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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
Non-implant based treatment options
Key points
- After finishing the phases of Patient assessment and Diagnostics, but before Treatment planning starts, a consensus must be reached between all parties on what the actual treatment will be.
- The patient must have enough information on possible treatment options, including non-implant based ones, to make his/her own independent decision.
Non-implant-based treatment options
After finishing the phases of Patient assessment and Diagnostics, but before Treatment planning starts, a consensus must be reached between all parties on what the actual treatment will be. The patient must have enough information on possible treatment options, including non-implant based ones, to make his/her own independent decision. Main & Adair (2015) have addressed key points of interest for dental health care professionals when obtaining informed consent. These points are:
- the process of informed consent requires a careful dialogue between dentist and patient;
- basing disclosure of any given risk on the chances (percentage) of it occurring is no longer acceptable;
- the dentist must carefully consider whether a risk is material by considering:
- whether a reasonable person in the patient’s position would be likely to attach significance to it, and/or
- whether the patient in question would probably attach significance to it;
- the patient should be made aware of reasonable alternative treatment options;
- the dentist should take steps to ensure that the patient gets, and has understood, this information;
- the consent form does not prove informed consent. It does, however, act as some record that the discussions have taken place. The dentist should keep a contemporaneous record of the consent process including risks and treatment options discussed.
One of the points of obtaining informed consent is that the patient should be made aware of reasonable alternative treatment options. Dependent on a specific situation, alternative non-implant based treatment options are:
- a 3-unit bridge supported by two natural teeth;
- a fixed resin-bonded bridge;
- a removable partial denture;
- orthodontic closure of the open space;
- no treatment.
A report from a consensus conference in 2015 by Beikler and Flemmig concluded that for better assessment of the efficiency of implant-supported prostheses in various clinical conditions, more economic evaluations are needed that follow well-established methodologies in health economics. There are studies which state that implant-supported single crowns provide better outcomes in terms of greater quality-adjusted tooth years or survival rates at lower costs compared to fixed partial prostheses.
