INCREASE CONSENT & REDUCE FAILURES

During and after the lockdown period for Covid 19 several of our Implant clinicians reported a spate of unexplained early implant failures in otherwise simple and straightforward cases prompting discussion about vaccinations and Vitamin D deficiency amongst others.

About Vitamin D

Vitamin D in its inactive form (vitamin D₃ or cholecalciferol) is synthesized in the skin with adequate exposure to the sun (ultraviolet light) and/or acquired through diet (figure 1). Vitamin D is a key player in bone growth and metabolism as it promotes the intestinal absorption of calcium and phosphorous. Vitamin D is vital for the health of the brain, cardiovascular system, respiratory tract, skin, and immune and endocrine systems.

Vitamin D Deficiency in Bone Grafting and Implant Dentistry

We used our free time to learn that 70% of patients are deficient without knowing it and are 3 times more likely to have implant failure than those smoking 20 cigarettes a day. (1) Deficiency has a prevalence as high as 50%–75% and associated with numerous dental complications. (2) 

Vitamin D also plays an important role in the dental field in the development of teeth, promotion of the immune response to oral microbial infections, and healing after periodontal, oral, and implant surgery. Low vitamin D is correlated with the failure of bone grafts and regenerative procedures. (3) A retrospective study of 1,740 implants investigated the correlation between low vitamin D and early implant failure and reported that:

A course of vitamin D tablets is inexpensive. However, over-the-counter supplements do not provide the level needed to boost deficiency. Even individuals taking 10,000 IU a day had lower bone mineral densities and increased bone resorption. (5). Testing is needed to know if patients taking supplements have reached the required levels. Home tests are inacurate and do not provide a numeric result meaning a lab test is needed at a cost of £60-£100 each time.

OUR OBJECTIVE

To help clients improve their success and reduce their failures.

We spoke to international experts and set out to source and register a blood test that provides a reliable numeric result, which could be done quickly without an additional appointment and ideally, one that could be done by non-clinical staff at minimum cost.

INTRODUCING THE SPARK D IN PRACTICE VITAMIN D TEST

Developed by US experts and awarded the 2020 most innovative portable diagnostics company award by Global Health and Pharmaceutical (GHP) magazine the Spark D Lateral flow ‘sandwich assay’ test detects Vitamin D2 and D3 in the range of 4 ng/ml – 100 ng/ml with high specificity and no interference of Biotin.

Spark D kit is highly accurate and contains all you need to complete a professional in-practice Vitamin D test with results comparable to those from a medical laboratory without the inconvenience or cost.

Testing is quick and does not need to distract a clinician.

Testing with Spark D takes 15 minutes and can be completed by nursing staff at consent and prior to surgery to ensure all patients are at the optimal level for surgery be that bone grafting or implant placement. The cost to practice is less than £20.

What is included in each Spark D test:

• Sterile lateral flow cassette.
• Micropipette.
• Reagent Solution.

Measurement is completed using the Spark D mobile phone application linked to your smart phone camera. (Developmental cube reader shown in images)

In practice report by Dr Minas Leventis (London UK)

Here is the report and opinion from Dr Minas Leventis after using the Spark D Rapid Test System in practice using it first on himself and then on my next 10 patients.

• All patients not on supplements were found to be deficient.
• One patient – a gardener had the highest reading of 68.5 ng/ml.
• Patients on supplements were above the normal limit (readings 31 – 42 ng/ml)

Noticeable improvement in patient engagement.

Dr leventis also noted that an important added value not at first expected was how well engaged my patients were in the test. ‘Everyone was impressed that I could offer them an accurate test chair side as part of the consent discussion. I think patients appreciate that their dentist pays more attention to evaluating medical and planning their case before having implants, so a good idea to have this as a standard during my implant consultations.’

‘I am sure it contributed to a more successful commitment’

PURCHASE SPARK D IN PRACTICE TESTS

Dental practices can buy Spark D rapid tests in units of 3 from Restore Surgical w E STORE LINK: https://restore-surgical.co.uk/product-category/regen-store/vitamin-d-testing/

ask@regen-store.co.uk

References

1. Dentistry Today. April 2020. Drs. Richard J. Miron, Michael A. Pikos, and Mark Bishara.
2. Ginde AA, Liu MC, Camargo CA. Demographic differences and trends of vitamin D insufficiency in the US population, 1988–2004. Arch Intern Med. 
3. Choukroun J, Khoury G, Khoury F, et al. Two neglected biologic risk factors in bone grafting and implantology: high low-density lipoprotein cholesterol and low serum vitamin D. J Oral Implantol. 2014;40)1)110-114.
4.  Mangano FG, Oskouei SG, Paz A, Mangano N, Mangano C. Low serum vitamin D and early dental implant failure: is there a connection? A retrospective clinical study on 1740 implants placed in 885 patients. J Dent Res Dent Clin Dent Prospects. 2018;12(3):174-182.
5. Burt LA, Billington EO, Rose MS, Raymond DA, Hanley DA, Boyd SK. Effect of high-dose vitamin D supplementation on volumetric bone density and bone strength: a randomized clinical trial. JAMA. 2019;322(8):736-745.