In our previous blog, we discussed some factors that our dental specialists at ARIA encourage our students to consider in the pre-surgical assessment of implant placement. Now let’s take a look at some surgical considerations.
General Medical Status
The patient’s general medical status must first be assessed to decide if implant treatment is possible. There are few absolute contraindications, such as acute illnesses or uncontrolled systemic diseases. Once controlled, however, these patients may be candidates for implant therapy. Other medical conditions, however, may still allow for implant treatment, albeit modified. Our Master Implant Course at ARIA can help you formulate a personalised treatment plan for such patients.
Intra-Oral Examination
Any intra-oral infections should similarly first be controlled to preserve the patients’ quantity and quality of their hard and soft tissue at and adjacent to the implant site. This may mean managing active periodontal disease, resolving local infections, and removing foreign bodies (amalgam remnants, infected root remnants).
Soft tissue morphology, including its biotype, should also be analysed to ascertain long term stability and aesthetics. In particular, soft tissue volume, quality and symmetry play a large role. As a general rule, papillae will reach the contact point between the prosthesis and adjacent tooth if the height from this contact point to the crestal bone is less than 5mm (Tarnow, Cho, & Wallace, 2000). Reduced soft tissue height increases the risk of black triangles and abutment-crown interface exposure. Our Melbourne and Adelaide courses discuss how these may influence aesthetics and oral hygiene, and how to best manage them.
The edentulous ridge anatomy should also be assessed through palpation, visual and radiographic examination of its height and width. The structural soundness of adjacent teeth and their periodontal status may also act as a guide to bone levels. Bone irregularities or even multi-rooted sockets may indicate the need for prior bone augmentation and soft tissue grafting. Our dental specialists at ARIA may advise and supervise such procedures for your patients.
Further Investigations
Accurately interpreting radiographs are essential in assessing the status of the underlying bone. As a minimum, this should be through an OPG and peri-apical radiograph, but a 3D computed tomography is highly recommended for precise analysis. Furthermore, the patient’s dental arch can be fitted with a clear custom-made plate containing a radiopaque build-up of the missing tooth. A radiograph then taken, can help visualise the implant’s location and act as the basis for a future surgical template (Henry, 2000).
Depending on the complexity of treatment, articulated study models can be an invaluable tool to assess the patient’s ridge in relation to their occlusion, and ridge-to-ridge relationship (Henry, 2000).
Consideration of these points can help produce well-placed, aesthetic and stable dental implants.
Images courtesy of Dr Luan Ngo and Dr Matthew Youssef
References
Henry P. J. (2000). Tooth loss and implant replacement. Australian dental journal, 45(3), 150–172. https://doi.org/10.1111/j.1834-7819.2000.tb00552.x
Tarnow, D. P., Cho, S. C., & Wallace, S. S. (2000). The Effect of Inter‐Implant Distance on the Height of Inter‐Implant Bone Crest. J Periodontol, 71(4), 546-549. doi:10.1902/jop.2000.71.4.546
