0 Patient Assessment
- 0.1 Patient demand
- 0.2 Overarching considerations
- 0.3 Local history
- 0.4 Anatomical location
- 0.5 General patient history
- 0.6 Risk assessment & special high risk categories
  - 5.1 Risk assessment & special high risk categories
  - 5.2 age
  - 5.3 Compliance
  - 5.4 Smoking
  - 5.5 Drug abuse
  - 5.6 Recreational drugs and alcohol abuse
  - 5.7 Parafunctions
  - 5.8 Diabetes
  - 5.9 Osteoporosis
  - 5.10 Coagulation disorders and anticoagulant therapy
  - 5.11 Steroids
  - 5.12 Bisphosphonates
  - 5.13 BRONJ / ARONJ
  - 5.14 Radiotherapy
  - 5.15 Risk factors
1 Diagnostics
- 1.1 Clinical Assessment
  - 0.1 Lip line
  - 0.2 Mouth opening
  - 0.3 Vertical dimension
  - 0.4 Maxillo-mandibular relationship
  - 0.5 TMD
  - 0.6 Existing prosthesis
  - 0.7 Muco-gingival junction
  - 0.8 Hyposalivation and Xerostomia
- 1.2 Clinical findings
  - 1.1 Occlusion
  - 1.2 Alveolar atrophy and insufficiency
  - 1.3 Skeletal consequences of edentulism
  - 1.4 Head-neck cancer
- 1.3 Clinical diagnostic assessments
  - 2.1 Microbiology
  - 2.2 Salivary output
- 1.4 Diagnostic imaging
  - 3.1 Imaging overview
  - 3.2 Intraoral radiographs
  - 3.3 Panoramic
  - 3.4 CBCT
  - 3.5 CT
- 1.5 Diagnostic prosthodontic guides
  - 4.1 Prosthodontic guides overview
  - 4.2 Wax-up, arrangement, mock-up
  - 4.3 Splints and imaging for surgery
  - 4.4 Provisionals
2 Treatment Options
- 2.1 Mucosally-supported
  - 0.1 Mucosally supported - Overview and important considerations
  - 0.2 Complete denture
  - 0.3 Immediate denture
  - 0.4 Occlusal schemes
- 2.2 Implant-retained/supported, general
  - 1.1 Prosthodontic options overview
  - 1.2 Number of implants maxilla and mandible
  - 1.3 Time to function
  - 1.4 Submerged or non-submerged
  - 1.5 Soft tissue management
  - 1.6 Hard tissue management, mandible
  - 1.7 Hard tissue management, maxilla
  - 1.8 Need for grafting
  - 1.9 Healed vs fresh extraction socket
  - 1.10 Digital treatment planning protocols
    
    9.1 Digital treatment planning protocols, introduction
    
    9.2 Digital treatment planning protocols, NobelClinician
- 2.3 Implant prosthetics - removable
  - 2.1 Implant overdenture, overview
    
    0.1 Implant overdenture, introduction
    
    0.2 Overdenture retention devices, overview
  - 2.2 Secondary splinting
  - 2.3 Primary splinting
- 2.4 Implant prosthetics - fixed
  - 3.1 Fixed implant prosthesis, introduction
  - 3.2 Screw-retained restorations
    
    1.1 Screw-retained
    
    1.2 Implant-supported vs abutment-supported
  - 3.3 Cement-retained restorations
    
    2.1 Cement-retained
    
    2.2 Abutment materials
  - 3.4 Framework materials
    
    3.1 Framework materials
    
    3.2 Veneering with ceramic
    
    3.3 Veneering with Acrylic
- 2.5 Comprehensive treatment concepts
3 Treatment Procedures
- 3.1 Surgical
  - 0.1 Surgical considerations
    
    0.1 Anesthesia
    
    0.2 Peri-operative care
    
    0.3 Post-operative care
    
    0.4 Flap-or flapless
    
    0.5 Wound closure
    
    0.6 Intra-operative complications
    
    0.7 Guided vs non-guided
    
    0.8 Semi-guided surgery with prosthetic template
    
    0.9 Guided surgery with drill guides
  - 0.2 Surgical protocols - general
    
    1.1 Crestal incision
    
    1.2 Choice of implant
    
    1.3 Parallel implant placement
    
    1.4 Tapered implant placement
    
    1.5 Insertion torque
    
    1.6 Insertion height
    
    1.7 Implant angulation
  - 0.3 Surgical protocols - mandible
    
    2.1 Implant placement with open flap procedure - mandible
    
    2.2 Grafting, mandible
  - 0.4 Surgical protocols - maxilla
    
    3.1 Implant placement - maxilla
    
    3.2 Grafting, maxilla
    
    3.3 Sinus lifting
    
    3.4 Zygomatic implants
    
    3.5 Pterygoid implants
    
    3.6 Problems and complications in maxillary implant surgery
- 3.2 Removable prosthetics
  - 1.1 Complete dentures
    
    0.1 Complete denture clinical protocol
    
    0.2 Complete denture impressions
    
    0.3 Complete denture - maxillo-mandibular relations
    
    0.4 Complete denture trial placement
    
    0.5 Complete denture placement
    
    0.6 Complete denture post-placement
  - 1.2 Implant overdentures
    
    1.1 Overdenture clinical protocol
    
    1.2 Implant overdenture impressions
    
    1.3 Implant overdenture maxillo-mandibular relations
    
    1.4 Implant overdenture trial placement
    
    1.5 Implant overdenture placement
    
    1.6 Implant overdenture post-placement
- 3.3 Fixed prosthetics
  - 2.1 Fixed implant prosthesis clinical protocol
  - 2.2 Impressions
    
    1.1 Impressions - overview
    
    1.2 Splinted vs unsplinted impression copings
    
    1.3 Open versus closed tray
    
    1.4 Parallel vs non-parallel
  - 2.3 Maxillo-mandibular relations
  - 2.4 Trial placement
  - 2.5 Framework trial placement
  - 2.6 Placement
  - 2.7 Post-placement
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 function check
  - 1.2 Provisionals / temporary prosthesis
  - 1.3 Oral hygiene instructions
  - 1.4 Occlusal guard
- 4.3 Post-treatment complications and management
  - 2.1 Bleeding
  - 2.2 Soft tissue and hard tissue
  - 2.3 Patient compliance / recall
  - 2.4 Biologic complications
  - 2.5 Esthetic complications
- 4.4 Recall visits and logistics
  - 3.1 Recall visits - overview
  - 3.2 Patient expectations
  - 3.3 General health check
  - 3.4 Professional oral hygiene
  - 3.5 Implant overdenture maintenance
  - 3.6 Occlusion check
  - 3.7 Probing
  - 3.8 Inflammation, infection
    
    7.1 Inflammation and infection - overview
    
    7.2 Infection, microbiological diagnostics
  - 3.9 Radiological control

治疗指南

术后软组织处理

Key points

术后软组织处理可以和定期控制回访一起进行
评估伤口愈合情况，对炎症或感染的任何迹象进行处理
仔细调整临时义齿，使之适合软组织的状况

术后软组织处理 - 时间安排

在对缺齿患者进行治疗后，无需安排特定的软组织控制回访。手术后第 1 - 3 天、第 7 - 14 天、第 4 - 6 周的传统术后控制涉及到软组织控制和处理。

在回访中对软组织进行评估

检查创伤闭合和缝线情况。如果伤口裂开，重新缝合并且/或者在需要时进行增补缝合（仅在 24 小时至 48 小时以内）。

检查有无炎症和感染的迹象，如肿胀、渗液、疼痛、流血

评估牙菌斑堆积和口腔卫生状况。如有牙菌斑则将其除去，需要时在口腔卫生方面进行重新指导。

建议从手术后的那天起，每天用 0.2% 洗必泰之类的抗菌漱口液漱口两到三次。

在第 7 - 14 天的第二次术后回访中进行重新评估。

软组织和临时义齿贴合度

小心控制临时义齿的贴合度，以避免软组织受伤。因为在愈合过程中软组织会发生变化，在必要时用柔软的重衬对义齿进行相应的调整。

检查杆卡和基台的设计是否正确，确保其不会引起组织增生。

如果出现缝合口肉芽肿，并且大量组织正在形成，用软组织激光仪、电烙器或解剖刀去除增生组织。软组织激光仪通常会提供良好的效果，出血也有限。它还使得被软组织遮住的种植体能够露出来。

如果在种植体植入后出现瘘管，使种植体露出来并装入一个基台。

临床分类

术后护理成功&失败/并发症

治疗指南

Edentulous

围术期护理

如果适用，根据手术的类型开具术前药物（例如，抗生素药物）

下面的清单列出了一些需要遵循的重要步骤，目的是确保患者知情，使之为即将开始的手术做好适当准备

患者评估

术前程序

立即观看

治疗指南

Edentulous

口腔卫生指导

所有的组织表面、修复体表面和种植体表面均应是口腔卫生辅助用具（如牙刷、牙缝刷和牙线或洁牙带）能够触及的。在治疗方案设计过程中，在设计种植体位置和修复体时考虑到最终口腔卫生结果至关重要。为此，所有口腔内修复体表面均应光滑，具有极佳的光洁度，以预防牙菌斑滞留。

患者每次就诊时均应接受口腔卫生指导，且可能需要回顾相关指导。这对于固定修复体尤其重要。应继续进行口腔卫生指导，直到患者能够使用适当的口腔卫生辅助用具独立清洁所有相关口腔内部位。尽管大多数患者都可以使用普通牙

术后护理

修复体

口腔卫生说明

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治疗指南

Edentulous

临时修复体

尽管会采用耐久性较差的不同材料，但临时修复体的制作在外形上应尽可能与期望的最终修复体相似。临时修复体的耐久性和功能性较差意味着患者应避免硬/脆的食物。应始终采取口腔卫生措施。为了减少修复体松脱的可能性，应针对粘接固位修复体调整牙线使用技巧，以便在使用后从唇侧/颊侧拉出牙线，而不是通过近中接触点迅速弹回来。

固定临时修复体（螺丝固位或粘接固位）可能会松动。修复体出现松动到重新拧紧或重新粘接之间的延迟可能会削弱种植体及周围软组织和硬组织的长期稳定性。必须向患者强调，如果他们怀疑固定临时修复体开始松动，必须尽快去牙医处就诊，而不

即刻负重/延迟负重

术后护理

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问题

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治疗指南

围术期护理

治疗指南

口腔卫生指导

治疗指南

临时修复体

Scientific References

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