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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
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3
Treatment Procedures
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3.1
Surgical
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3.2
Removable prosthetics
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3.3
Fixed prosthetics
-
3.1
Surgical
- 4 Aftercare
Need for grafting
Key points
- Reduced bone volume or unfavorable shape of alveolar bone may require grafting or bone augmentation prior to implant placement
- Depending on shape of bone defect lateral or vertical graft procedures are applied
- For a better diagnosis 3-D computed tomography is preferrable
Indication for grafting - Anatomical
There are three main indications for grafting from an anatomical perspective:
- Vertical bone deficiency
- Horizontal bone deficiency
- Local bone defect
Indication for grafting - Clinical
From a clinical perspective, two additional considerations are important factors when considering the need for grafting:
- Inadequate bone volume for reliable implant insertion
- Excessive risk of intra- or postoperative mandibular fracture
Is grafting necessary?
In a patient-centered approach, avoiding bone grafting must be considered when alternative options offer a predictable outcome: use of less/short/narrow implants, use of zygomatic anchorage.
To ensure the correct diagnosis and need for grafting, 3-D CT images should preferrably be available. Some examples of grafting need and process include:
- Lateral grafting in case of Cawood class 4 with a marked knife-edge ridge of the alveolar process (Fig 1 & Fig 2).
- No grafting necessary in case of Cawood class 5 (Fig 1). Insertion of implants without grafting is feasible.
- Vertical grafting in case of Cawood class 6 with complete absence of the alveolar process and extreme atrophy of the mandibular body (Fig 1 & 3). In such cases a height of the mandible of >7 mm and of the horizontal width of >6 mm is considered a clinical indication for grafting.
- Vertical grafting is indicated in case of extensive local bone defects.
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