibiotic or

sub-gingival irrigation will most likely be ineffective in the treatment of a peri-implantitis.

2. Bleeding Upon Gentle Provocation:2. Bleeding Upon Gentle Provocation: Immediately after probing, the assessment for profuse

bleeding, a bleeding point or line is assessed. Ideally, there is no bleeding suggesting peri-implant

health. Any bleeding is a sign of inflammation and is a symptom of peri-implant mucositis and

possibly peri-implantitis. With the Fonthill Implant Care Protocol peri-implant mucositis is often

reversible. However, if left untreated, mucositis may progress to a peri-implantitis may rapidly and

non-linearly. Given the challenges of treating peri-implantitis, early detection of mucositis is critical. A

summary of the updates to the Global Classification System for Peri-Implant Health, Peri-Implant

Mucositis, and Peri-Implantitis have been published in this edition of this journal.

3. Suppuration:3. Suppuration: A positive finding of suppuration indicates a serious biological complication. This

finding triggers the prompt referral of the patient to the surgeon who placed the implant. Systemic or

localized antibiotics are not effective and surgery will likely be required to stabilize the periodontal

tissues, decontaminate the implant and repair the bone loss. At the risk of inducing an air emphysema

in the fragile subgingival tissues around an implant, subgingival air-polishing decontamination should

not be attempted.

4. A. Keratinized Tissue:4. A. Keratinized Tissue: It is advantageous to have a thick collar of keratinized tissue supporting

the implant. This provides resistance to abrasion as well as rigidity to the peri-implant sulcus. A lack of

attached keratinized tissue predisposes the patient to recession and bone loss around the implant and

is often noted on the buccal aspects of implants in the mandibular posterior and the lingual of

implants in the mandibular anterior. Where there is less than 2 mm of attached gingiva around an

implant, a mucogingival graft to add support to the peri-implant tissues is recommended.

B. Recession:B. Recession: A healthy implant generally experiences no recession. If more than 2mm of recession

is noted around the implant, this should be flagged as a biological complication and should be

evaluated by the surgeon who placed the implant. Immediate implantation is associated with more

recession due to the loss of bundle bone when compared to implants placed using a delayed

technique. Recession does not usually manifest immediately, but typically takes several years to

develop. Once recession develops around an implant, it is possible to graft the area. However,

outcomes of a graft around an implant is less predictable than that around natural teeth. Depending

on the thickness of the tissue supporting the implant, often the recession will arrest once past the gap

of the implant/abutment or crown/abutment interface.

5. Occlusion:5. Occlusion: Changes in the patient’s occlusion can increase forces on the implant predisposing it to

damage of the crown (chipping, cracks), screw loosening and possibly bone loss around the implant.

These changes include new restorations, loss of periodontal support, parafunction or orthodontic

therapy. The occlusion of the implant should be kept light enough to allow two layers of shimstock to

pass through the occluding teeth with the patient in maximum intercuspation and in lateral

excursions (Fig. 4Fig. 4).

Fig. 4Fig. 4

Use of shimstock to assess occlusions.

6. Interproximal Contacts:6. Interproximal Contacts: A definitive, wide contact point is ideal. A loose or open contact leads to

food impaction which subsequently can cause peri-implant inflammation, but more commonly, leads

to decay on the natural tooth adjacent to the implant.

7. Embrasure Space Amenable for Oral Hygiene:7. Embrasure Space Amenable for Oral Hygiene: There should be adequate space between

implants, between implants and teeth, under bridges and around bars to allow for effective personal

mechanical plaque control. Too often a fixed prosthesis is designed that restricts the patient from

using an interproximal brush or floss to mechanically disturb the biofilm on all surfaces. Adequate

embrasure space is a non-negotiable parameter for long-term peri-implant health.

8. Mobility:8. Mobility: Mobility of an implant is assessed differently from natural teeth. Perhaps a better term is

a rotation. Rather than moving the crown in a buccal-lingual direction with two instruments, the

implant requires a more personal touch. This is best assessed using the finger and thumb in a

rotational manner and assessing for the slightest amount of rotation.Implants should not have any

rotation or buccal-lingual mobility (Fig. 5Fig. 5). Any mobility with an implant must be investigated. This

suggests either a restorative complication (loose abutment or screw) or osseo-separation (loss of

implant integration). Both complications must be treated to prevent damage to the internal

component of the implant with the former, and bone loss and tissue destruction in the latter. The use

of non-original equipment manufacturer components is often the source of implant mobility.

Fig. 5Fig. 5

A test of mobility/rotation of the implant.

9. Condition of Prosthesis:9. Condition of Prosthesis: The condition of the crown, superstructure, or over denture and

locators must be evaluated for cracks, chips, retention and the ability for the patient to clean around it

(prosthesis design).

10. Plaque/Biofilm:10. Plaque/Biofilm: Updated from our previously published version of the implant care protocol, the

evaluation of plaque/biofilm distribution on the crown, implant surface, adjacent teeth, and peri-

implant tissues is now the final step in the clinical assessment. Disclosing the field with a plaque

disclosing solution is suggested for this final step. Once disclosed, an intra-oral photograph should be

taken of the area to document the plaque distribution and to serve as a launching point for a

meaningful oral hygiene discussion. For anterior teeth or where aesthetics are of a concern, intra-oral

photographs are recommended to document the condition of the tissues and implant prior to

disclosing plaque.

Radiographic assessment:Radiographic assessment:

It is essential to have a radiograph taken at the time the implant crown is delivered. This serves as a

useful comparison and allows the clinician to evaluate changes in crestal bone height as well as other

incidental findings such as calculus or cement. The clinician should always examine the natural teeth

adjacent to implants as decay can be easily overlooked when focusing on the implant alone.

Radiographs of the implant should not be taken to celebrate an anniversary, but rather according to

the following protocol:

1. At the crown/superstructure delivery,2. Approximately three months after crown delivery,3. Approximately one-year after crown delivery,4. Every five years, or5. If signs of peri-implant disease develop.

2. Disclose2. Disclose

Updated from the previous version of the Implant Care Protocol, plaque score has been eliminated

from the assessment in favour of making the biofilm visible through a disclosing agent (Fig. 6Fig. 6). Using

a disclosing agent serves three purposes, 1) records the plaque distribution (marginal tissues vs.

enamel surface), 2) allows an interactive discussion with the patient regarding biofilm mitigation

strategies, and 3) allows for guided biofilm management by the clinician.

Fig. 6Fig. 6

Use of disclosing agent to visualize and assess plaque and biofilm accumulation. Apowerful tool for patient motivation and empowerment.

Using a disclosing solution breaks down many barriers to communication with the patient. Many

patients overestimate the effectiveness of their oral hygiene regimen and despite investing in

expensive brushes, patients often require some coaching on how to improve. Disclosing solutions

quickly demonstrate to the patient that technique is very important in effective home care. Patients

can’t ignore the personal, factual, indisputable evidence revealed through disclosing. It allows the

dental professional to engage in a discussion of precision oral hygiene instruction tailored to the

patient.

Fundamentally, dental professionals are taught to remove deposits (calculus, plaque, stain) from teeth

and leave the cleanest surface behind. Biofilm plays a bigger role than calculus in the disease process,

but it is invisible to the naked eye. Clinicians are drawn to stain and calculus because it is easy to

identify. When we disclose biofilm, we can suddenly see the stain on the patient’s teeth that may

unknowingly be left behind otherwise.

Framing the conversation about disclosing is important in maximizing the benefit of good home and

professional oral hygiene. Patients need to be informed that the disclosing is for their benefit, and not

to embarrass them. A useful phrase to highlight this point is, “We are using a dye to help see the

bacteria on your teeth so they can be thoroughly removed.”

Using a microbrush, disclosing the biofilm around the implant gives the clinician a guide to focus

therapy on and facilitates the guided disruption of the biofilm. A photo of the disclosed area provides

a useful record of the level of plaque control without having to assign an arbitrarily calculated number

(i.e., plaque score). The use of an OptraGate is a useful retraction method to avoid staining the

patient’s lips with the disclosing agent.

3. Motivate and Empower3. Motivate and Empower

Two essential questions to ask the patient at each supportive periodontal therapy appointment:

A. Have you noticed any change in the implant area?A. Have you noticed any change in the implant area?

If the patient has noticed changes, this usually indicates a restorative (loose crown or food impaction)

or biological complication (peri-implant disease). Intervention is required as these complications will

not resolve spontaneously.

B. How are you caring for the implant?B. How are you caring for the implant?

Implants are high maintenance devices requiring daily attention. Although they cannot develop decay,

they still develop a significant biofilm and this can lead to clinically significant inflammation.

When asking questions of the patient, it is important to listen not with the intent to reply, but to

understand. The goal is to develop a personalized plan for the patient which includes sustainable

patient administered mechanical plaque control. Raising awareness that the implant is different from

natural teeth is also important. This should include using a powered toothbrush and interdental

brushes or a cross-over floss technique (Fig. 7Fig. 7). When using floss on rough implant surfaces or

restorations, floss remnants may be left behind which may in turn lead to plaque-related peri-implant

inflammation. As such, in cases of exposed rough dental implant surfaces interproximal brushes (i.e.,

Tepe, Gum, etc.) or soft picks may be a better mechanical plaque control strategy.

Fig. 7Fig. 7

Demonstration of the cross-over floss technique.

4. Instrumentation4. Instrumentation

Given the ineffectiveness of any subgingival irrigation on disturbing the biofilm, a new strategy is

required for implant maintenance. We have eliminated the pre-instrumentation peroxide swabbing of

the tissues as well as the chlorhexidine application post-instrumentation from the updated version of

the implant care protocol.

Powder and air jet devices should be used to remove sub- and supra-gingival biofilm and staining

around implants (Fig. 8Fig. 8). They are gentle on soft tissues, allow for shorter treatment times and may

cause less discomfort for the patient. The most commonly used powders are sodium bicarbonate,

glycine and erythritol (Table 2Table 2). The powder type is very important. Sodium bicarbonate can be used

to remove stains on enamel surfaces, but it should not be used on soft tissues or on implant surfaces.

Glycine is recommended for supra-gingival polishing around teeth and implants. Erythritol powder

can be used on both sub- and sub-gingival surfaces around implants and is therefore the

recommended powder to be used in air polishing devices.

Fig. 8Fig. 8

Supra-gingival guided biofilm removal with the use of air polishing.

Table 2Table 2

A comparison of available air polishing powders and their uses.

In periodontal probing depths of 1-4 mm, glycine-powder air polishing using a standard air polishing

nozzle is more effective at removing sub-gingival biofilm than manual or ultrasonic instruments.11 At

probing depths of 5-9 mm, using a sub-gingival nozzle, erythritol powder air polishing is more

effective at removing sub-gingival biofilm than manual or ultrasonic instrumentation11 (Fig. 9Fig. 9). For

sub-gingival sites, a sub-gingival nozzle is required to deliver the water-directed powder spray. This

can be achieved in 5 second bursts in pockets greater than 5 mm.

Fig. 9Fig. 9

Sub-gingival biofilm removal with the use of air polishing.Photos courtesy of Dr. Magda Mensi

There are some contraindications to air polishing and requirements before instrumenting with a

supra- or sub-gingival air polisher. Patients with a known allergy to erythritol or chlorhexidine are not

candidates for sub-gingival air polishing.

Given air polishing produces aerosols, the use of a high-volume suction is required as are the

universal precautions normally used for all patients. A pre-procedural rinse, such as 0.12%

chlorhexidine may reduce the bacterial contamination of aerosols and is recommended. With patients

who have respiratory problems such as chronic obstructive lung disease, or any condition that

interferes with breathing or swallowing, air polishing should be avoided. All patients should wear

protective eyewear and there has been some debate about potential damage to contact lenses with

air polishing.

5. Check and Document5. Check and Document

Once the air-polishing is complete, an explorer is gently used to determine if there are any foreign

bodies in the sulcus. Calculus can be removed with a titanium curette or scaler. Because a biofilm can

live under the calculus, a second round of air polishing is recommended if an accretion has been

liberated during this step. Other foreign bodies may include residual cement, bone chips or tooth

fragments and careful evaluation of the radiograph may help the clinician identify these potential

liabilities. Detailed documentation, including intra-oral photos and radiographs (if necessary) are an

essential part of this Implant Care Protocol.

6. Recall6. Recall

The frequency of the implant care protocol is customized to meet the individual patient’s needs. A

history of periodontal disease would support a three-month recall interval. With no history of

periodontal disease, the implant care protocol should be performed on a 6-month interval.

ConclusionConclusion

Regular, thorough periodontal maintenance is required for all implant patients, especially those with a

history of periodontitis. Frequency does not take the place of thoroughness. Early identification of

implant problems and evidence-based interventions can prevent more serious complications. Co-

operation by the entire dental team is required for the successful outcome for the patient. The implant

care responsibility is a critical component of informed consent prior to implant surgery and should be

discussed with the patient. This responsibility needs to be consensually assigned and not simply

delegated or assumed by the surgeon.

Peri-implantitis is a silent disease and patients are generally unaware of a problem unless a dental

professional alert them to the situation. This article is not meant to provide guidelines on how to treat

peri-implantitis due to poor surgical or technical execution. However, along with proper periodontal

maintenance of natural teeth, it does contribute to the foundation of oral health. Strict adherence to

the implant care protocol can prevent peri-implantitis and mucositis and serves to ensure that the

implant is the successful long-term solution all stakeholders plan for it to be.

Oral Health welcomes this original article.

Acknowledgements:Acknowledgements: The authors would like to acknowledge the work of Dr. Magda Mensi and her

permissions to use her clinical photos to support this work (Fig. 9Fig. 9).

ReferencesReferences

1. Fritz PC., Dakin LM., Lavoie DM., Sabo SM., Hamm CP. (2012) Supportive Implant TherapyProtocol for the Patient with Single or Multiple Implants. Oral Health.

2. Roccuzzo M, Bonino F, Aglietta M, Dalmasso P. (2011) Ten-year results of a three armsprospective cohort study on implants in periodontally compromised patients. Part 2: clinicalresults. Clin Oral Impl Res. 23(4): 389-395.

3. Derks J and Tomasi C. (2015) Peri-implant health and disease. A systemic review of currentepidemiology. J Clin Periodontol. 42(Supple 16): S158-S171.

4. Furst MM, Salvi GE, Lang NP, Persson GR. (2007) Bacterial colonization immediately afterinstallation on oral titanium implants. Clin Oral Implants Res 18(4): 501-508.

5. Lang NP, Lindhe J. (2015) Clinical Periodontology and Implant Dentistry, 2 Set Volume. Wiley-Blackwell 6th Edition.

6. Faddy MJ, Cullinan MP, Palmer JE, Westerman B, Seymour GJ. (2000) Ante-dependence modelingin a longitudinal study of periodontal disease: the effect of age, gender, and smoking status. JPeriodontol. 71(3): 454-459.

7. Knight ET, Liu J, Seymour GJ, Faggion GM Jr, Cullinan MP. (2016) Risk factors that may modify theinnate and adaptive immune responses in periodontal diseases. Periodontol 2000. 71(1): 22-51.

8. Ribeiro LIG, Ind PW. (2016) Effect of cannabis smoking on lung function and respiratorysymptoms: a structured literature review. NP J Prim Care Respir Med. 26: 16071.

9. Heitz-Mayfield LJA, Salvi GE. (2018) Peri-implant mucositis. J Clin Periodontol. 45(Suppl 20): S237-S245.

10. Schwarz F, Derks J, Monje A, Wang H-L. (2018) Peri-implantitis. J Clin Peridontol. 45(Suppl 20):S246-S266.

11. Cobb CM, Daubert DM, Davis K, Deming J, Flemmig TF, Pattison A, Roulet JF, Stambaugh RV.(2017) Consensus Conference Findings on Supragingival and Subgingival Air Polishing. 38(2): e1-e4.

About The AuthorAbout The Author

Dr. Fritz, BSc, DDS, FRCD(C), PhD (Perio), MBA is a full-time periodontist in Fonthill, ON

and is on a mission to redefine the way people think about periodontal and implant

wellness. He leads an extraordinary, collaborative, empowered team of clinicians,

makers, scientists and artists who are all working together to innovate the dental

specialty of periodontics and redefine the patient experience.

Donna M. Lavoie, RDH is a full-time dental hygienist in the practice of Dr. Peter C. Fritz.

Donna has been involved in clinical practice, research projects and peer mentoring of

dental hygienists.

Roxanne More, RDH is a full time registered dental hygienist in the practice of Dr. Peter

C. Fritz. She has nearly 30 years of clinical experience and has an endless passion for

learning.

Linda M. Dakin, RDH is passionate about educating dental hygienists. She graduated

from Niagara College in 1987 and obtained her teaching adults certification in 2001.

She is a full-time clinical hygienist in a periodontal office in Fonthill, Ontario. She is also

a part time clinical and periodontal educator at a private dental hygiene college. Linda

has lectured internationally on periodontal therapy, implant therapy, and research

methodology.

Angie Nahli, RDH is a registered dental hygienist honing her clinical skills full-time at a

periodontal practice in Fonthill, ON. Angie has found her passion in the reinvention of

today’s patient experience through the integration of technology. In the last year,

Angie designed and launched an application available on the App Store and Google

Play, used chair-side by dental professionals worldwide.

Dr. Amanda B. Longo, BSc, MSc, PhD is the Chief Innovation Officer and Director of

Strategy of a private periodontal surgery clinic in Fonthill, ON. She is internationally

recognized through her influence in research, innovation and knowledge mobilization.

Amanda’s key strength is as a catalyst for optimizing team performance and

implementing innovative initiatives for the benefit of the individual, the team, and the

patient of tomorrow.

RELATED ARTICLE: Safer Implant TreatmentRELATED ARTICLE: Safer Implant Treatment