Patient assessment and diagnosis in implant treatment Ranuch TAK ID: 555130017-3
8/13/2019 Pt Assessment and Diagnosis
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Patient assessment anddiagnosis in implant
treatmentRanuch TAK ID: 555130017-3
8/13/2019 Pt Assessment and Diagnosis
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Objective
Analyzing available evidence on patient assessment for
implant treatment
Special consideration type Single implant
Partial edentulous
Edentulous jaw
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Introduction
Implant treatment we have to evaluate implant are indicated
Particular patient
Specific oral situation
Framework of comprehensive reconstructive tx plan
Even implant is increasing in practice
The incidence of failure also reports & lawsuits
Peri-implantitis is highly associated smoking
previous periodontal disease
Micro-organism
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Literature search strategy
Search Medline via PubMed
Implant tx – end of Septemper, 2007
Handsearch 2000 up
Inclusion criteria
Implant indications & contraindications
How to examine the implant patient
Diagnostic techniques of implant patient
Totally 20 articles from PubMed, 22 from handsearch
20 articles are selected
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Pt’s history & Implant Contra
Indication
Initial medical questionnaires
Past and current disease
Temporary/ long term medication
Smoking Special dietary features
Dental questionnaires and examination
Recurrent caries
Perio history/peri-implantitis Trauma
Insufficient bone quality
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General Contra Indication
Poor general health (required medical supervision)
Young age still in growth
Other
High risk caries
Alcoholism, smoking
ASA score
Bone diseases (osteonecrosis)
Receiving radiation, chemotherapy, biphosphonate
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Clinical examination
Extra-oral examination
Correct facial proportion (divided into 3 thirds)
Facial asymmetry
Lip and cheek support
Facial skeletal classification
Intermaxillary relation
Incisal edge position of the maxillary centrals & occlusal plane
Neurologic test of areas innervation TMJ movement
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Upper lip length
It measures from base of the column (subnasal) – philtrum in
rest and determine central incisal visible
Short length 10-15mm & 4mm incisal
Average length 21-25mm & 2 mm incisal
Long length 31-35mm & 0.25mm incisal
Smile line
Prevalence of low smile line 75%
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Intra-oral examination
Dental examination
Edentulous regions
Quality/quantity of the mucosa & contour of underlying bone
Existing prosthesis
Occlusal status & functional exam
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Aspects of tx planning
Implant tx plan should be considered during Extra & Intraexamination
Single tooth case
Related to adjacent teeth & neighboring structure
Partial edentulous case
Extraction questionable teeth
Implant-implant > implant-tooth
Edentulous case
Pt desired & expectation are priority
Speech , food entrap
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Diagnosis aids
Diagnosis wax up
Tx plan, provisional
Radiologic diagnosis Underlying vital structures
Bone quality & quantity
Study casts
Diagnosis
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Anatomic and topographic structures
Quality and quantity- Good- Insufficient but
mainly good- Poor
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Conclusion
Pt evaluation and assessment: tx planning
Advantages and disadvantages of recommended therapy
and alternative treatment are explained to the pt
Final treatment decision and informed consent are selected
by patient themselves.