Innerview in a Full-Mouth Hygiene Recall for a 75-Year-Old Patient

Clinic & Practitioner Overview
Dr. Howard Golan, DDS, runs a family dental practice with a strong emphasis on integrating advanced diagnostic technologies. With decades of restorative experience, his practice focuses on long-term patient care and early detection of implant and tooth complications. The clinic is located in Nassau County, NY.

The information in this case study pertains to future capabilities, currently under clinical evaluation – Not yet FDA cleared.

Routine Hygiene Exam Uncovers Hidden Structural Issues

A 75-year-old female presented for a routine hygiene recall appointment. She had a full-arch fixed implant restoration and multiple long-term restorations, including:

Full-arch upper fixed implant restoration (20+ years old)
Lower anterior fixed bridge (20+ years old)
Posterior implants replacing lower first molars
Remaining lower teeth restored with crowns and bridges

Despite a complex restorative history, the patient had no complaints at the time of the visit.

Clinical Examination Findings

During the hygiene exam, the following observations were made:

Generalized gingival inflammation was more than usual, particularly around teeth #20-29. The tissue appeared slightly erythematous, though no suppuration or deep pocketing was noted.
Generalized recession around the upper implants, but no significant inflammation was observed in these areas.
Tooth #30 showed radiographic bone loss and peri-implantitis, prompting further evaluation. The bone loss pattern suggested possible biomechanical overload, though the patient had no reported discomfort.
No mobility or major concerns were noted during the hygienist’s manual exam, and the patient reported no functional issues with chewing.

Given the patient’s extensive restorative history, the hygiene team decided to proceed with additional diagnostic imaging and InnerView assessment. While no overt symptoms were present, the subtle gingival inflammation and radiographic bone loss raised concerns about underlying structural integrity. The decision was made to take a closer look at these restorations to identify any early-stage issues before they could lead to failure.

Radiograph of Implant #30 revealing peri-implant bone loss, prompting further InnerView assessment

How InnerView Changed the Diagnosis

After reviewing the radiographs, the clinician performed an InnerView scan to assess the stability of the implants and restorations.

Mobility Readings

Upper arch: Normal readings, confirming implant stability after 20+ years.
Lower arch: Normal readings for both implants and natural teeth.

NFE Readings & Structural Defects Detected

Implant #19i – High Structural Instability
NFE Score: 144, indicating significant implant instability.
ERG scan revealed two large peaks, suggesting a hidden mechanical defect at the implant-abutment interface.

Teeth #20 & #21 – Elevated NFE Scores

ERG graphs showed multiple short peaks, indicating structural inconsistencies within the restorations.
No visible clinical issues, but InnerView detected possible early-stage mobility or failing posts.

Irregular Energy Return Graphs indicate structural weakness in both teeth.

Teeth #28 & #29 – High NFE Scores & Recurrent Decay

Splinted PFM crowns on these teeth had been in place for over 20 years.
High NFE readings suggested possible post-loosening or debonding.
Decay was confirmed beneath the restorations upon crown removal.

Implant #30i – Peri-Implantitis and Structural Concerns

Radiographic bone loss and high NFE reading suggested early implant complications.
No clinical looseness was detected, but the InnerView scan confirmed mechanical concerns

Clinical Examination After Reviewing InnerView Results

Implant #19i: Slight movement in the crown was detected.
Teeth #20, #21, #28, and #29:
- - Appeared normal clinically, but InnerView suggested hidden structural weaknesses.
  - Given the age of these restorations and their placement opposite a fixed implant, replacement was recommended.

Mobility reading pre-treatment and ERG show elevated readings for Teeth #20, #21, #28, and #29, indicating structural inconsistencies within the restorations

Intervention Guided by InnerView Data

Planned Treatment

Replace crowns on #20, #21, #28, and #29 (possible core/post replacement).
Expose and evaluate the abutment screws on #19 and #30.
Peri-implantitis treatment for Implant #30i.

Follow-Up Confirms Stability

Immediate Intervention – Implant #19i

Since the implant was cement-retained, an occlusal access hole was drilled.
The abutment screw was exposed and retorqued to correct the mechanical defect.
A post-tightening InnerView scan confirmed stability, as the NFE score dropped from 144 to 53.

InnerView trendline for Implant #19i shows a significant drop in NFE score (144 → 53) following abutment retorquing, confirming restored implant stability and improved mechanical integrity over time.

InnerView Takeaways & Clinical Impact

Early Detection Prevented Undiagnosed Implant Instability

The patient had NO symptoms, and manual testing did not detect movement.
Without InnerView, the instability in #19i and high-risk restorations would have gone undetected.

Data-Driven Insights Enable Proactive Treatment

InnerView provided real-time, quantifiable evidence of implant stability concerns.
The clinician adjusted treatment plans based on data, rather than waiting for symptoms.

Routine Monitoring Ensures Long-Term Implant Success

InnerView will be performed every six months to track implant stability and restoration performance.

Optimizing Patient Care with InnerView

This case highlights how InnerView transforms diagnostics, ensuring long-term implant success by:

Identifying hidden implant and restoration issues before they become symptomatic.
Guiding proactive treatment decisions based on objective data.
Enabling early intervention to prevent costly, complex failures.

Innerview in a Full-Mouth Hygiene Recall for a 75-Year-Old Patient

Howard Golan, DDS

Routine Hygiene Exam Uncovers Hidden Structural Issues

Clinical Examination Findings

How InnerView Changed the Diagnosis

Mobility Readings

NFE Readings & Structural Defects Detected

Teeth #20 & #21 – Elevated NFE Scores

Teeth #28 & #29 – High NFE Scores & Recurrent Decay

Implant #30i – Peri-Implantitis and Structural Concerns

Clinical Examination After Reviewing InnerView Results

Intervention Guided by InnerView Data

Planned Treatment

Follow-Up Confirms Stability

Immediate Intervention – Implant #19i

InnerView Takeaways & Clinical Impact

Early Detection Prevented Undiagnosed Implant Instability

Data-Driven Insights Enable Proactive Treatment

Routine Monitoring Ensures Long-Term Implant Success

Optimizing Patient Care with InnerView

More Case Studies

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