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0
Patient Assessment
- 0.1 Patient Demand
- 0.2 Anatomical location
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0.3
Patient History
- 2.1 General patient history
- 2.2 Local history
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0.4
Risk Assessment
- 3.1 Risk Assessment Overview
- 3.2 Age
- 3.3 Patient Compliance
- 3.4 Smoking
- 3.5 Drug Abuse
- 3.6 Recreational Drug and Alcohol Abuse
- 3.7 Condition of Natural Teeth
- 3.8 Parafunctions
- 3.9 Diabetes
- 3.10 Anticoagulants
- 3.11 Osteoporosis
- 3.12 Bisphosphonates
- 3.13 MRONJ
- 3.14 Steroids
- 3.15 Radiotherapy
- 3.16 Risk factors
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1
Diagnostics
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2
Treatment Options
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2.1
Treatment planning
- 0.1 Non-implant based treatment options
- 0.2 Treatment planning conventional, model based, non-guided, semi-guided
- 0.3 Digital treatment planning
- 0.4 NobelClinician and digital workflow
- 0.5 Implant position considerations overview
- 0.6 Soft tissue condition and morphology
- 0.7 Site development, soft tissue management
- 0.8 Hard tissue and bone quality
- 0.9 Site development, hard tissue management
- 0.10 Time to function
- 0.11 Submerged vs non-submerged
- 0.12 Healed or fresh extraction socket
- 0.13 Screw-retained vs. cement-retained
- 0.14 Angulated Screw Channel system (ASC)
- 2.2 Treatment options esthetic zone
- 2.3 Treatment options posterior zone
- 2.4 Comprehensive treatment concepts
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2.1
Treatment planning
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3
Treatment Procedures
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3.1
Treatment procedures general considerations
- 0.1 Anesthesia
- 0.2 peri-operative care
- 0.3 Flap- or flapless
- 0.4 Non-guided protocol
- 0.5 Semi-guided protocol
- 0.6 Guided protocol overview
- 0.7 Guided protocol NobelGuide
- 0.8 Parallel implant placement considerations
- 0.9 Tapered implant placement considerations
- 0.10 3D implant position
- 0.11 Implant insertion torque
- 0.12 Intra-operative complications
- 0.13 Impression procedures, digital impressions, intraoral scanning
- 3.2 Treatment procedures esthetic zone surgical
- 3.3 Treatment procedures esthetic zone prosthetic
- 3.4 Treatment procedures posterior zone surgical
- 3.5 Treatment procedures posterior zone prosthetic
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3.1
Treatment procedures general considerations
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4
Aftercare
Drug Abuse
Key points
- Drugs, prescribed or not, can interfere with implant surgery, related medication and treatment outcomes.
- In case of drug abuse, such as painkillers and benzodiazepines, the risk becomes relevant.
- It is critical to evaluate if the patient’s drug abuse affects the planned treatment and the necessary compliance.
Prescribed drugs
The medical history should reveal if the patient takes any prescribed medication (see also ‘General Patient History’) and especially whether in the correct dosage. Fear of oral surgery may induce a temporary overconsumption of drugs such as beta-blockers or psychotropics. Among psychotropes, abuse of narcotic analgesics from the opioid group such as the moderately potent pentazocine, tilidine, and tramadol, must be taken seriously. A complicating factor is that some trade names of the very potent morphine and derivatives are not easy to recognize, i.e. Roxanol, Kadian, MS contin, etc.
Anti-depressants and tranquilizers are also psychotropes and have addictive potential. Monoamine oxidase inhibitors and tricyclic antidepressants have many adverse effects and are addictive.
Local anesthesia with (nor)adrenalin can result in acute hypertension in the presence/abuse of MAO inhibitors, tricyclic antidepressants, non specific beta adrenergic blockers, cocaine, phenothiazides. Albuterol in asthma inhalers for example, can increase blood pressure and pulse rate.
Multiple drug intake reveals multiple health issues, all possibly interfering with surgery and/or treatment compliance. A cytochrome P enzyme which is responsible for the biotransformation of one drug can be inhibited by another and thus cause toxicity. The clinician must be careful to consider possible drug interactions and contra-indications as both accumulate as a patient takes more medications.
Nonprescribed / OTC drugs
A first question should be why the patient takes OTC (over the counter) drugs and/or food supplements. Grapefruit for example interferes with the breakdown of statins, the most prescribed anticholesterol medication, leading to its accumulation. Some forms of licorice can result in digoxin toxicity. Ease of purchase of these drugs predisposes to overconsumption and dosage should be recorded.
Some OTC drugs can interfere with the planned medications and procedures. For example, Aspirin prolongs the bleeding time and food supplements such as gingko interact with blood thinners…
Some OTC drugs like cough syrups can be addictive. They often contain dextromethorphan which, when consumed in large amounts, give the impression of being high.
Drug abuse and implant treatment
When a patient is addicted to drugs, the clinician must consider interactions with planned treatment and medication. In addition, a broader question arises of whether the patient medically, psychologically and socially qualifies for implant-based treatment with its necessary compliance and maintenance care. Referral to an internist or specialist may be indicated for additional medical and psychological advice. In case of doubt, consider non-implant based treatment alternatives until drug abuse has ceased.
Drug abuse influences especially:
- blood pressure
- blood coagulation
- healing processes
- body’s immune reaction
- interactions with treatment-related medication
- social behavior
Medical records
Record all available information about drug/food supplement intake in your patient file.
