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

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 Tooth #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

Tooth #19 (Implant) – 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.

The information below refers to future capabilities, currently under development andclinical evaluation. Not yet FDA cleared.

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.

Both implants measured 73, indicating weaker osseointegration than expected, despite appearing stable on radiographs.

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.

Tooth #30 – 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

Tooth #19: Slight movement in the crown was detected.
Tooth #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

Treatment Plan & Immediate Intervention

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 Tooth #30.

Immediate Intervention – Tooth #19

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 Tooth #19 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 #19 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