Condition of natural teeth
- Condition of remaining teeth and surrounding tissues has influence on treatment planning.
- Condition of remaining teeth and surrounding tissues has influence on prognosis of an implant-supported restoration.
A healthy oral condition is a prerequisite for successful dental implant treatment. A thorough investigation of remaining teeth with respect to caries disease, quality of restorations, and quality of endodontic treatments is important for the prognosis of these teeth.
If remaining teeth are not healthy, with non-acceptable restorations, restorative treatment should be done first. The remaining dentition should be free from periodontal and apical periodontitis lesions. Not only could this infection possibly influence osseointegration of the dental implant, but equally important, it is not clear if these teeth could be rescued.
In general, first all restorative, endodontic and periodontal treatment should be finished to provide insight to the prognosis of remaining dentition. Without this, it is not sensible to start a single-tooth treatment and risk that the treatment has to be altered before restoration has finished.
Periodontal condition of surrounding tissues has also influence on the prognosis of the implant-supported restoration itself. Insufficient oral hygiene and (a history) of periodontitis are risk factors for peri-implant mucositis and peri-implantitis and therefore on survival of the implant-supported restoration. Therefore, it is of key importance to obtain information on pocket probing depth and bleeding on probing as part of the diagnostic phase.
Reason for tooth loss
Reason for tooth loss could have its influence on biological and technical complications in the follow-up period as well as on aesthetic outcome.
If the tooth to be replaced has been lost because of periodontitis, there is an extra risk for developing peri-implantitis.
If the reason for tooth loss is because of paranormal function such as bruxing or clenching in the past, technical complications could possibly happen again in the future.
If the reason for tooth loss is a trauma with a large amount of bone loss or because of a severe peri-apical infection with subsequent bone loss, an extensive bone augmentation procedure is necessary. Extensive bone augmentation procedures endanger a harmonious aesthetic outcome.
Figure 1: Patient with a wish for implant-supported restorations in position 11 and 21 (#8 and 9 UNIV); insufficient oral hygiene and gingivitis in remaining dentition.
Figure 2: Patient with a wish for an implant-supported restoration in position 26 (#14 UNIV); presence of insufficient restorations and a history of periodontitis in the remaining dentition.