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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
Steroids
Key points
- Most steroid drugs are glucocorticoids to regulate metabolic and immune functions.
- Increased production or long-term medication with steroids can lead to osteoporotic symptoms.
- There is no evidence of an association between steroid treatment and implant treatment success.
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 steroids (like steroid hormones or bile acid) are synthesized from Cholesterol. Steroids are also part of some vitamins (e.g. Vitamin D) and poisons (e.g. Digitalis).
General medical implications
Steroid insufficiency is due to a lack or malfunction of the relevant enzymes consequent to genetic disorders or adrenal gland pathology. The cortex of these glands produce corticosteroids. Their insufficiency can lead to critical metabolic and hormonal malfunctions. Many elderly (female) patients present a lack of sex steroid hormones and related symptoms (osteoporosis), when untreated. Most medical steroid drugs are corticosteroids (glucocorticoids/cortisone or mineralocorticoids/aldosterone). Increased production or long-term medication with cortisone may lead to osteoporosis (due to reduced intestinal calcium absorption) and to diabetes (see respective chapters). Steroid drugs (such as prednisone, prednisolone) are administered in case of lack of steroids, various immune and inflammatory diseases (eczema, neurodermitis, lichen planus, rheumatic diseases, psoriasis), chronic intestinal diseases (Crohn's disease, ulcerative colitis), asthma and as adjunct medication such as after organ transplantation and chemotherapy.
A thorough anamnesis/medical history will identify the need to consult an internist / family doctor before initiating treatment.
Implications for implant treatment
Patients undergoing long-term steroid therapy are likely to develop symptoms of osteoporosis. There is no evidence for an impact of osteoporosis on oral implant survival. Consider influence on treatment with bisphosphonates in osteoporotic patients.
In treatment planning consider thorough evaluation of bone quality and density with available imaging technology. Be prepared to re-assess and re-evaluate bone density during clinical procedures. Adapt clinical protocols adequately; consider specific (undersized) drill protocols and appropriate implant selection for soft bone.
Prolonged steroid intake is associated with an increased incidence of infections. Association with anti-inflammatory painkillers (such as Ibuprofen) increases the risk of a stomach or duodenal ulcer.
When extensive surgery is needed, steroid treatment may be necessary in patients suffering from Addisson disease to reduce the risk of adrenal crisis. The latter is caused by lack of cortisol due to stress.
