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

麻醉

Key points

选择麻醉方式时应遵循最有利患者的原则
医护人员必须接受复苏程序和可用设备方面的适当培训
根据药物效力的不同，静脉镇静可能会导致清醒镇静或全身麻醉
全身麻醉：意识丧失，即使采用疼痛刺激也不能唤醒患者
应针对所选的手术谨慎考虑是否采用全身麻醉方式
在清醒镇静期间，可与患者保持进行语言交流

一般注意事项

麻醉方式的选择取决于很多可变因素，包括治疗的复杂性、治疗持续时间，以及是否需要患者在治疗期间保持意识和反应能力等等。一般情况下，临床医师应与患者讨论可能采用的麻醉方式和镇静类型的利弊，从中选择能够以最少量的麻醉剂和镇静剂完成治疗程序的类型。应认真遵循有关根据患者的医疗状况选择麻醉方式的指导原则。

两种主要麻醉/镇静类型包括局部麻醉剂浸润麻醉和局部麻醉剂区域麻醉。两种麻醉类型都可以与清醒镇静结合采用。在执行复杂手术时，可考虑全身麻醉，并应向患者推荐训练有素且拥有丰富全身麻醉操作经验的专科医生。

局部麻醉剂浸润麻醉

主要使用利多卡因、阿替卡因或甲哌卡因，可选用或不选用通过注射器注射的卡普尔瓶装血管收缩剂
针头斜面应与骨膜平行
缓慢注射加热至体温的麻醉剂
应先于注射实施表面麻醉
麻醉持续时间因患者的新陈代谢和焦虑状况而异

局部麻醉剂区域麻醉

下牙槽阻滞麻醉，用于控制下颌远端部位的疼痛
在皮质骨较少的非萎缩下颌前部，通常采用局部浸润麻醉就已足够
此过程对技术的要求高于局部浸润麻醉
必须进行抽吸，因为 5% 的抽吸结果为阳性，需要调整针头方向并重新抽吸，否则重新注射并重新进行抽吸
面部神经可能会暂时麻痹

清醒镇静

通常与局部麻醉结合使用
患者保持清醒，能够对口头指令做出适当的反应
通过鼻腔给予一氧化二氮和氧气。一氧化二氮具有镇静和止痛效果
静脉 (IV) 注射苯二氮类药物是一种安全且广泛使用的清醒镇静实现方法
实施清醒镇静有一些禁忌证，例如妊娠、过敏和酒精中毒。因此，了解详尽的病史非常重要
在清醒镇静期间，应准备复苏设备、正压供氧系统和插管供随时使用
应遵循有关实施清醒镇静的国家/地区规定

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全身麻醉

在全身麻醉期间，会达到完全的意识丧失、记忆丧失、痛觉丧失、骨骼肌松弛，以及自主神经系统丧失控制状态
因此，全身麻醉应仅限医院或设备齐全的医学中心实施，而且应保证这些场所可使用基本的医疗监护术后设施
使用术前可乐定或苯二氮类药物可减少所需的麻醉剂剂量
必须进行生理监测和气道管理
麻醉持续时间一般不会导致问题

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临床分类

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