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

Parafunctions

Key points

Parafunctional activities can apply high forces to implant-based restorations and may require adequate adaptation of the treatment plan and restoration design.
Perform clinical assessment of parafunctional signs (occlusal wear, occlusion, etc.)
Consider reinforcement of prosthetic work (such as selection of strong implant design), and non-implant based prosthetic treatment alternatives.

Parafunctions - effects

Parafunctional activities can discourage the treatment option of a resin bonded fixed partial denture. It can however also apply high forces to both implant and prosthetic components. These forces can lead to fracture or loosening of screws and abutments, chipping of the veneering material or fracture of the prosthetic reconstruction. Parafunctional activity may contribute to crestal peri-implant bone loss and/or implant fracture.

Functional risk assessment

To assess the possibility of past or ongoing parafunctional activity, the following assessments should be considered:

Observe clenching, jaw closing path, jaw muscle hypertrophy
Examine occlusion, functional movements, lateral forces, enamel/dentin condition, signs of abrasion. However abrasion evidently reveals the past and not necessarily ongoing parafunctions
Look for repeated chipping of existing ceramic restorations, parafunctional habits and bruxism
Assess loss of posterior support, tooth position, supra-/infraocclusion, bone structure and condition

Treatment considerations

If parafunction is detected or has already caused considerable damage to the natural dentition, it is recommended to adapt and plan the implant-based reconstruction accordingly and/or consider non-implant based treatment alternatives, especially in cases with myogenic dysfunctions. Consider functional treatment of dysfunctions before planning implant-supported rehabilitation.

Adaptation of the implant type & diameter
Selection of a strong connection (internal/conical)
Adaptation and reinforcement of prosthetic superstructure and design, adaptation of occlusal concept, short or no extensions and caution with full-ceramic constructions.
Night guard protection

Questions

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