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Treatment guidelines

Edentulous

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All-on-4® treatment concept

Patients wearing complete dentures often suffer from esthetic and functional discomfort and compromised denture retention and chewing function. Denture adhesives are often applied. Many patients perceive this...

Edentulous treatments
Implants in compromised sites
Immediate loading / provisionalization
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Treatment guidelines

Edentulous

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Healed vs fresh extraction socket

The treatment of the edentulous jaw can be a mixture of placing implants in healed and fresh extraction sockets. Unequal hard and soft tissue levels around the implants (Fig. 1&2), especially in the interforaminal region, can be adjusted by leveling the bone...

Immediate implant placement
Success & failure
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Treatment guidelines

Edentulous

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Alveolar atrophy and insufficiency

Teeth extractions are followed by a reduction of the bucco-lingual as well as the vertical dimension of the residual alveolar ridge. The ensuing resorption is progressive and even the basal jaw may become involved. In the lower jaw, the....

Radiology
Systemic factors
Patient assessment
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Treatment guidelines

Edentulous

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Microbiology

Epithelial desquamation in the oropharynx limits bacterial accumulation, except on the tongue dorsum and in the tonsillar crypts. Loss of teeth dramatically reduces the load of periodontal pathogens except for Aggregatibacter actinomycetemcomitans and to a...

Implants in compromised sites
Local factors
Patient assessment
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Treatment guidelines

Edentulous

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Mouth opening

Most patients’ mouth opening readily permits access for routine prosthodontic and surgical treatment interventions. Limited mouth opening or microstomia is encountered in patients exposed to sclerodermia, diffuse systemic...

Temporomandibular Joint
Systemic factors
Patient assessment
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Treatment guidelines

Edentulous

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Risk factors

Relevant risk factors for implant treatment:

  • Children and adolescents (during ongoing bone/skeletal development), unless in selected anodontia patients. However, implant placement for orthodontic treatment purposes is indicated.
  • Uncontrolled metabolic diseases such as Diabetes Mellit...
Local factors
Systemic factors
Patient assessment
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Treatment guidelines

Edentulous

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Radiotherapy

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. The latter side-effect renders mucosally supported dentures even more difficult to...

Systemic factors
Patient assessment
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Treatment guidelines

Edentulous

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Steroids

A steroid is an organic compound and a type of lipid substance. Steroids play a critical role in metabolism, for example, as the dietary fat Cholesterol, as bile acids or as steroid hormones (e.g. Cortisone/Glucocorticoids, Estrogens, Testosterone). The more complex...

Systemic factors
Patient assessment
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Treatment guidelines

Edentulous

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BRONJ / ARONJ

A critical side effect in the oro-maxillo-facial region observed in patients undergoing administration over a long period of time and especially intravenously, bisphosphonate therapy may predispose to ‘bisphosphonate-related osteonecrosis of the...

Systemic factors
Patient assessment
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Treatment guidelines

Edentulous

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Bisphosphonates

Bisphosphonates (BP) inhibit osteoclast activity and remain in the bone for a prolonged period. Bisphosphonates are the most commonly prescribed drugs to treat osteoporosis, bone fragility disorders, like Paget’s disease, osteogenesis imperfecta...

Systemic factors
Patient assessment
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Treatment guidelines

Edentulous

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Coagulation disorders and anticoagulants therapy

Patients may have compromised blood coagulation due to inherited hemophilia or acquired disorders of coagulation resulting from preventive anticoagulant therapy in case of cardiovascular diseases. There are also states of heightened coagulation...

Systemic factors
Patient assessment
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Treatment guidelines

Edentulous

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Osteoporosis

Osteoporosis is a frequent disease affecting predominantly postmenopausal women. The prevalence is 7% in women aged 55 and raises to 19% in women aged 80. Osteoporosis is diagnosed by a decreased radiologic bone density (DXA-score). Primary osteoporosis is more...

Systemic factors
Patient assessment
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Treatment guidelines

Edentulous

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Diabetes

Diabetes refers to metabolic diseases where blood sugar levels are too high, a condition termed hyperglycemia, and where symptoms as increased hunger, weight loss, more frequent urination, weakness and fatigue and excessive thirst are observed. High...

Systemic factors
Patient assessment
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Treatment guidelines

Edentulous

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Recreational drugs and alcohol abuse

It is important to evaluate signs indicating if the patient abuses alcohol or takes recreational drugs and may have developed addictions. In general these drugs have a psychedelic,...

Systemic factors
Patient assessment
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Treatment guidelines

Edentulous

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Drug abuse

The medical history should reveal if the patient takes any prescribed medication and especially whether in the correct dosage. Fear of oral surgery may induce a temporary overconsumption of drugs such as beta-blockers or...

Systemic factors
Patient assessment