0 Patient Assessment
- 0.1 Patient demand
- 0.2 Overarching considerations
- 0.3 Local history
- 0.4 Anatomical location
- 0.5 General patient history
- 0.6 Risk assessment & special high risk categories
  - 5.1 Risk assessment & special high risk categories
  - 5.2 age
  - 5.3 Compliance
  - 5.4 Smoking
  - 5.5 Drug abuse
  - 5.6 Recreational drugs and alcohol abuse
  - 5.7 Parafunctions
  - 5.8 Diabetes
  - 5.9 Osteoporosis
  - 5.10 Coagulation disorders and anticoagulant therapy
  - 5.11 Steroids
  - 5.12 Bisphosphonates
  - 5.13 BRONJ / ARONJ
  - 5.14 Radiotherapy
  - 5.15 Risk factors
1 Diagnostics
- 1.1 Clinical Assessment
  - 0.1 Lip line
  - 0.2 Mouth opening
  - 0.3 Vertical dimension
  - 0.4 Maxillo-mandibular relationship
  - 0.5 TMD
  - 0.6 Existing prosthesis
  - 0.7 Muco-gingival junction
  - 0.8 Hyposalivation and Xerostomia
- 1.2 Clinical findings
  - 1.1 Occlusion
  - 1.2 Alveolar atrophy and insufficiency
  - 1.3 Skeletal consequences of edentulism
  - 1.4 Head-neck cancer
- 1.3 Clinical diagnostic assessments
  - 2.1 Microbiology
  - 2.2 Salivary output
- 1.4 Diagnostic imaging
  - 3.1 Imaging overview
  - 3.2 Intraoral radiographs
  - 3.3 Panoramic
  - 3.4 CBCT
  - 3.5 CT
- 1.5 Diagnostic prosthodontic guides
  - 4.1 Prosthodontic guides overview
  - 4.2 Wax-up, arrangement, mock-up
  - 4.3 Splints and imaging for surgery
  - 4.4 Provisionals
2 Treatment Options
- 2.1 Mucosally-supported
  - 0.1 Mucosally supported - Overview and important considerations
  - 0.2 Complete denture
  - 0.3 Immediate denture
  - 0.4 Occlusal schemes
- 2.2 Implant-retained/supported, general
  - 1.1 Prosthodontic options overview
  - 1.2 Number of implants maxilla and mandible
  - 1.3 Time to function
  - 1.4 Submerged or non-submerged
  - 1.5 Soft tissue management
  - 1.6 Hard tissue management, mandible
  - 1.7 Hard tissue management, maxilla
  - 1.8 Need for grafting
  - 1.9 Healed vs fresh extraction socket
  - 1.10 Digital treatment planning protocols
    
    9.1 Digital treatment planning protocols, introduction
    
    9.2 Digital treatment planning protocols, NobelClinician
- 2.3 Implant prosthetics - removable
  - 2.1 Implant overdenture, overview
    
    0.1 Implant overdenture, introduction
    
    0.2 Overdenture retention devices, overview
  - 2.2 Secondary splinting
  - 2.3 Primary splinting
- 2.4 Implant prosthetics - fixed
  - 3.1 Fixed implant prosthesis, introduction
  - 3.2 Screw-retained restorations
    
    1.1 Screw-retained
    
    1.2 Implant-supported vs abutment-supported
  - 3.3 Cement-retained restorations
    
    2.1 Cement-retained
    
    2.2 Abutment materials
  - 3.4 Framework materials
    
    3.1 Framework materials
    
    3.2 Veneering with ceramic
    
    3.3 Veneering with Acrylic
- 2.5 Comprehensive treatment concepts
3 Treatment Procedures
- 3.1 Surgical
  - 0.1 Surgical considerations
    
    0.1 Anesthesia
    
    0.2 Peri-operative care
    
    0.3 Post-operative care
    
    0.4 Flap-or flapless
    
    0.5 Wound closure
    
    0.6 Intra-operative complications
    
    0.7 Guided vs non-guided
    
    0.8 Semi-guided surgery with prosthetic template
    
    0.9 Guided surgery with drill guides
  - 0.2 Surgical protocols - general
    
    1.1 Crestal incision
    
    1.2 Choice of implant
    
    1.3 Parallel implant placement
    
    1.4 Tapered implant placement
    
    1.5 Insertion torque
    
    1.6 Insertion height
    
    1.7 Implant angulation
  - 0.3 Surgical protocols - mandible
    
    2.1 Implant placement with open flap procedure - mandible
    
    2.2 Grafting, mandible
  - 0.4 Surgical protocols - maxilla
    
    3.1 Implant placement - maxilla
    
    3.2 Grafting, maxilla
    
    3.3 Sinus lifting
    
    3.4 Zygomatic implants
    
    3.5 Pterygoid implants
    
    3.6 Problems and complications in maxillary implant surgery
- 3.2 Removable prosthetics
  - 1.1 Complete dentures
    
    0.1 Complete denture clinical protocol
    
    0.2 Complete denture impressions
    
    0.3 Complete denture - maxillo-mandibular relations
    
    0.4 Complete denture trial placement
    
    0.5 Complete denture placement
    
    0.6 Complete denture post-placement
  - 1.2 Implant overdentures
    
    1.1 Overdenture clinical protocol
    
    1.2 Implant overdenture impressions
    
    1.3 Implant overdenture maxillo-mandibular relations
    
    1.4 Implant overdenture trial placement
    
    1.5 Implant overdenture placement
    
    1.6 Implant overdenture post-placement
- 3.3 Fixed prosthetics
  - 2.1 Fixed implant prosthesis clinical protocol
  - 2.2 Impressions
    
    1.1 Impressions - overview
    
    1.2 Splinted vs unsplinted impression copings
    
    1.3 Open versus closed tray
    
    1.4 Parallel vs non-parallel
  - 2.3 Maxillo-mandibular relations
  - 2.4 Trial placement
  - 2.5 Framework trial placement
  - 2.6 Placement
  - 2.7 Post-placement
4 Aftercare
- 4.1 Surgical aftercare
  - 0.1 Medication
  - 0.2 Post-operative soft tissue management
  - 0.3 Suture removal
  - 0.4 Post-surgical recommendations
- 4.2 Prosthetic aftercare
  - 1.1 Esthetic and function check
  - 1.2 Provisionals / temporary prosthesis
  - 1.3 Oral hygiene instructions
  - 1.4 Occlusal guard
- 4.3 Post-treatment complications and management
  - 2.1 Bleeding
  - 2.2 Soft tissue and hard tissue
  - 2.3 Patient compliance / recall
  - 2.4 Biologic complications
  - 2.5 Esthetic complications
- 4.4 Recall visits and logistics
  - 3.1 Recall visits - overview
  - 3.2 Patient expectations
  - 3.3 General health check
  - 3.4 Professional oral hygiene
  - 3.5 Implant overdenture maintenance
  - 3.6 Occlusion check
  - 3.7 Probing
  - 3.8 Inflammation, infection
    
    7.1 Inflammation and infection - overview
    
    7.2 Infection, microbiological diagnostics
  - 3.9 Radiological control

治疗指南

患者依从性/回访

Key points

就确保长期治疗成功而言，患者依从性与其他任何影响因素具有同样的重要性
了解患者的生活方式和家居文化对于实现有效的规范依从很重要
旨在提高患者依从性的标准化教育方案应成为治疗计划和治疗后护理的一部分

患者依从性注意事项

患者依从性是促进口腔修复取得长期成功的关键因素。临床医师/牙科医生应积极关注患者依从性问题。医生可能会将不依从指示的患者视为造成问题的根源。实际上，需要考虑四个关键问题。

患者环境

首先，必须理解患者的文化和生活方式。努力改变与患者社会环境不一致的行为是不太可能成功的。考虑采用不同的行为技术来改变患者的态度并提高患者依从性则可起到一定作用。比较有效的做法是设定较小的目标，争取循序渐进而不是立即实现全面的改变。

将维护和依从性融入治疗计划

其次，治疗团队的每个成员都应将口腔卫生指导和修复体维护教育视为优先事项。通过将此类活动正式融入治疗计划和维护阶段，并在定期回访时投入足够的时间和精力，可加强患者的相关意识。通过这种方式，团队可确保口腔健康、修复体使用寿命和患者满意度。

第三，有证据表明，积极参与治疗方案设计的患者更有可能依从指示。医生家长式的做法将导致患者依从性较差。

第四，通过医生与患者之间的关系可以明确预测随后的依从性。

患者性格

患者性格是患者依从性的重要预测指标。具有较高接受度、较为顺从的患者更容易依从指示，也愿意采取医生要求他们采取的行动。但无动于衷/模棱两可的患者会表现出中等程度的依从性，持怀疑态度的患者则很难依从指示，因为他们根本不相信您尝试教导他们的内容。因此，在患者面谈和治疗方案设计期间确定患者是否持怀疑态度非常重要。

临床分类

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患者病史

初步评估 — 患者问诊

临床医师应注意与患者的目光处于同一水平，这样做非常有效。例如，如果患者坐着，临床医师也应坐着。建议临床医师在问诊时不要让患者坐在牙科手术椅上，因为这种方式不易于建立自信。这样更有助于了解患者个性、期望和医疗状况的主要信息。了解患者主诉之后应符合治疗期望，这一点至关重要。在所有患者问诊过程中，应保护患者隐私。

整体健康评估

应对以下生物系统进行整体健康评估：

心血管
血液
神经
胃肠
泌尿生殖器
代谢疾病
手术和医院就诊历史
过敏、皮肤（特别是对牙齿修复材料的过敏）
感染、特定感染（肝炎、HIV）
头颈部症状，包括血管瘤、鼻部或鼻窦手术和喉部或口咽部并发症

...

全身因素

患者评估

治疗指南

Edentulous

依从性

种植体治疗是一种采用各种治疗步骤的长期综合治疗，需要充分的长期治疗后护理。因此需要患者充分参与、尽力配合并遵从医嘱。因此，临床医师必须在患者评估阶段，评估患者是否能够坚持长期治疗和治疗后护理。

为了使患者充分了解为了取得长期成功应遵从的要求，临床医师应与患者讨论治疗时间和时间表，告知遵从医嘱的重要意义，并在治疗时调整行为和限制。比如讨论吸烟、临时修复体、愈合阶段的咀嚼力较差、社会生活干扰、暂时不适、发病率、治疗后可能需要佩带防磨牙托以及治疗的风险等问题。

如果临床医师不确定患者是否能够充分遵从种植体治疗的要求，可根据

患者评估

治疗指南

Edentulous

回访 - 概述

要达到良好的长期效果，必须安排定期回访控制预约。理想情况下，至少每 6 个月安排一次回访预约，对患者的总体健康、药物治疗和口腔状况进行系统的检查。根据患者的积极性和口腔卫生水平，临床医师可以考虑提高回访的频率。

是否达到了患者预期和提高了生活质量？

评估患者的总体健康、患者依从度和口腔卫生状况

由牙医、保健师或助理进行专业预防治疗。

检查修复体有无松动（脱胶、螺丝断裂或松

术后护理

问题

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