0 Patient Assessment
- 0.1 Patient Demand
- 0.2 Anatomical location
  - 1.1 Anterior and posterior location considerations
  - 1.2 Dentogingival complex and biologic width
- 0.3 Patient History
  - 2.1 General patient history
  - 2.2 Local history
- 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
1 Diagnostics
- 1.1 Clinical assessment and clinical findings
  - 0.1 Lip line, smile line
  - 0.2 Mouth opening
  - 0.3 Condition of natural teeth
  - 0.4 Occlusion and functional aspects
  - 0.5 Soft tissue condition
  - 0.6 Periodontitis
  - 0.7 Bone volume and interdental space
  - 0.8 Temporo-mandibular disorders (TMD)
- 1.2 Diagnostic imaging
  - 1.1 Diagnostic imaging overview
  - 1.2 Intra-oral radiographs
  - 1.3 Panoramic
  - 1.4 Cone Beam Computer Tomography (CBCT)
  - 1.5 Computed Tomography (CT)
  - 1.6 Intra-oral imaging and scanning
- 1.3 Prosthodontic tools
2 Treatment Options
3 Treatment Procedures
- 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
  - 2.1 Provisionalization procedures esthetic zone
  - 2.2 Impression options and procedures
  - 2.3 Placement of restoration
  - 2.4 Screw-retained restorations
  - 2.5 Cement retained restorations
- 3.4 Treatment procedures posterior zone surgical
- 3.5 Treatment procedures posterior zone prosthetic
  - 4.1 Provisionalization procedures posterior zone
  - 4.2 Impression options and protocols
  - 4.3 Placement of restoration
  - 4.4 Screw-retained restorations
  - 4.5 Cement-retained restorations
4 Aftercare
- 4.1 Surgical Aftercare
  - 0.1 Medication
  - 0.2 Post-operative soft tissue management
  - 0.3 Suture removal
  - 0.4 Post-surgical recommendations
- 4.2 Prosthetic Aftercare
  - 1.1 Esthetic and functional check
  - 1.2 Provisional restoration
  - 1.3 Oral hygiene instructions
  - 1.4 Occlusal guard
- 4.3 Post treatment complications and management
  - 2.1 Bleeding
  - 2.2 Soft tissue, hard tissue, adjacent teeth
  - 2.3 Patient compliance/recall
  - 2.4 Biologic complications
  - 2.5 Esthetic complications
- 4.4 Recall visits and logistics
  - 3.1 Systematic recall/review
  - 3.2 Patient expectations
  - 3.3 General health check
  - 3.4 Professional oral hygiene
  - 3.5 Check of prosthetic restoration
  - 3.6 Probing
  - 3.7 Inflammation, infection
  - 3.8 Microbiology diagnostics
  - 3.9 Radiographic control
  - 3.10 Natural teeth

Treatment guidelines

Bleeding

Key points

Any surgical intervention can be followed by bleeding.
Management consists of revision of the suture and compression dressings.
In case of damaged vessels coagulate/stitch vessels. Keep in mind that damage of sublingual arteries can be a fatal complication!
Consider antibiosis to prevent infection of hematoma.

Postoperative bleeding

Possible causes:

Wound dehiscence/adaptation, insufficient suturing, patient unrest or non-compliance, damaged vessel, anticoagulant medication

Management:

Compression of the wound for > 10 minutes, re- and additional suturing, modulate anticoagulant therapy, coagulate/stitch damaged vessel

Warning:

Damage of sublingual arteries can lead to intense hemorrhage. Subsequent elevation of floor of the mouth can lead to (fatal) airway obstruction ! An early symptom of sublingual swelling may be a muffled speech. In such situation ensure free airways (intubation, tracheotomy), revise surgery area with coagulation/closure of sublingual artery (this will be usually a maxillo-facial emergency surgery and imply general anesthesia).

Hematoma, swelling

Check if bleeding occurs, manage bleeding as mentioned above.

Consider antibiosis to prevent hematoma (super-)infection.

Questions

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