Optimized Implantology & Periodontology: Measurable Safety at the Chair

Dentistry is undergoing a profound transformation. For decades, it was regarded as a predominantly mechanical discipline – removing caries, placing fillings, inserting implants. Yet the recognition that oral and systemic health are inextricably linked is fundamentally changing clinical practice. Biomarkers such as Vitamin D, C-reactive protein (CRP), HbA1c, TSH and ferritin provide information that goes far beyond findings in the mouth – and can directly influence treatment outcomes.

With the Igloo Pro Reader, dental practices have access to a compact point-of-care analyser that determines these parameters directly at the treatment chair – from just a few microlitres of capillary blood, in three to fifteen minutes. No laboratory order, no time lost, no appointment rescheduling. Chairside diagnostics thus becomes an integral part of the dental workflow. This article explains why blood testing in the dental practice is no longer a future vision, what evidence supports it, and how practices can implement this step in concrete terms.

Why Blood Tests in the Dental Practice? The Paradigm Shift Towards Systemic Dentistry

The relationship between oral health and general health is bidirectional and far more extensive than many practitioners have long assumed. Periodontitis – one of the most common chronic diseases worldwide – is not merely a local event in the sulcus. It is accompanied by a measurable increase in systemic inflammatory markers, above all C-reactive protein. A recent meta-analysis from 2024, evaluating 25 studies with a total of 1,748 patients, demonstrated that successful periodontal therapy significantly reduces serum levels of CRP, interleukin-6 and fibrinogen. In reverse, this means: the dentist does not merely treat the periodontium – they influence the cardiovascular risk profile of their patients.

Conversely, systemic factors directly affect treatment success in the mouth. A Vitamin D deficiency, for example, impairs bone remodelling and immune response, which is particularly clinically relevant in implantological procedures. A systematic review from 2024, published in Nutrients, analysed data from 1,462 participants with 4,450 implants and documented implant loss rates of up to 11.4 per cent in patients with severe Vitamin D deficiency. Poorly controlled diabetes – identifiable by the HbA1c value – further worsens wound healing and increases the risk of peri-implantitis.

In this context, an often overlooked circumstance gains significance: the dental practice is, for many adults, the most frequent regular medical point of contact. The six-monthly recall interval means that dentists see their patients on average more frequently than many general practitioners. This frequency makes the practice an ideal setting for targeted screening of systemic risk factors – provided the diagnostic tools are available and practical for everyday use.

The professional community has now embraced this paradigm shift. The S3 guideline of the DGI and DGZMK, published in August 2025 (AWMF registry number 083-055), recommends for the first time an individualised Vitamin D screening for at-risk patients before implantation and explicitly names "quality-controlled in-office finger-prick rapid tests" as a suitable method. The guideline emphasises that this is not a blanket routine screening, but a targeted diagnostic approach for patients with anamnestic deficiency, unexplained early implant losses or recurrent peri-implant infections.

That the trend towards chairside diagnostics in dentistry is far from a marginal phenomenon is also demonstrated by industry developments: at the DGI Congress in October 2025, Camlog and Preventis presented a joint collaboration for point-of-care testing in implantology. Globally, the point-of-care diagnostics market is growing from USD 31.57 billion in 2024 to a projected USD 51.19 billion by 2032 – an average annual growth rate of 6.2 per cent (Fortune Business Insights, 2024).

For dental practices wishing to take this step now, the Igloo Pro Reader from PolarisDX offers a compact, IVDR-compliant solution. The immunofluorescence-based analyser determines over ten biomarkers from capillary blood – quantitatively, with a coefficient of variation below two per cent – and integrates seamlessly into daily practice at a weight of just 600 grams. The following sections examine the individual biomarkers in detail, the clinical evidence, and practical integration into the treatment workflow.

Vitamin D and Implantology – What Does the Current Evidence Say?

Vitamin D is far more than a "bone vitamin". As a key regulator of calcium and phosphate homeostasis, it controls mineralisation of the alveolar bone, promotes differentiation of osteoblasts and simultaneously modulates both the innate and adaptive immune response. These three functions – bone formation, bone remodelling, immune regulation – are precisely the biological processes on which successful osseointegration of dental implants depends. A Vitamin D deficiency thus intervenes at multiple points simultaneously in the healing cascade.

The clinical evidence increasingly supports this relationship. A systematic review published in Nutrients in 2024 evaluated data from 1,462 participants with a total of 4,450 implants. The results showed implant loss rates between 3.9 and 11.4 per cent – with the highest rates occurring in patients with severe Vitamin D deficiency, particularly when additional risk factors such as smoking or existing periodontitis were present (Nutrients, 2024). A paper in Quintessenz Implantologie from 2025 concluded that an insufficient Vitamin D status can delay healing and increase the risk of peri-implantitis. As early as 2022, a study in the International Journal of Implant Dentistry had confirmed the association between Vitamin D levels and long-term implant survival. The evidence is not monolithic, but the direction is consistent: a low Vitamin D status is a relevant risk factor for implant success.

This guideline recommendation deserves a nuanced interpretation. That no blanket screening is recommended is understandable given the heterogeneous evidence base. At the same time, the group of at-risk patients in implantological practice is by no means small. Looking at epidemiological data for Germany, approximately 62 per cent of the adult population is insufficiently supplied with Vitamin D – meaning serum levels below 30 ng/ml. During winter months, the proportion of manifestly deficient individuals with levels below 20 ng/ml reaches up to 50 per cent. Risk groups include particularly older patients, individuals with limited sun exposure, people with obesity and patients on certain long-term medications. In an implantological practice whose patient clientele frequently falls into the 50-plus age group, a substantial proportion of patients is likely to be eligible for individualised screening.

The guideline deliberately names chairside rapid tests as a suitable diagnostic instrument. The reason is obvious: if the decision regarding supplementation or postponement of the implantation date is to be made on the same treatment day, a laboratory result with a two to three day waiting period is hardly practical. The Igloo Pro Reader determines the quantitative Vitamin D3 level in approximately three minutes from capillary blood – directly at the treatment chair, without laboratory submission. The result is immediately available and enables an instant therapeutic decision: proceed with implantation as planned, supplementation and follow-up monitoring, or targeted referral to the general practitioner. More about the role of Vitamin D3 in implantology and its practical implementation in daily practice can be found in our in-depth article.

CRP and Periodontitis – Recognising Inflammation Markers Chairside

C-reactive protein is one of the best-studied systemic inflammatory markers in medicine. It is produced by the liver and responds within six to twelve hours to both acute and chronic inflammatory stimuli – regardless of their localisation. In general medicine and cardiology, CRP has long been established as a cardiovascular risk marker. The American Heart Association and the Centers for Disease Control classify relative risk using the following thresholds:

For dentistry, this classification is relevant for a specific reason: periodontitis is a chronic inflammatory disease that demonstrably influences CRP levels. The underlying mechanism is well described pathophysiologically. Periodontal pathogenic bacteria enter the bloodstream through the ulcerated pocket epithelium and trigger a systemic inflammatory response. CRP levels correlate significantly with the severity of periodontal disease (Paraskevas, 2008). The relationship is bidirectional: just as periodontitis increases systemic inflammatory burden, a chronically elevated inflammatory level in turn worsens periodontal healing – a self-reinforcing cycle that is particularly clinically relevant in patients with diabetes mellitus or coronary heart disease.

An honest assessment is important here: CRP is a non-specific marker. An elevated value alone does not prove periodontitis, and numerous other conditions can also raise levels. The diagnostic value of CRP in the dental practice therefore lies not in primary diagnosis, but in therapy monitoring and risk stratification – as an objective supplement to clinical parameters such as probing depth and bleeding on probing.

This is precisely where current evidence provides a compelling argument. A meta-analysis from 2024, evaluating 25 studies with a total of 1,748 patients, demonstrated that successful periodontal therapy significantly reduces serum levels of CRP, interleukin-6 and fibrinogen (Meta-analysis, 2024). CRP thus becomes a measurable therapy success marker: if the value decreases after scaling and root planing, treatment success can be objectified not only clinically but also biochemically. For patients, this has an additional effect that should not be underestimated – a visible laboratory value that improves through therapy can significantly strengthen compliance and motivation for continued periodontal treatment.

In practice, the use of this inflammatory marker has frequently failed due to logistics. A venous blood draw with laboratory submission for a CRP value is hardly proportionate in the dental setting. The Igloo Pro Reader solves this problem: quantitative CRP measurement is performed in just a few minutes from capillary blood, directly at the treatment chair. Specific use scenarios include risk stratification before initiating systematic periodontal therapy, monitoring after completed scaling and root planing, and targeted screening in high-risk patients with diabetes or cardiovascular comorbidities. The result is immediately available for discussion – and can directly inform treatment planning.

HbA1c – Diabetes Screening in the Dental Practice

The link between diabetes mellitus and periodontitis is one of the best-documented bidirectional relationships in medicine. Periodontitis is considered the "sixth complication" of diabetes: hyperglycaemia promotes periodontal tissue destruction, impairs immune defence in the sulcus and delays wound healing after periodontal surgical procedures. Conversely, uncontrolled periodontitis complicates blood sugar regulation through chronic inflammatory burden – a cycle that mutually sustains both conditions and is directly relevant for implantological planning.

Against this backdrop, the dental practice is increasingly coming into focus as a screening partner. In Germany, an estimated two million people live with undiagnosed type 2 diabetes. The dental practice is, for many of these patients, the most regular medical contact point – two recall appointments per year represent a higher contact frequency than with many general practitioners. A chairside screening for pre-diabetes in patients with severe or treatment-resistant periodontitis could address this diagnostic gap.

The appropriate marker for this is HbA1c, the glycated haemoglobin value. It reflects average blood sugar control over the past eight to twelve weeks and – unlike fasting glucose – requires no fasting state. According to American Diabetes Association criteria, the normal range is below 5.7 per cent, values between 5.7 and 6.4 per cent are classified as pre-diabetes, and from 6.5 per cent as diabetes. Internationally, dentistry is already moving in this direction: ADA guidelines in the USA recommend dental HbA1c screening for at-risk patients, and the International Diabetes Federation explicitly supports interdisciplinary screening approaches. In Germany, this is not yet clinical standard, but given the evidence base and international developments, a clear trend is emerging.

The Igloo Pro Reader enables HbA1c measurement in approximately five minutes from capillary blood – without laboratory submission, without requiring the patient to fast. If a conspicuous value is found, a targeted referral to the general practitioner or diabetologist follows. The dentist thus becomes a health navigator who not only identifies systemic risks but actively integrates them into the care pathway.

Pre-operative Diagnostics – Risk Minimisation Before Surgical Procedures

Implantation, augmentation, sinus lift or apicoectomy are elective procedures. This means: there is a time window in which modifiable risk factors can be identified and corrected before the patient is in the treatment chair. Pre-operative diagnostics in implantology has until now been largely limited to imaging and medical history. With chairside biomarker diagnostics, this picture can be expanded by a systemic dimension.

The following overview shows which parameters provide clinically relevant additional information before surgical procedures:

A practical protocol can be integrated into the existing practice workflow without generating additional appointments. Ideally, biomarker screening takes place one to two weeks before the planned procedure – for example during the planning appointment. As a baseline set for a pre-implantological check, the combination of Vitamin D, CRP and ferritin is recommended. Results are documented in the patient record. Where values are conspicuous, three clinical options are available: targeted supplementation with follow-up monitoring, postponement of the procedure until optimisation, or referral to the treating specialist.

The Igloo Pro Reader measures all the parameters mentioned – in one session, from one capillary blood sample, with one device. This makes pre-operative risk stratification a standardisable workflow that can be implemented both in specialist implantological practices and in general practices performing oral surgery. This principle of biomarker-based risk minimisation extends beyond dentistry: more about biomarker panels for longevity diagnostics can be found on our overview page for preventive health diagnostics.

Chairside Testing with the Igloo Pro Reader – How It Works

The preceding sections have shown which biomarkers are clinically relevant in dental practice and what evidence supports chairside diagnostics. The crucial question for daily practice, however, is: how can point-of-care testing be concretely implemented without disrupting the treatment workflow? The Igloo Pro Reader, manufactured by DX365 GmbH in Berlin and distributed by PolarisDX, was designed precisely for this requirement profile.

The measurement principle of the Igloo Pro is based on immunofluorescence – an established analytical method that delivers quantitative results with specific measurement values and units. Unlike qualitative rapid tests that merely show a yes-or-no result, the Igloo Pro Reader enables differentiated assessment: a Vitamin D value of 18 ng/ml requires a different clinical consequence than a value of 28 ng/ml. The analytical precision is expressed as a coefficient of variation below two per cent. The device is IVDR-compliant and CE-marked, weighs approximately 600 grams and fits on any treatment trolley or countertop.

The procedure for a chairside measurement can be described in a few steps:

1. Collect capillary blood – a finger prick suffices; depending on the parameter, 10 to 20 microlitres of blood are required.
2. Apply sample – the capillary blood is applied to the pre-filled test cassette for the desired biomarker.
3. Insert cassette – the test cassette is placed into the Igloo Pro Reader; measurement starts automatically.
4. Wait for measurement – depending on the biomarker, analysis time is three to fifteen minutes.
5. Read and document result – the quantitative measurement value appears on the display and can be discussed immediately.

The biomarker portfolio comprises over ten parameters from a single device: Vitamin D3, CRP, HbA1c, TSH, ferritin, cholesterol (HDL, LDL, total) and more. The test cassettes can be used individually or combined as a panel – for example as a pre-implantological check with Vitamin D, CRP and ferritin in one session. The Igloo Pro Reader is LIS and HIS compatible, so results can be electronically transferred to the patient record. No user calibration is required; reagents are ready to use and storable at room temperature. PolarisDX provides practice teams with structured training and ongoing support. All technical details about the Igloo Pro Reader can be found on the product page.

How chairside diagnostics with the Igloo Pro compares to traditional laboratory submission is shown in the following comparison:

Specific prices and leasing options for the Igloo Pro Reader are available through our personal consultation.

Billing as a Private Health Service (IGeL) – GOÄ Codes and Revenue Potential

The clinical evidence for chairside diagnostics is compelling – but in practice, the question of economic feasibility inevitably arises. Point-of-care tests performed without a medical indication in the sense of statutory health insurance fall within the scope of individual health services (IGeL). The patient bears the costs themselves. Billing follows the German Fee Schedule for Physicians (GOÄ), as dentists bill medical services pursuant to § 6 para. 2 GOZ under GOÄ. For IGeL billing in the dental practice, clearly defined framework conditions thus apply.

The following GOÄ codes form the basis for billing chairside blood tests:

Code 3511 is applied as an analogous code for immunofluorescence-based determination on the POC device. When multiple parameters are determined in one session, it can be applied correspondingly multiple times. The multiplier factors range normally between 1.0x and 2.3x; a higher factor up to 3.5x is possible with written justification.

What does this mean in concrete euro terms? The following example calculation provides an orientation:

For economic evaluation, the break-even point is decisive. The investment in the Igloo Pro Reader typically pays for itself from approximately 15 to 20 tests per month. A practice performing five chairside tests per week – for example as part of implant planning or periodontitis monitoring – generates additional monthly revenue of approximately €800 to €1,200. Beyond direct revenue, there is a difficult-to-quantify but real secondary effect: patients who experience thorough diagnostics and have their values discussed directly develop a stronger bond with the practice. IGeL diagnostics thus becomes a differentiating feature compared to competitors.

Formally, certain requirements must be observed. For patients with statutory health insurance, a written IGeL contract is required before the procedure, informing about the self-pay nature of the service and containing a cost estimate. Where a medical indication exists – such as an anamnestic Vitamin D deficiency before implantation – the service may be exempt from VAT under § 4 No. 14a UStG.

Note: The codes and amounts shown are for orientation purposes. Correct billing depends on the individual treatment situation. We recommend consultation with your billing service.

Specific prices for the Igloo Pro Reader, leasing options and an individual profitability model for your practice are available in a personal consultation.

Case Study: 32reasons Dental Team Hamburg

How chairside diagnostics can be concretely implemented in daily dental practice is demonstrated by the example of the 32reasons dental team in Hamburg. The practice, specialising in implantology and aesthetic dentistry, was looking for a way to expand implant planning to include pre-operative biomarker diagnostics – without being dependent on external laboratories and their waiting times.

The solution: the practice team led by Dr. Zug integrated the Igloo Pro Reader into the existing workflow and primarily uses it for Vitamin D screening before implantological procedures. The measurement typically takes place during the planning appointment – the patient receives their result in the same consultation where the implantation is discussed.

The practice experiences to date confirm what the evidence suggests: patient education gains substance when a concrete laboratory value is available that practitioner and patient can discuss together. Where previously a general recommendation for Vitamin D supplementation stood, there is now an individual measurement value with a clear therapeutic consequence. The practice team reports noticeably higher compliance with supplementation because the value is tangibly "in black and white" for patients. At the same time, the practice generates additional revenue through IGeL billing of Vitamin D and ferritin tests, contributing to the amortisation of the device.

"The Igloo Pro has expanded our implant planning by an additional dimension. We can now identify risk factors before they become a problem – and our patients take supplementation more seriously when they have seen their own values."

– Dr. Zug, 32reasons Dental Team Hamburg

Read the full case study: 32reasons Dental Team Hamburg

Quality Assurance and Regulatory Requirements – What Dentists Need to Know

Anyone wishing to introduce point-of-care testing in their dental practice faces, alongside the clinical and economic evaluation, a justified question: what regulatory requirements apply, and how complex is their implementation?

The fundamental regulatory prerequisite concerns the device itself. The Igloo Pro Reader and the associated test cassettes are approved under the European In Vitro Diagnostic Regulation (IVDR, EU 2017/746) and bear the CE mark. IVDR conformity ensures that the analysis system meets European requirements for safety, performance and analytical quality. For the practice, this means: the device may be used in a professional medical setting and delivers regulatorily validated results.

The second level concerns quality assurance in ongoing operations. The German Medical Association Guideline for Quality Assurance of Laboratory Medical Examinations – RiliBÄK for short – also applies to POCT in the dental practice. Specifically, this means: the practice must perform internal quality controls through regular control measurements, participate in external proficiency testing and document the results. This may initially sound like considerable administrative effort. In practice, however, internal quality control with modern POC devices is largely automated – the Igloo Pro Reader performs control measurements in a standardised manner, and documentation is digital.

PolarisDX supports practices in implementing these requirements in a structured manner from the outset: from setting up internal quality control to registering for proficiency tests, training the practice team and providing ongoing technical support. The goal is that regulatory obligations do not burden daily practice but function as a natural part of the workflow. More about training and support from PolarisDX

Conclusion: The Dental Practice Becomes a Diagnostic Interface

Dentistry is evolving. What was regarded for decades as a predominantly mechanical discipline is increasingly opening up to a systemic perspective – and chairside blood diagnostics is a concrete, implementable expression of this transformation today. The evidence base supports this step: the S3 guideline of the DGI and DGZMK recommends in-office rapid tests for at-risk patients before implantation (AWMF 083-055, 2025), systematic reviews document the influence of Vitamin D status on implant success (Nutrients, 2024), and meta-analyses confirm CRP as an objectifiable therapy marker in periodontal treatment.

For the dental practice, this results in benefit on three levels. Clinically, risk-adapted treatment planning based on individual biomarker values enables better treatment outcomes – whether in implantology, periodontology or pre-operative preparation. Economically, IGeL billing of chairside tests opens an additional revenue stream with attractive margins that pays off even at moderate test volumes. Strategically, the practice differentiates itself from competitors, strengthens patient retention and positions itself as modern and prevention-oriented.

The Igloo Pro Reader from PolarisDX makes entry into chairside diagnostics accessible: compact, IVDR-compliant, over ten biomarkers from one device, without laboratory logistics. The question is no longer whether point-of-care testing will come to dentistry – but when your practice will begin.