Preoperative assessment for implants

Preoperative assessment for implants

Introduction :

The rehabilitation of the jaws through implant therapy is inseparable from compliance with a process commonly called “Pre-implant assessment”.

The main role of the balance sheet is made up of:

• Assessment of the patient’s initial medical situation: medical investigation and general condition of the patient.
• Determining a treatment plan
• Guide the practitioner in order to facilitate the practitioner’s approach and meet the patient’s expected needs.
• Help establish a climate of trust: From the first approach to the patient,

The practitioner must pay particular attention to his personality through all of his requests and questions, and identify his anxieties regarding the conditions for success of the different treatments.

1. Initial interview: first consultation
   1. . Patient request:

The patient’s request determines the main objective of the treatment, this request should not be disregarded, in terms of aesthetics in particular, implant dentistry has limits that should be known and communicated to the patient not only during the first consultation but also during subsequent appointments.

2. general health condition:

The medical questionnaire allows the general condition of the patient to be assessed, lifestyle is also important “patient smoker or alcohol consumer”

Pre-operative blood tests are sometimes recommended: CBC, fasting blood sugar, sedimentation rate, etc., a cardiovascular examination and an ECG are sometimes necessary in patients over 45 years old.

• Information that must appear in the medical file: Civil status and state of health of the patient

  Contact details of the attending physician

  Contact details of the specialist doctor

  Correspondence exchanged between the various healthcare professionals involved Letter from the referring practitioner who refers the patient

Drug prescriptions Surgical history

Medical history Lifestyle habits

The most recent X-rays Recent biological examinations

3. Age :

Implant treatment is contraindicated in children under 16 years of age, due to growth that is not yet complete. However, there is no upper age limit if the subject is in good general health without concomitant pathology that contraindicates implant treatment.

4. Patient psychology and motivation:

The anxious psychological profile, the high level of demand and the low resilience of certain patients must be considered in the development of the treatment plan. Indeed, the risk of grievances, of

Dissatisfaction or even abandonment of care must be taken into account. Before undertaking any therapy, the patient must be informed:

  Success rates, risks inherent to one’s general condition and lifestyle habits as well as the cost of treatment.

  Of all the therapeutic alternatives that can replace implant-supported rehabilitation.

  Informed consent is mandatory and must be signed by the patient after agreeing to all conditions, possible complications and costs of treatment.

5. Availability :

Some treatments such as bone grafting require a high level of patient availability.

3. Clinical examination:
   1. Exoral examination: examine; The soft parts of the face

  Symmetry and facial profile, face shape

  Harmony and equality of the three levels of the face Evaluate the vertical dimension

  Assess smile type, lip support, smile line, TMJ palpation

  Examination of mouth opening and assessment of the degree of opening.

2. Endo-oral examination:

Dental check-up

Periodontal assessment Occlusal assessment

Prosthetic assessment

Aesthetic evaluation.

4. Radiological examination:

Radiographic examinations are essential complementary examinations in the pre-implantation assessment. They are useful in their specificities throughout the treatment: retroalveolar radiographs, orthopantomogram, CT scan, the analysis of their data supports the therapeutic decision.

1. Panoramic radiography:

It is commonly used as a screening test during the pre-implant assessment and allows the following to be assessed:

The different dental and bone pathologies. The available bone height

  The relationships between the edentulous site and the surrounding anatomical elements.

2. Retro-alveolar radiography/Long cone assessment

Retroalveolar radiography provides unique information on a set of three to four teeth and their immediate surroundings. It provides information on:

Periodontal condition of teeth Bone trabeculation

  The presence of any residual apices

  The presence of a possible excess of endodontic filling paste

  The intrinsic value of a particular tooth, the presence of an apical pathology, a coronal root fracture, a cyst, a deep caries

  The axis of the collateral teeth, in particular the root convergence in the intercalated edentulous areas of small extent.

3. Cone beam computed tomography:

Cone beam is one of the most modern complementary examinations for therapeutic planning. It is a method of choice for identifying the anatomical structures to be respected, the bone deficiencies to be treated and evaluating the harvesting sites. Cone beam provides information on bone density and therefore on the primary stability of implants.

4. Computed tomography (CT) scan:

Preceding the cone beam, CT represented the reference examination for evaluating implant sites, it allows:

To better understand the anatomical obstacles with the aim of implant planning, thus, in the maxilla and in the absence of pathologies, the study mainly focuses on,

• The importance of the incisive canal and its position
• The size and anatomy of the maxillary sinuses
• The height of the alveolar bone in relation to the nasal fossae
• The tuberosity regions.

In the mandible, the analysis essentially targets:

• The position of the mandibular canal
• The emergence of the mental nerve and a possible retrograde path
• The posterior lingual concavity(ies) opposite the submaxillary gland
• To confirm the diagnosis of possible bone insufficiency and guide the practitioner towards the reconstructive technique most suited to the clinical case
• To prefer or eliminate a site for harvesting an autogenous graft
• Implant planning with or without the use of a radiological guide.

5. Implant study:
   1. Photographs:

Some exobuccal and intraoral photographs will be recommended for: To be analyzed during the different therapeutic phases

Record the patient’s aesthetic characteristics Communicate with the patient.

2. Study model and mounting on articulator:

Articulated study models allow the study of occlusion

  Inter-arcade reports

Available prosthetic space Interferences

  Occlusal pathologies

3. Diagnostic added wax

The creation of a diagnostic wax-up allows us to determine: The ideal position of the implants

  Preview of the final aesthetic and phonetic result

4. Temporary diagnostic prosthesis:

This prosthesis allows the information provided to the laboratory during the diagnostic wax-up stage to be transposed into the mouth.

A preview of the labial support of the vertical dimension, the position of the necks, as well as the shapes and location of the future crowns are obtained.

5. Radiographic guide:

The radiographic guide is created directly from the diagnostic models. This guide allows visualization of the desired implant location on the oblique CT reconstructions. It is then transformed into a surgical guide; by materializing a guide well for the pilot drill, in the desired axis. This axis will be a compromise between the ideal prosthetic axis and the available bone volume at the site.

The radiographic guide can be made using a thermoformed plate or acrylic resin in which radiopaque markers are incorporated and which contribute to the reading of radiological examinations.

Conclusion :

The first consultation is a fundamental time in implant treatment . After a rigorous clinical examination, a careful reading of the imaging and mounting of the study models on an articulator, it is appropriate to analyze all possible prosthetic solutions and present them to the patient with their advantages and disadvantages. A systematic pre-implant pre-prosthetic study certainly increases the number of steps upstream, but allows to limit the difficulties during the treatment.

Preoperative assessment for implants

  Untreated cavities can cause painful abscesses.
Untreated cavities can cause painful abscesses.
Dental veneers camouflage imperfections such as stains or spaces.
Misaligned teeth can cause digestive problems.
Dental implants restore chewing function and smile aesthetics.
Fluoride mouthwashes strengthen enamel and prevent cavities.
Decayed baby teeth can affect the health of permanent teeth.
A soft-bristled toothbrush protects enamel and sensitive gums.
 

Preoperative assessment for implants