Dear friends, we're now reaching the end of the 5th Module in our course. And by now you have seen that living with dental implants as a patient, or as a dentist is not entirely care free. On the contrary, we need to stick to certain fundamental principles in order to ensure long lasting success. Careful patient selection, careful treatment planning and execution will bring success to our interventions. Nevertheless it is maintenance that will ensure that the patients will stay happy in the long term. The first thing we need to do once we have completed our treatment is to document a baseline. That means to record the basic parameters of the tissues and the prosthesis, and save this as a reference for every future follow-up examination. The second important thing is to establish the risk profile of the patient. In Module 2, we discussed in detail of all the risk parameters. When you do that then you can also determine how frequently you will need to see the patient for the rest of his or her life. Every time we have a maintenance visit, there are three important parameters we always have to review. The patient, the prosthesis, but also the peri-implant issues in particular. At the patient level, we want to update the medical history and look for any changes in the systemic health, the medication or the behavioural aspects of the patient The Peri Apical Radiograph might be very important on an annual basis, not only to look at the bone, but also to be able to early detect any problems with the prosthetic components of the prosthesis, the abutment or the implant. Occlusal and functional examination is very important. And then of course don't forget to ask the patient about his experience with the prosthesis you have given him, his daily function, his satisfaction with all the parameters of the prosthesis. Remember there are certain factors that we always have to take in consideration in our risk assessment. History of periodontitis, smoking or history of smoking, Diabetes Mellitus, a previous implant complication of any type, as it can increase the risk for future complications, and also different types of parafunction or bruxism. Then the next item to focus is the prosthesis itself. Look at the design of the prosthesis, and the emergence profile. And make sure that the prosthesis allow the patient to clean and clean efficiently. Look at the veneering defects, any type of cracks or defects in the porcelain might actually be hints for trouble that is coming. Also take a very close look at the components of the implant and the prosthesis. That you can do through a very well taken Peri Apical Radiograph as we discussed in this Module. Sometimes playing with the contrast and the exposure of a digital radiograph can actually reveal the relation between the different components of the implant prosthesis, and give you hints about upcoming problems. Finally, have a very close inspection of the peri-implant and the periodontal tissues. Look for plaque index and the bleeding index, and also control for calculus, or any signs of inflammation. Probe around the implants and be very mindful of any increase in probing depth as compared to your baseline. And also register any other signs of soft tissue problems, such as recessions. Bone loss can be controlled radiographically, if necessary. And with that, we're coming slowly to the end of the 1st MOOC in Implant Dentistry - the 1st Massive Open Online Course for Dental Implants. The Friday sun is about to set here in Hong Kong. And as Friday night is moving slowly around the globe, we're about to complete this exciting five-week-long trip in the world of dental implants. It has been an amazing learning experience for all of us. And I do hope that you have learned at least as much as we have throughout this time, that we had the opportunity, the pleasure, and I would say the honour to interact with so many students, colleagues, professionals, all over the globe, and get to understand so much more about how to practice, how to teach and how to assess dental implants. We will continue this journey, and we will try to make it better and more efficient, and more productive and more fruitful for everyone. For now, I would like to express our sincere gratitude to all of us, students, learners, tutors, teaching assistants, lecturers, and everyone who has contributed to this amazing experience, and I want to say that there is no end to that. The network that we have established, the communication, and the connection we have established, will stay and will only grow with time. And we'll meet again, online or in person. Thank you all very much.
