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Dental implants. Medical examination

author icon By Dr. George Ghidrai

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 year lifespan for the prosthetic teeth.

For this, proper planning is essential. The medical examination and the imaging methods allow the practitioner to devise a treatment plan that will give the implant supported prosthesis the best prognosis.

The medical examination will have to focus on all the important issues, from general health conditions to local conditions, the assessment of bone support, the soft tissue structure etc.

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

Medical history

The medical history is a discussion with the patient, during which the physician tries to gain useful information about the patient general health condition, local conditions, previous surgery, medication, allergies and others.

This information is important in planning for implants since some health conditions or drug use may contraindicate or 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 doctor may ask specific questions about various factors he considers important in formulating the diagnosis.

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

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

  • Review of systems - systematic questioning about different organ systems

  • Family diseases - especially those relevant to the implant treatment

  • Childhood diseases - mainly those relevant to the implant treatment

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

    Those 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 bisphosphonates drugs require 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 that patients have to fill in.

Physical examination

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

All the important aspects are examined. Additional important information is obtained after a dental radiography and/or a CT scan.

  • Examining the remaining teeth

    The practitioner investigates the remaining teeth for cavities, erosions, abrasion, color changes or other pathological conditions. A dental radiography may be indicated.

    It is important to determine whether the teeth are healthy or endodontic therapy is required. It is possible that some of the teeth show advance damage and/or chronic infections and can no longer be treated.

    It is advisable to perform the extractions before the treatment plan is devised. This way, all missing teeth will be restored with the implant supported prosthesis.

  • 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.

    bone loss after extraction bone loss after extraction bone loss after extraction

    Additional information about the quality and quantity of bone are gathered after a dental radiography and/or CT scan.

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

    bone graft and dental implant bone graft and dental implant bone graft and dental implant

  • 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 the implant.

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

    Besides that, 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 proper placement of dental implants

    teeth migration may prevent
    proper placement of dental implants

    Other conditions, like people who grind their teeth also increase the force on implants and increase 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

    In order for an implant to survive long-term, it needs to have a thick healthy soft tissue (gingiva) envelope around it. Sometimes, soft tissue is deficient, so the surgeon needs to reconstruct it (soft tissue reconstruction).

    soft tissue grafting for dental implants

    There are various diseases of the oral mucosa that temporary prevent the placement of dental implants. The treatment will be conducted before the surgical procedure.

  • Examining the oral hygiene

    Proper and thorough oral hygiene is a prerequisite for successful dental implant rehabilitations. A poor oral hygiene greatly increases the risk of failure.

    Therefore, it is important that the dentist or hygienist help patients learn good oral hygiene techniques and point out areas of the mouth that may require extra attention during brushing and flossing.

  • Examining the existing prostheses

    Some of the existing prostheses may need replacement. If this is the case, after their removal, the quality of the abutment teeth is assessed. The treatment plan will consider restoring these areas as well.

Last review and update: February 2019

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