Pre-implant clinical examination
- Introduction
When faced with edentulism, several prosthetic solutions are available to the patient. The general condition, the clinical context, and the patient’s motivations will be elements to take into consideration when choosing the treatment plan. Informed consent will be necessary before turning to the implant solution.
Pre-implant analysis is fundamental. It requires a real study of the clinical case, the overall context and the implant site. Many steps are general to implantology, others are more specific to the anterior sector in order to optimize the aesthetic aspect.
- First consultation
The first consultation is often a first contact between the patient and the practitioner. A dialogue must be established to facilitate the trusting relationships essential to any care. It is useful to write down the patient’s request(s): aesthetic request and/or functional request.
At this stage, a file must be created which includes a set of information relating to the patient’s state of health, their social and administrative contact details, and the nature of the care. This will constitute all the elements enabling monitoring by the treating practitioner or any other practitioner.
The patient is given a certain amount of information concerning the therapeutic possibilities, the course of treatment and the implant technique.
The different stages and examinations required during the following consultations must be explained to him in order to achieve successful treatment.
- Constitution of the file
This file includes:
- patient administrative information
- Name
- First name
- Age
- Address
- Person responsible if patient is a minor, or under guardianship or curator
- Personal or business phone numbers.
- Social security number.
- Occupation.
- Reimbursement body.
- Patient history :
- Medical :
- Cardiovascular.
- Gastroenterological.
- Pulmonary.
- Neurological.
- Hormonal.
- Gynecological and obstetrical
- Allergic.
- Taking medication
In the past and currently the reasons for these drug intakes as well as the doses.
Particular attention will be paid to certain drug families:
- Bisphosphonates
- Antiplatelet agents and vitamin K antagonists
- Long-term chemotherapy (for breast cancer, for example)
- Exo-oral examination
- Facial asymmetry
- Opening limitation.
- Opening in deviation.
- Joint noises.
- Subluxations.
- Recurrent dislocations.
- Muscle constrictions
- Endo-oral examination
Oral lesions: we will look for edema, erythema, erosions due to poorly adjusted prostheses, biting if the patient has been toothless for a long time.
Fibro-mucosa: it will be evaluated in relation to quality and thickness: Healthy or irritated, thinned or thick, hypertrophied, mobile, detached from its underlying bony support or floating, thus requiring pre-implant surgery
- The amount of attached gum
- The tongue: volume, position, mobility
- The vestibule: if there are any scarring bridles and frenulums.
- Bone crest morphology: resorption class, measurement of bone height and thickness.
Examination of salivary flow and fluidity, and the appearance of the salivary gland orifices.
Antagonistic teeth, if the patient is partially edentulous:
- Periodontal status
- Carious lesions
- The quality of maxillary prostheses, fixed or mobile.
The patient’s level of oral hygiene.
Pre-implant clinical examination
- Occlusal analysis
Its aim is to detect any possible occlusal pathology (which will then need to be treated before considering the placement of an implant) and to define a treatment plan for occlusal-prosthetic purposes based on an articulator assembly.
This analysis therefore requires study models mounted on an articulator in order to evaluate the vertical dimension of occlusion, then the inter-arch relationships in both the vertical and horizontal directions. In addition, wax-ups can be made in order to study, on the one hand, the aesthetic rendering of the future prosthesis, and on the other hand, to produce a radiological splint and a surgical guide.
The radiopaque gutter will make it possible to study the feasibility of the implant-supported prosthetic project and to check the possibility of placing the implants in the optimal positions for the future prosthesis.
- Paraclinical examination
- Biological assessment
Blood count (CBC)
Sedimentation rate (SSR)
Bleeding time (BT)
Kaolin partial thromboplastin time (TPT)
Quick Time (PT)
Calcemia
Blood sugar
- Aesthetic analysis
For about 65% of patients, aesthetic demand is a priority. In order to meet these requirements, an aesthetic analysis is essential before any treatment is considered.
Before carrying out this analysis, a dialogue with the patient about the requirements of their aesthetic request is essential as well as taking photographs: from the front, from the side and from the smile.
The first thing to observe is first of all the patient from the front. Indeed there are several
elements to identify, the most important of which is the vertical median line which passes through the
center of the face . It allows to evaluate the symmetry of the face.
Other lines must be taken into account: the horizontal interpupillary line and the incisal edge line in order to create restorations that will make these two lines parallel.
The exobuccal examination also includes a dento-labial analysis. The movement and tone of the lips are studied. The exposure of the teeth at rest should ideally be 1 to 5 mm depending on the height of the lips, age and sex.
- The incisor-lower lip curve should be convex.
The smile line is very important in aesthetic restoration. It is necessary to observe whether the patient has a gummy smile: that is, a smile that more or less reveals the gum of the necks of the maxillary incisors.
Pre-implant clinical examination
Pre-implant clinical examination
- gummy smile, b- average smile line, c- low smile line
Note: Observe the shape of the teeth: are they oval, square, triangular? Are the two central incisors symmetrical?
The color of the teeth is to be spotted. The color contains three elements, it is the Preston triad: hue, saturation and brightness.
Hue: This is the chromatic tone.
Saturation: This is the amount, intensity of color.
Brightness: This is the amount of white in the color, this defines the brilliance of the tooth.
Pre-implant clinical examination
Baby teeth need to be taken care of to prevent future problems.
Periodontal disease can cause teeth to loosen.
Removable dentures restore chewing function.
In-office fluoride strengthens tooth enamel.
Yellowed teeth can be treated with professional whitening.
Dental abscesses often require antibiotic treatment.
An electric toothbrush cleans more effectively than a manual toothbrush.