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0
Patient Assessment
- 0.1 Patient demand
- 0.2 Overarching considerations
- 0.3 Local history
- 0.4 Anatomical location
- 0.5 General patient history
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0.6
Risk assessment & special high risk categories
- 5.1 Risk assessment & special high risk categories
- 5.2 age
- 5.3 Compliance
- 5.4 Smoking
- 5.5 Drug abuse
- 5.6 Recreational drugs and alcohol abuse
- 5.7 Parafunctions
- 5.8 Diabetes
- 5.9 Osteoporosis
- 5.10 Coagulation disorders and anticoagulant therapy
- 5.11 Steroids
- 5.12 Bisphosphonates
- 5.13 BRONJ / ARONJ
- 5.14 Radiotherapy
- 5.15 Risk factors
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1
Diagnostics
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1.1
Clinical Assessment
- 0.1 Lip line
- 0.2 Mouth opening
- 0.3 Vertical dimension
- 0.4 Maxillo-mandibular relationship
- 0.5 TMD
- 0.6 Existing prosthesis
- 0.7 Muco-gingival junction
- 0.8 Hyposalivation and Xerostomia
- 1.2 Clinical findings
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1.3
Clinical diagnostic assessments
- 2.1 Microbiology
- 2.2 Salivary output
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1.4
Diagnostic imaging
- 3.1 Imaging overview
- 3.2 Intraoral radiographs
- 3.3 Panoramic
- 3.4 CBCT
- 3.5 CT
- 1.5 Diagnostic prosthodontic guides
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1.1
Clinical Assessment
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2
Treatment Options
- 2.1 Mucosally-supported
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2.2
Implant-retained/supported, general
- 1.1 Prosthodontic options overview
- 1.2 Number of implants maxilla and mandible
- 1.3 Time to function
- 1.4 Submerged or non-submerged
- 1.5 Soft tissue management
- 1.6 Hard tissue management, mandible
- 1.7 Hard tissue management, maxilla
- 1.8 Need for grafting
- 1.9 Healed vs fresh extraction socket
- 1.10 Digital treatment planning protocols
- 2.3 Implant prosthetics - removable
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2.4
Implant prosthetics - fixed
- 2.5 Comprehensive treatment concepts
- 4 Aftercare
Post-operative care
Key points
- Post-surgical appointments should be planned together with surgery appointment
- The main objectives of post-operative care include control of the healing of the surgical site and evaluation of interim-provisionalization (if provided)
- In case of delayed loading check all prosthetic components and healing components
- At the first post-operative appointment check closely for signs of inflammation and paresthesia
Considerations
The main objectives of post-operative care include control of the healing of the surgical site and identifying risks which could affect healing and, where pertinent, osseointegration. In addition, post-operative visits provide the opportunity to evaluate the functional and esthetic attributes of provisional prostheses.
Some general recommendations regarding post-operative care are provided below. However, the exact timing and frequency of post-operative visits should be established on an individual patient basis.
Day 1, 2 or 3 after surgery
- General health condition of patient; how does the patient feel?
- Evaluation of the wound: suture condition, color of the soft tissues, bleeding, pain, swelling and other signs of inflammation
- Has full return of sensation taken place or does paresthesia persist?
- Atraumatic wound cleansing and disinfection
- Re-iteration of oral hygiene measures but not of surgical field
- If not done on day of surgery, atraumatic insertion of the provisional prosthesis
Day 7–14 after surgery
- General health condition of patient; how does the patient feel?
- Evaluation of the wound: color of the soft tissues, bleeding, pain, swelling and other signs of inflammation
- Evaluation of signs and symptoms of infection
- Non-resorbable suture removal and assessment of soft tissues
- Debris removal in wound area (if necessary)
- Check of all prosthetic components and healing/temporary components
- Check of fit and function/occlusion of provisional prostheses. Adjustments and soft relining of denture may be needed.
- In case of a delayed loading protocol it is helpful to ensure that the provisional prosthesis sits freely around implants and loading is minimal
- If needed re-instruction of patient about oral hygiene measures also of surgical area
Week 4-6 after surgery
- Evaluation of the soft tissue condition and potential inflammation/infections signs
- Re-evaluation of provisional prosthesis and check of prosthetic components and healing/temporary components
- Check of fit and function/occlusion of provisional prostheses. It may be necessary to replace the soft reline material in the provisional prosthesis
- Control of provisional denture and adjustment as necessary in order to ensure that the provisional prosthesis sits freely around implants and loading is minimal
- If needed, re-instruction of patient regarding hygiene measures
- Further timing for definitive prosthetic rehabilitation and/or recall visits
