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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
Intra-operative complications
Key points
- Evaluation of hard tissue configuration/dimension based on imaging, helps to avoid intraoperative complications such as bone perforation, vessel and nerve injury.
- The limited surgery associated with single implant placement may lead to refrain from cross-sectional imaging and thus limit the preoperative information about the anatomy of the osteotomy area to panoramic or intra-oral radiographs.
- General intraoperative complications such as a patient who panics or presents a tachycardia are rare considering the short surgery time.
- More specific for single implant placement can be the lack of sufficient mesio-distal space for the instruments.
Cortical perforation
Due to the jaw bone resorption after tooth loss the resulting configuration and dimension cannot be evaluated precisely by panoramic or intra-oral radiographs. Additional cross-sectional imaging i.e. cone-beam computed tomography (CBCT) can be necessary to reduce the risk of perforation. For single implant placement this risk is limited but not absent, such as in the molar area. An increase in resistance during drilling represents a warning for penetration of the cortex. The permanent control of the preparation depth as well as low pressure during implant bed preparation are essential to avoid drill deviation and perforation.
Vascular injury
When installing single implants in the molar region of the mandible the risk for a lingual concavity should be considered. Perforation of the lingual cortical plate can lead to vessel damage in the floor of mouth. Massive hemorrhages of the floor of the mouth can lead to life-threatening dyspnea which can necessitate further interventions, such as intubation. (See also Related Article 'Bleeding')
Inferior alveolar nerve injury
Again in the molar region one has to take into account, even for single implant placement, the course of the mandibular canal since lesions of the lower alveolar nerve can lead to permanent anaesthesia or paraesthesia. Some nerves present branches which are hard to detect on panoramic or intra-oral radiographs.
Bone dehiscence
Especially in the frontal part of the maxilla, single implant insertion can lead to a dehiscence because of the narrow bone crest. This can lead to further interproximal bone remodelling and subsequent soft tissue recession with a compromised aesthetic outcome if the patient uncovers this area during smiling.
Damage to neighbouring periodontal ligament or tooth root.
During the osteotomy one can come into close contact with an adjacent tooth. This intra-operative complication will only lead to symptoms much later.
