Diagnostic procedures prior to implant placement
Competent treatment planning is a long term key to the long term success of implant therapy. The indications and contraindications must carefully be balanced and optional treatments must be taken into the decision making process in each individual patient eligible for implant therapy.
The following diagnostic aids may be utilized in presurgical considerations to assist in determining the number, location, type, and angulation of the implants and abutments:
1. Diagnostic casts, mounted or mountable
2. Imaging techniques
3. Surgical template.
Thorough medical and dental histories, clinical photographs, study casts, periapical and panoramic radiographs as well as linear tomography or computerized tomography of the proposed implant sites should be obtained.
The most important step in treatment planning is determining the prognosis for the dentition, and in particular the prognosis of the tooth in question. Teeth requiring root amputation, hemisection, or advanced periodontal procedures may have a questionable prognosis and patients should be given reasonable options before implementing such treatments. Non vital teeth or fractured teeth at gingival margin with roots less than 13mm and are mostly considered the treatment of choice.
In the esthetic zone, the scallop of the periodontium, level of crestal and interproximal bone, smile line, and morphology of the gingival tissues must be considered before initiating treatment.
Proposed inter-implant distance, as well as existing contact relationships and interproximal bone, must be analyzed before implant placement.
Patients with a thin or moderately thin periodontium will often show soft tissue recession at implanted sites. In such cases it is advisable to use procedures like orthodontic forced eruption procedures before tooth removal and implantation. This allows bone and soft tissues to move coronally, thereby assuring adequate mucosal tissue adjacent to the implant. In the case of soft tissue deficiency or a slight soft tissue recession after tooth extraction, sub epithelial connective tissue grafting can further augment tissue height and thickness, thereby enhancing the esthetic outcome.
Radiographic examination should evaluate the availability of native bone and bone shape, quality, quantity, bone width, and bone height. They are necessary to determine the height of available bone and for selection of the dimensions of the implants. They also may be needed to determine the proximity of potentially complicating structures including the maxillary sinuses, foramina, mandibular canal, and adjacent teeth or roots.