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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
Probing
Key points
- At the last follow-up visit, Bleeding on Probing (BoP), Plaque Score (PS), and Probing Depth (PD) can be recorded using a plastic periodontal probe.
- Careful probing does not cause permanent damage to periimplant tissue seal.
- Connective tissue level measured by probing correlates well with underlying marginal bone height in healthy sites.
- Probing depths increasing over time, associated with bleeding and eventually exudate, are a cause for concern.
Bleeding on probing (BoP), plaque score (PS), and probing depth (PD) can be recorded to monitor the peri-implant soft tissues and to identify eventual problems of the underlying bone, although the correlation of probing depth with crestal bone height falls as a site exhibits more soft tissue inflammation. Progressive increases in probing depth should lead to radiographic assessment to ascertain crestal bone height and any changes from previously recorded radiographs.
Probing parameters
Probing disrupts the epithelial attachment to implant surfaces but does not cause permanent damage to the periimplant soft tissue seal. Mucosal penetration around endosseous implants is similar, but not identical, to penetration of periodontal tissues. Compared to teeth, the probe tip approximates crestal bone more closely and within 1-1.5 mm. The extent of probe penetration is influenced be the probing force, ideally 0.25 Newtons. Therefore, automated controlled-force probes offer better reproducibility of probing depth. Other factors that influence probing depth are angulation, probe tip diameter, implant surface characteristics, presence of cement remnants, and degree of soft tissue inflammation. Using plastic probes prevents scratching the abutment and prosthetic surfaces, which would favor plaque accumulation.
- BoP can be evaluated on four sites around each implant (mesial, distal, buccal, and lingual) according to the Mombelli Index:
0, no bleeding;
1, spot bleeding;
2, linear bleeding; and
3, spontaneous bleeding. - PS on the abutment/restoration complex (defined as the presence of plaque, yes/no), can be evaluated by running the periodontal probe around the implant, parallel to the abutment surfaces.
- PD can be measured with a periodontal probe using a very light pressure, to the nearest millimeter at six sites around the dental implant. The highest, most unfavorable, value was registered.
It is important to establish probing depths at the time of prosthesis placement to allow for comparison over time. A recommended method is to identify a fixed reference point on the prosthesis and measure probing depth relative to this point. However, occasionally, the prosthesis inhibits access and compromises angulation necessitating removal of the prosthesis.
