How to select patients and to plan treatment for implant restorations?

This summary is based on the article published in the Dental Clinics of North America: Patient selection and treatment planning for implant restorations (January 2014)

Key Messages

• The development of a complete systemic health evaluation with particular emphasis on factors influencing osseo-integration is a first step in the evaluation of implant patients.
• An assessment of the overall oral health and ability of patients to maintain ideal oral health is a key step in characterizing potential dental implant patients.
• Without mounted diagnostic casts and simple intraoral and perioral photographs, it is nearly impossible to make the proper assessment of local conditions that impact the delivery of successful dental implant prostheses.
• 
  An important step in the evaluation of implant patients is the radiographic assessment of osseous architecture and quality in relationship to the contours of the planned dental prosthesis.
• 
  Sufficient information to safely and effectively place a dental implant includes the spectrum of diagnostic data that includes the representation of the osseous condition of the intended implant site.

Systemic contraindications to implant therapy

Absolute contraindications

• Osteopathies and disorders of bone metabolism
• Renal insufficiency and uremia
• Liver disease
• Hyperthyroidism
• Hypopituitarism
• Connective tissue diseases and specific autoimmune diseases (lupus)
• Leukopoietic and erythropoietic disease (eg, coagulopathies, plasmacytoma)
• High-dosage radiotherapy

Relative somatic conditions

• Osteoporosis
• Aggressive rheumatoid arthritis
• Treated endocrine disorders
• Anticoagulant treatment
• Drug and alcohol abuse
• Low-dosage radiotherapy

Temporary contraindications

• Transient infections
• Systematic therapies affecting wound healing
  • Anticoagulant
  • Immunosuppressive therapy
  • Corticosteroids
  • Chemotherapy

Data from LillW, Solar P. Indications, diagnosis, and recall. In: Watzek G, editor. Endosseous implants: scientific and clinical aspects. Chicago: Quintessence Publishing Co; 1996. p. 153–82.

Local contraindications to implant therapy

Unresolved bone loss attributed to the following:

• Osteomyelitis, osteoradionecrosis, fibrous bone dysplasias
• Apical periodontitis
• Existing residual roots

Unresolvable bone deficiencies

• Vertical bone volume of posterior maxilla or mandible
• Horizontal deficiencies without resolution

Adjacent tooth limitations

• Root proximity
• Aesthetic limitations

Soft tissue and mucosa

• Pathologic conditions
• Deficient attached gingival at proposed implant site

Oral hygiene

• Evidence of unwillingness to perform hygiene
• Local factors that preclude performance of oral hygiene

Data from LillW, Solar P. Indications, diagnosis, and recall. In: Watzek G, editor. Endosseous implants: scientific and clinical aspects. Chicago: Quintessence Publishing Co; 1996. p. 153–82.

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