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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
Microbiology diagnostics
Key points
- Microbiological sensitivity testing, may be clinically relevant when peri-implantitis; evidence is present.
- It is important to stress the importance of accurate surgical procedure, proper oral hygiene instructions and prosthetic constructions that allow accessibility for oral hygiene around implants are key factors to the long term success of dental implants.
- Marginal bone loss can lead to deepened pockets. Superinfection can develop peri-implantitis. Bone maintenance in the long-term perspective are to be expected when adequate levels of oral hygiene are kept.
Microbiota parameters
Following implant insertions in patients with residual dentition, the implant surfaces were colonized by the same bacteria present on the surfaces of the remaining teeth. Plaque accumulation at implants will result in the development of an inflammation at implant sites. Some studies show an increased incidence of peri-implantitis and implant loss in patients with a history of periodontitis, smoking, excess cement, and lack of supportive therapy. Two-piece implants unavoidably present a micro-gap between the implant and the abutment. Bacterial leakage at the interface between abutments and implants, as well as along the abutment screw assemblies was convincingly documented as well. Presence of microbiota vary according to studies. Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), Porphyromonas gingivalis (P. gingivalis), and Tannerella forsythia (T. forsythia) are key pathogens in the process of periodontitis and probably also play a significant role in the development and progression of peri-implant mucositis and peri-implantitis.
Antibiotic medication selection
For peri-implantitis the beneficial effects of a systemic antibiotic, as adjunct to mechanical/surgical treatment remain unproven. Whether the composition of submucosal microbiota is a determining factor for the effectiveness of therapy remains unsubstantiated. Microbial testing can help selecting proper antibiotic by detecting resistant species.
Microbiology tests
Available tests for on an outpatient population:
- phase-contrast microcopy
- culturing
- latex agglutination test
- checkerboard DNA-DNA hybridization
- polymerase chain reaction
Phase-contrast microscopy:
Simple and fast chair-side test which provides proportion of cocci/rods/filaments and motile organisms. Increased % of motile organisms has been associated with aggressively of periodontitis; this relationship is not established for peri-implantitis.
Culturing
Culturing is technique sensitive and time-consuming. Determines sensitivity towards antibiotics. Paper points are inserted in the peri-implant pocket and transported in a vial to the laboratory.
Latex-agglutination test
Consists of beads coated with specific antibodies. When contacting target antigens from the sample, à clumping of beads. Simple and rapid.
Checkerboard DNA-DNA hybridization
Optimal test for complex ecosystems. Allows identification of large numbers of species in many samples. ≥104 bacteria allow detection.
Polymerase chain reaction
Involves amplification of DNA sequence by a primer. If amplification occurs, presence of target species proven. ≥ 10 bacteria can be detected. Biofilm may contain enzymes which inhibit reaction.
In view of these results we should like to stress the importance of giving proper oral hygiene instructions to the patients who are rehabilitated with dental implant and of proper prosthetic constructions that allow accessibility for oral hygiene around implants.
