Physical Diagnosis And Patient Assessment Evaluating Implant Candidates Flashcards
What has been one of the biggest advancements in dentistry?
Implants
Can finally attach roots to our dental prosthesis
T/F: There is a steep learning curve to dental implant therapy
True
What do all implant candidates require?
Medical and dental history
Clinical exam
Radiographic work up
Necessary to make a tx plan that best meets pts needs and expectations
Big 3 Pre-op considerations
Systemic health status
Local bone considerations - adequate quantity, quality, and position of bone
Financial considerations
Financial considerations
Can pt afford implants and maintenance?
Insurance?
Systemic health considerations
Can they tolerate the procedure under local or general anesthesia?
Any contra-indications to surgery?
Risk to overall health and well being
Local bone considerations
Bone height, width, position, proximity to inferior alveolar nerve, proximity to maxillary sinus, attached gingiva, occlusion, skeletal jaw position, TMJ
Pre op assessment
Medical history
Dental history
Psychological history
Clinical exam
Radiology work up
Medical history
Any absolute contraindications to implants?
Relative contraindications?
Dont forget psychiatric condition
Are uncontrolled medical conditions a contraindication to dental implants?
YES
What are the most common medical conditions that would prohibit the placement of dental implants?
Cardiovascular - can they tolerate placement under local or general anesthesia?
What is the most common metabolic disorder?
Diabetes - insulin vs non insulin dependent
Control is important
Their HbA1C
Med History Red Flags
Hemophilia
Head and neck radiation therapy
Bisphophonate therapy
IDDM
Pregnancy
Immunocompromised host for any number of disease states
Pts on blood thinner/platelt inhibitors
Immunotherapy
Med history habit red flags
Tobacco - 2 to 3 times more chance failure ~ 15-25%
Alcohol
Clenching /grinding/ bruxism
Psychological evaluation
Does pt understand what they are about to undertake?
Are they competent to make decision for treatment?
Can they tolerate total failure of treatment if that were to occur?
Patient expectations?
Dental history
How were teeth lost ? - caries, Periodontal disease, trauma
Congenitally missing teeth
How long have teeth been missing
Edentulous or partially endentulous
Prior restorative attempts
What are we trying to establish when asking the pt about their dental history?
Their Dental IQ
Hoping it is high, they fully understand the risks and benefits
Physical exam
Jaw opening
Muscles of mastication tenderness
Skeletal jaw relationships (skeletal class)
Health of remaining dentition if present
Soft tissue pathology
Inter-arch space for prosthesis
TMJ issues
Physical exam/palpation
Width of keratinized gingiva
Contour of labial bone
Contour of lingual/palatal bone
Width of bony ridge
Contour of mylohypid ridge, undercuts
Presence/absence of tori
Clinical exam
Vital signs
Dental implants are a restorative option with surgical implications - this is surgery
Inadequate quantity of bone options
- Increase quantity = grafting
- Reposition the nerve
Sinus evaluation options
Sinus bump/elevation augmentation
Sinus lift augmentation
With or without simultaneous implant placement
Esthetic zone
Smile line!
High smile line= difficult
Low smile line = less difficult
These cases are always more challenging than posterior
Radiographic work up
Periapical films
Panorex
Lateral ceph
CBCT (CT scan)
What are we looking at with radiology?
Amount of bone - quantity
Type of bone - quality
Position of bone
Proximity to structures
Pathology of jaws
Anatomical variations
Diagnostic wax ups
Can show feasibility of planned restoration
Can be used for surgical guides
Needed from more complex restorative cases
Start with desired restoration, then work backwards if possible
Take home points of assessment
Understand pts goals
Discuss all options
Thorough history and physical
Start simple, dont be afraid to say no
