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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
Radiotherapy
Key points
- Implant-based treatment in radiated bone is possible and often the preferred way to provide a functional restoration.
- Doses above 55 Gy (Gray) interfere critically with osseointegration.
- Adequate antibiotic therapy and eventually hyperbaric oxygen may prevent osteoradionecrosis.
- Due to functional limitations, oral hygiene home care and need for checking cancer recurrences, consider removable prostheses/obturators.
Radiotherapy
Rehabilitation of patients with oral cancers is usually done in a combined way with surgical, chemo- and radio-therapy. Radiotherapy predisposes to fibrotization, ischemia and xerostomia.
Implant-based restoration options
There is clinical evidence that implants can successfully be inserted in radiation-treated bone. Meta-analysis revealed a failure rate of <5 % in the mandible. Long-term implant survival rates seem however to be reduced, and may influence treatment expectations, in the context of the estimate survival time for a patient.
It has been suggested that implant surgery be postponed for 9-12 months after radiation therapy but data to support this are scarce. Therefore, in order to offer the patient earlier rehabilitation, the length of postponement may be shortened if clinical circumstances which indicate that bone healing potential is sufficient.
Clinicians should consider a two-stage surgical protocol to avoid implant site infection and to promote undisturbed osseointegration. In addition, osseointegration in radiated bone is considerably slower. Hyperbaric oxygen therapy may be useful. In all surgical scenarios, antibiotic protection to prevent infected osteoradionecrosis is critical. Patients should be informed about therapy staging. Reopening surgery is recommended after another 3 months.
Due to the functional limitations of the radiated patient, rehabilitation may not achieve the same overall functional level as in a healthy patient. Patients should be informed of the likely compromise during the treatment planning phase in order to set reasonable treatment outcome expectations.