Contraindications to implant treatment
Introduction :
Implant treatment remains a solution of choice for different types of edentulism; the implant has proven its success over the years, and has allowed for better stability and durability of the future prosthesis, however, implant treatment remains contraindicated in certain situations.
First consultation:
- fundamental time of implant treatment, it can determine the success or failure of implant treatment.
- Patient-practitioner interview
- Patient expectations regarding comfort, aesthetics, function.
- The practitioner must be attentive to the patient’s wishes in order to understand their personality as well as a possible psychological evaluation.
- Absolute contraindications:
I.1) General contraindications:
A) Heart Diseases: Among these heart diseases we cite:
- valve prosthesis wearers
- Patients with a history of infective endocarditis
- Severe heart failure
- Severe cardiac arrhythmia.
Patients with these heart diseases are considered to be at high risk of developing infective endocarditis after surgery.
B) Hemopathies: Among these hemopathies we cite:
- severe anemia: Worsening of anemia
- Neutropenia below 1000/mm3: Risk of infection.
- Thrombocytopenia less than 50,000/mm3: Risk of bleeding after the procedure.
c) Chronic renal failure:
- CKD causes bone metabolism disorders with immunosuppression, a risk of hemorrhage and anemia which can disrupt osseointegration.
D) Patients irradiated in the Oro-facial sphere:
- Irradiated bone is fragile bone; and the oral cavity is subject to changes; both of these elements make the implant solution unlikely.
E ) Patients on immunosuppressants:
- These are transplant patients, in whom immunosuppressive treatment is maintained for life.
F ) Acute hepatitis:
- They are an absolute contraindication due to disorders of coagulation factors,
delayed healing and risk of secondary infections.
G) Chronic alcoholism:
- May be an absolute contraindication due to possible liver function disorders, immunosuppression; and changes in the oral environment.
H) Drug users:
- These patients are often unstable, have poor hygiene, and are predisposed to “AIDS” infections…
I.2/ Relative or temporary contraindications:
These are the conditions where implant treatment is temporarily contraindicated:
- poorly controlled diabetes.
- Myocardial infarction less than six months
- Stroke lasting more than six months
- Patients undergoing chemotherapy.
Contraindications to implant treatment
1.2.1/ conditions with a risk of hemorrhage:
a) Patients on antiplatelet drugs:
According to the recommendations of the SFMBCB, for the management of patients on antiplatelet agents in Odontostomatology “2005”; the continuation of treatment with low-dose aspirin does not contraindicate oral or implant surgery being very low compared to the thromboembolic risk following the cessation of treatment.
b) Patients on anticoagulants:
Implant surgery can be performed without stopping AVK treatment, except in the case of multiple implants with an INR exceeding 3 and hospital intervention is then necessary.
c) Hemophiliac patients:
Any surgical procedure is possible for a haemophiliac provided that it is carried out in a hospital setting and that post-operative haematological monitoring is validated.
1.2.2/ metabolic risk conditions:
- Endocrine disease, hyperparathyroidism:
In its severe form, hyperparathyroidism causes accelerated bone resorption, this pathology would therefore be a contraindication to implant surgery, for moderate forms of this disease, implant surgery is not contraindicated.
b ) Bone diseases:
Paget’s disease, osteoporosis, osteogenesis imperfecta….
1.2.3/ contraindications induced by a treatment:
- High-dose corticosteroids:
Long-term corticosteroids are associated with impaired healing and an increased risk of postoperative infection. However, no studies confirm these risks in implantology.
b) Bisphosphonates:
The occurrence of ONJ is more rapid in patients treated with IV Bps than in patients treated with oral Bps.
c) Chemotherapy:
Wait for the remission phase if not the end of chemotherapy…
1.2.4/ toxic contraindications:
- Tobacco:
Tobacco is considered a factor in implant failure. Heavy smokers are at increased risk of impaired healing and bone metabolism. Cessation of tobacco use is beneficial and may improve the success rate of implant treatment.
b) alcohol:
Alcoholism can lead to impaired healing and can cause osteopenia. The degree of intoxication must be assessed before therapeutic decisions are made.
1.2.5/ contraindications of physiological origin:
- Child under 16:
Dental implants are generally contraindicated in young patients before growth is complete; however, there would be no upper age limits. However, long and complex procedures should be avoided in elderly patients.
b) Pregnancy:
Plan to have the implant fitted outside of pregnancy.
- Concept of informed consent
1. Legislation and liability in implantology:
Implantology today represents a well-defined specialty and a
young, well-codified science in the field of oral and prosthetic rehabilitation.
2. The practitioner’s responsibility:
Implantology is one of the main sources of conflict between practitioners and
patients, due to the always possible failure of the implant procedure, the cost
high treatment rates and changing patients’ attitudes toward their doctors.
3. The expert’s mission
After the assignment and depending on the questions asked by the judge, the difficulty
for the expert will reside in the fact that he will have to assess the existence, the content and
the value of a contract between the practitioner and his patient.
The fundamental analysis of the expertise will be based on the possession of a file
well-kept and complete clinic, and possession of a flawless administrative file.
4. The patient’s medical file
It generally includes:
– A preoperative clinical record.
– A detailed treatment plan.
– A precise operational report.
– Control X-rays.
- clinical control examinations
5. The administrative file:
He will understand
– double the quote.
– the prescriptions
– letters to colleagues.
– the patient’s consent.
Informed Consent Template:
Contraindications to implant treatment
Conclusion :
The care of a patient for implant treatment goes through several phases, the first consultation remains a fundamental and crucial time before undertaking implant treatment, it is from this first consultation that the practitioner will be able to establish a detailed file of the patient, and for the indication or not, of the placement of a dental implant.
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