Dental implants. Medical examination

Last Updated: 10.01.2024

Author: George Ghidrai, MD  

In the presence of healthy tissues, well-integrated dental implants with appropriate biomechanical loads can have long-term success rates: 93 to 98 percent for the fixture and 10 to 15 years lifespan for the prosthetic teeth.

For this, proper planning is essential. The medical examination and imaging methods allow the practitioner to devise a treatment plan that should give the implant-supported restoration a long-term success rate.

The medical examination will focus on all the essential issues, from general health conditions to local conditions, the assessment of bone support, the soft tissue structure, and the patient's oral hygiene.

The medical examination involves the medical history - an account of the symptoms experienced by the patient, followed by the physical examination.

a. Medical history

During the medical history, your healthcare provider will try to gain helpful information about your general health condition, local conditions, previous surgery, medication, allergies, and others.

This information is vital in planning for implants since some health conditions or drug use may restrict the placement of implants. For example, long-term steroid use, osteoporosis, and other diseases that affect the bones can increase the risk of early failure of implants.

The medical practitioner may ask you specific questions about factors he considers crucial in formulating the diagnosis.

• Identification and demographics - your name, age, height, and weight

• Past medical history - includes major illnesses, any previous surgery/operations, or any current ongoing disease

• Review of systems - systematic questioning about different organ systems

• Family diseases - especially those relevant to the implant treatment

• Childhood diseases relevant to the implant treatment

• Social history - including living arrangements, occupation, marital status, number of children, if you use any drugs (including tobacco, alcohol, or other recreational drugs), oral hygiene status, if you had any recent foreign travel, and exposure to various environmental pathogens.

  Patients with poor oral hygiene, heavy smokers, and diabetics are all at greater risk for a variant of inflammatory disease that affects implants called peri-implantitis, increasing the chance of long-term failures.

• Regular and acute medications - include those prescribed by doctors and others obtained over-the-counter or alternative medicine.

  For example, the use of bone-building drugs, like bisphosphonate drugs, requires special consideration with implants.

• Allergies - to medications, food, latex, and other environmental factors

History-talking may also be available in a printed set of questions you must fill in.

b. Physical examination

During the physical examination, the practitioner carefully investigates your entire oral cavity, focusing on the area needing the implant reconstruction. Specific methods are used: inspection (or visual examination), palpation, and percussion with the help of the examination tools.

dental examination tools

All key aspects are examined. Additional information will be gathered after the dental radiography and CT scan.

• Examining the remaining teeth

  Your medical practitioner thoroughly examines your remaining teeth for issues like cavities, erosion, abrasion, color changes, or other pathological conditions. X-rays might be necessary to identify if certain teeth require endodontic treatment.

  In some cases, teeth might display significant damage or chronic infections. Based on this, your dentist might opt to extract specific teeth, while others may require endodontic therapy. Prior to starting the implant procedure, all remaining teeth must receive appropriate treatment.

  
  

• Examining the bone support

  For an implant to osseointegrate, it needs to be surrounded by a healthy quantity of bone. Therefore, the bone will have to achieve an adequate width and height.

  

  Additional information about the quality and quantity of available bone is gathered after the imaging methods: dental radiography and CT scan.

  When the bone is deficient, the surgeon must reconstruct it (either before or during implant placement) using various bone grafting techniques.

  

  
  

• Examining the occlusion or bite

  The long-term success of implants is determined, in part, by the forces they have to support.

  Biomechanical forces created during chewing can be significant. Concentrated forces can result in fracture of the bridgework, implant components, or loss of bone adjacent to the implant.

  Therefore, the position of dental implants will be selected so that implants distribute forces evenly across the prosthetics they support.

  Moreover, an over-eruption (caused by teeth migration) may prevent the proper placement of dental implants and the accurate construction of the prosthetic device because of the lack of space.

  

  teeth migration may prevent
  the proper placement of dental implants

  Other conditions, like people who grind their teeth, also increase the force on implants and the likelihood of failures. It is advisable to treat all these conditions before the placement of dental implants.

  
  

• Examining the gums and soft tissue support

  For optimum success rates, an implant needs to have a thick, healthy soft tissue (gingiva) envelope around it. Soft tissue is sometimes deficient, so the surgeon must reconstruct it.

  This procedure is called soft tissue reconstruction.

  

  Various conditions that affect the oral mucosa may temporarily prevent the placement of dental implants. These conditions will be addressed before the surgical procedure.

  
  

• Examining the oral hygiene

  Proper and thorough oral hygiene is a prerequisite for successful dental implant rehabilitation. Poor oral hygiene dramatically increases the risk of failure.

  Therefore, your dentist or hygienist must help you learn good oral hygiene techniques and point out areas of your mouth that may require extra attention during brushing and flossing.

  
  

• Examining the existing restorations

  Some of your existing restorations (such as crowns or dental bridges) may need replacement. If this is the case, the quality of the abutment teeth is assessed after their removal. The treatment plan will consider restoring these areas as well.

Every dental practitioner will conduct the medical examination in their own, proven way. The steps described above are only meant to give you a general idea about the process to better understand the importance of proper planning for long-term implant success.