Indications and contraindications for implant treatment
Dr. SADAOUI
INTRODUCTION: Certain elements are necessary for making a therapeutic decision such as the general and psychological state of the patient, their oral hygiene, their motivation and their aesthetic request.
1-Indications:
The indication for implants arises in various situations:
- Single edentulousness delimited by healthy adjacent teeth;
- dental agenesis;
- lack of retention of a removable prosthesis;
- instability of a removable prosthesis;
- functional discomfort with removable prostheses;
- psychological refusal of a removable prosthesis
- parafunctional habits that compromise the stability of a removable prosthesis;
- Inadequate location and number of residual pillars;
- lack of dental abutments to make a fixed prosthesis;
- request for conservative therapy, refusal to mutilate healthy teeth).
Indications and contraindications for implant treatment
Contraindication to implant treatment:
1-systemic diseases
a-Cardiovascular diseases : It affects “at risk” subjects in 2/3 of cases. It is the result of bacteremia induced by the surgical procedure or a “risky” procedure such as scaling. The progression of endocarditis can be rapid (generally endocarditis due to golden staphylococcus) or slow (most often endocarditis due to viridans streptococcus).
It often manifests itself by a fever and the presence of cutaneous signs (petechiae). These clinical signs should alert the practitioner. A blood culture can confirm the diagnosis in order to begin appropriate antibiotic therapy as soon as possible.
In high-risk patients, implants are contraindicated.
In patients at moderate risk, the risk/benefit ratio should be assessed with the cardiologist.
b-Blood diseases:
Patients with coagulation disorders (hemophilia, anticoagulants, etc.) should be treated with the usual precautions. Before any intervention, it is recommended to consult the patient’s doctor in order to establish a precise course of action. In the event of difficulty, the advice of a hematologist or specialist should be sought.
c-Nervous system damage:
Epileptics are prone to convulsive disorders that may be associated with loss of consciousness. The muscle contractions and forces generated during these convulsions can be considerable.
It is recommended, before any treatment, to ensure with the neurologist that the epilepsy is under control.
d-Endocrine diseases:
Diabetes impairs microvascularization, leads to a decrease in the immune response and affects the bone remodeling process.
Diabetic patients are therefore more susceptible to infections following oral surgery. Healing is slower, it is recommended to control diabetes before performing implant surgery. Maintaining blood sugar levels reduces the implant failure rate observed in diabetics.
Osteoporosis , even in the presence of significant calcium loss, is not a risk factor. On the other hand, patients on bisphosphonates will be treated with caution because of the risk of osteonecrosis.
Implants may be contraindicated in cases of uncontrolled endocrine pathology (severe hyperparathyroidism).
e-Respiratory impairment:
Certain pathologies (chronic bronchitis, pulmonary emphysema, tumor) can create an operative risk. The latter contraindicates any non-urgent oral surgery.
f-Gastrointestinal involvement:
Xerostomia and gastroesophageal reflux (GERD) with hyperacidity are likely to modify salivary pH and lead to disorders in the healing of the mucous membranes.
A gastroduodenal ulcer can reveal a state of stress, sometimes associated with bruxism. It requires rigorous monitoring.
g-Kidney and urinary diseases:
Healing is impaired by impaired renal function. Chronic renal failure may be a risk factor during implant surgery. A consultation with the specialist is essential.
h-Immune diseases:
Patients with HIV (human immunodeficiency virus) can undergo implant surgery after checking the CD4+ T-cell count if it is higher than 200/mm3 (the normal CD4+ count is 1000 to 1500/mm3) and if the p24 antigen assay is negative. Indeed, when the number of CD4+ T-cells in the blood is lower than 200/mm3, patients are prone to opportunistic infections due to the immune deficiency.
Patients with acute rheumatic fever (ARF) should receive antibiotic prophylaxis before the implant procedure.
Acute rheumatic fever is an autoimmune inflammatory disease characterized by the production of anti-pyogenic streptococcus antibodies (B-hemolytic A streptococcus) acting by cross-reaction on the heart muscle. Repeated infections lead to lesions in the heart (heart valve disease). In the absence of preventive antibiotic therapy before any surgical procedure, the practitioner can cause bacteremia during the procedure. Bacteria from the oral flora (mainly S. viridans) stick to the valvular sequelae and cause infective endocarditis.
i-Malignant pathologies :
During the active period of chemotherapy or radiotherapy, the placement of implants is contraindicated.
Cervicofacial irradiation induces an alteration of primary and secondary vascularization, it is likely to interfere with osteointegration. It induces more or less severe xerostomia which can harm the maintenance of good hygiene. From 6 months beyond radiotherapy, the placement of implants is not formally contraindicated, it is however preferable to assess the risk of osteoradionecrosis with the oncologist before any therapeutic decision. The latter will precisely determine the field of irradiation, the dose and the age of radiotherapy.
j-Skin and mucous membrane damage:
Mucosal pathologies (lichen planus, erythema multiforme or lupus erythematosus) can disrupt soft tissue healing. However, wearing an implant-supported fixed prosthesis is preferable to a removable prosthesis because any compression of the soft tissues can then be avoided.
K-Motor skills impairment :
Some patients have limitations or reductions in manual dexterity. They often lead to insufficient brushing and approximate hygiene, which may compromise the durability of the implants. The therapeutic indication as well as the analysis of the benefit/risk ratio must be evaluated.
Indications and contraindications for implant treatment
2-Risk factors :
a-Tobacco :
Tobacco toxicity is linked to a physical component (modification of the oral environment by raising the temperature) and a chemical component (nicotine content, tar, carbon monoxide and other vasoactive and cytotoxic substances). Tobacco impairs healing by causing hypoxia and peripheral vasoconstriction. It acts on the immune system and interferes with osteoblastic function. It can be responsible for an increase in bone resorption in heavy users, of more than 10 cigarettes/day.
This could explain why stopping smoking 1 week before surgery and 8 weeks after can reduce its deleterious effects and improve implant success (Bain, 1996; Lambert; et al., 2000).
b-Alcohol:
At the physiological level, the toxic action of alcohol affects the liver. In addition, alcohol affects blood clotting by disrupting the synthesis of prothrombin and vitamin K. It inhibits the proliferation of osteoblasts and increases osteoclastic activity. Thus, bone metabolism decreases, affecting tissue healing.
c- Bruxism:
Bruxism does not interfere with the osseointegration period or the long-term prognosis of implants. However, it can be a factor in prosthetic complications due to a higher number of fractures of the prosthetic ceramic.
The prescription of a nighttime occlusal splint also proves to be of great benefit.
d-Infectious or endodontic focus:
It seems obvious to avoid implant placement in infected sites, particularly if the sites are purulent.
Clinically, implantation in infectious sites does not constitute a contraindication provided that antibiotic therapy is combined before and after placement of the implants as well as careful cleaning and curettage of the extraction sockets.
3- Age-related risk factors :
Advanced age is not a contraindication to dental implants.
On the other hand, in young patients, implant treatment should not be undertaken when growth is still incomplete.
However, children with hypodontia or anodontia associated with rare congenital syndromes such as ectodermal dysplasia may escape this contraindication because the benefit of treatment outweighs the risk.
Indications and contraindications for implant treatment
Bibliography
-Mr. DAVARPANAH, S.SZMUKLER-MONCLER, PMKHOURY, B. JAKUBOWICZ-KOHEN, H. MARTINEZ Manual of clinical implantology
Concept, protocols and recent innovation 2nd edition
Indications and contraindications for implant treatment
Wisdom teeth may need to be extracted if they are too small.
Sealing the grooves protects children’s molars from cavities.
Bad breath can be linked to dental or gum problems.
Bad breath can be linked to dental or gum problems.
Dental veneers improve the appearance of stained or damaged teeth.
Regular scaling prevents the build-up of plaque.
Sensitive teeth can be treated with specific toothpastes.
Early consultation helps detect dental problems in time.