Thorough treatment planning is quintessential for implant success. At ARIA, we teach our students to consider factors throughout the pre-surgical, surgical and post-surgical phases that may modify treatment. Let’s go through a few things to keep in mind in the pre-surgical phase.
Patient Selection
The first step is deciding if implants should be considered as a treatment option. If the patient requires tooth replacement, their functional and aesthetic expectations act as a significant deciding factor on whether a dental implant, bridge or removable denture is preferred. The benefits and limitations of each procedure should be explained to the patient, particularly as they relate to his/her oral and general health. Our implant courses in Melbourne and Adelaide guide dentists through these decision-making processes, and how best to prepare their patients for implants.
Implants require good oral hygiene compliance to better ensure uneventful healing and long-term peri-implant tissue health. Gingival indices, personality and psychological assessments are useful tools to determine this.
Site Preparation
Long-term prognosis of a dental implant also improves when the patient achieves periodontal health for their remaining natural teeth. Any oral infections need to be treated first. Adjacent teeth with subgingival restorations should also be factored in to estimate the bone loss due to subcrestal tissue attachment and periodontal ligament loss.
Brief Periodontal Assessment
Gingival biotype (thin, moderate, thick) can act as a preliminary guide to bone level and thickness that will surround the dental implant. Thin highly scalloped biotypes, commonly associated with triangular shaped teeth, are at a greater risk of bone loss due to the thinner crestal bone support. Augmentation therapies at the time of implant placement (type 1) may be recommended to help prevent buccal plate resorption and marginal tissue recession (Hämmerle et al., 2004). Where there is compromised or loss of buccal plate integrity, a staged approach before implant placement (type 3 or 4) may be recommended. Our dental specialists at ARIA can advise you on what approach is best for your patient.
Practical Concerns
Dental implants fix into the dental arch by osseo-integration, acting similarly to an ankylosed tooth. Therefore, adolescent growth spurt should be completed to avoid infra-occlusion.
Site access should also be assessed. As a general guide, there should be inter-arch space of at least 30mm for access to posterior sites. Restricted mouth opening or TMJ problems may be complicating factors. Bruxism, while not shown to worsen with implant placement, may increase the risk of technical complications due to parafunctional loading, and thus should be managed prior to the restoration phase.
Aesthetic Concerns
Aesthetic considerations are of course important, in particular the patient’s smile line, papillae exposure, and teeth proclination. This should be discussed with the patient during treatment planning as it is a subjective matter. These aim to guide the implant position to create the patient’s natural smile.
Images courtesy of Dr Matthew Youssef
Reference
Hämmerle, C. H. F., Hämmerle, C. H. F., Chen, S. T., Chen, S. T., Wilson, T. G., & Wilson Jr, T. G. (2004). Consensus statements and recommended clinical procedures regarding the placement of implants in extraction sockets. Int J Oral Maxillofac Implants, 19, 26-28.
