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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
Implant design and implant selection, posterior zone
Key points
- Short and tilted implants can avoid bone grafting.
- In the posterior maxilla, if the residual alveolar bone height is 3 to 6 mm, a transcrestal approach and placing 8 mm implants may lead to less complications than a lateral window approach.
- Wide-diameter implants (≥ 5 mm) offer a greater surface area and better primary stability in case of post-extractive implants, replaced implants, and poor bone density.
In the posterior jaw areas, tooth loss is usually associated with alveolar bone resorption and sinus pneumatization or alveolar nerve superficialization.
Today, the most commonly used implant design is a tapered body, with a moderately rough implant surface, and conical implant-abutment interface. Furthermore, the platform shifting concept, through the use of a smaller abutment diameter, introduces an horizontal inward component to the establishment of the biological width, (that otherwise is a vertical process), contributing in preserving the marginal bone level.
Short implants (5 mm) can be successfully loaded in mandibular and maxillary bone, but poor crown/ implant (C/I) ratios may lead to excessive crestal bone loss.
Tilted implants can be used to avoid the need for bone grafting. They might compromise the prosthetic emergence profile and long-term hygienic maintenance. Although no difference between axial and tilted implants has been reported, they might compromise the prosthetic emergence profile and long-term hygienic maintenance.
Different augmentation techniques in the maxillary sinus with simultaneous or delayed installation of implants have been reported. The insertion of implants in combination with maxillary sinus floor elevation using a lateral window approach is a predictable treatment option with high implant survival rates and few surgical complications. Nevertheless, according to a recent Cochrane systematic review, for residual alveolar bone heights of 3 to 6 mm, a transcrestal approach to lifting the sinus lining and placing 8 mm implants may lead to less complications than a lateral window approach.
Implant placement in fresh molar extraction sockets still allows achieving of good primary implant stability by using, for example, wide and/or tapered implant designs. Wide-diameter implants (≥ 5 mm) with reduced length offer a large bone-to-implant contact (BIC) area and better primary stability. Increasing the width of implants has been shown to reduce the amount of biomechanical stresses at the crestal bone level which may reduce potential marginal bone loss. Computer-guided implant protocols may help clinicians to place straight and tilted implants, avoiding elevation of large flaps and challenging surgical techniques, causing less pain and discomfort to patients.
