Dental implants. The treatment plan

Last Updated: 10.01.2024

Author: George Ghidrai, MD  

Planning for dental implants is probably the most crucial step of the entire treatment. Depending on the case's complexity, several medical professionals may be involved in this stage.

• Oral surgeon - a specialized practitioner who will place the implants inside the jawbone and perform any additional surgical procedures
• Prosthodontist - the physician in charge of the prosthetic phase and the general design of the prosthetic restoration
• Gnatologyst - in charge of creating a functional occlusion to help distribute the chewing forces evenly across the implant-supported reconstruction
• Dental technician - usually with specific training in the field of implantology
• Physicians of other specialties

Modern computer software is also available for highly accurate planning.

An accurate treatment plan will positively impact the implant fixtures' success rate and the prosthetic device's lifespan.

When the treatment plan is designed, all the information gathered during the medical examination and the imaging methods will come together. Moreover, other important factors will have to be considered:

• the dental clinic's facilities and technological equipment: some implant designs need cutting-edge technology that might not be available in every location
• patient preferences for a particular type of restoration; for example, some people prefer to have fixed (permanent) crowns and bridgework instead of removable ones
• patient's financial situation; sometimes, patients cannot afford a particular solution
• available time; many times, an implant restoration needs more time to be completed (up to 6 months), and patients should be available for a various number of appointments
• medical practitioners preferences: most practitioners will opt for proven therapeutic solutions that were successful on other patients treated in the past
• other factors may also be involved; remember that the available therapeutic solutions may be very different depending on the geographic area

What are the main steps in devising the treatment plan?

The treatment plan will address all essential issues. Once completed, the patient will be aware of all the procedures required to finalize the implant-supported restoration.

a. General considerations

Some severe general health conditions absolutely preclude placing implants, while other situations are evaluated on a case-by-case basis.

In such situations, your doctor may recommend an appointment to a specialist physician (depending on the medical condition, this may be a cardiologist, an oncologist, or another specialized health care provider).

b. The treatment of all existing mouth conditions

Before any surgical procedures, all structures inside the mouth cavity should be adequately treated.

• The treatment of teeth decays
• The treatment of gingivitis, periodontal disease, and any other soft tissue conditions
• Endodontic therapy for teeth with chronic infections
• Professional dental cleaning and scaling
• Removal of the teeth that can no longer be treated

c. Selecting the type of implant-supported prosthesis

The final prosthetic can be either fixed, where a person cannot remove the teeth from their mouth, or removable, where they can remove the prosthetic.

Where the prosthetic is fixed, the dental crown or bridge is attached to the abutments with either lag screws or cement. Where the prosthetic is removable, a corresponding adapter is placed in the prosthetic so that the two pieces can be secured together.

d. Selecting the number of implants and the type and position of each dental implant

Planning the position and number of implants is key to the long-term health of the prosthetic since biomechanical forces created during chewing can be significant.

Number

The number of implants directly depends on the type of prosthetic restoration. Normally, a removable denture needs fewer supporting implants than a fixed denture (although this is not a general rule).

Position

Dental implants have no periodontal ligament; hence, there is no sensation of pressure when biting. Consequently, the forces created are higher.

To offset this, the location of implants must distribute forces evenly across the prosthetics they support. Concentrated forces can result in fracture of the bridgework, implant components, or loss of bone adjacent to the implants.

Implants' ultimate location is based on both biological (bone type, vital structures, health) and mechanical factors. Implants placed in thicker, stronger bone ( e.g., the front part of the bottom jaw) have lower failure rates than implants placed in lower-density bone (such as the back part of the upper jaw).

When a more exacting plan is needed, the dentist can make an acrylic or plastic guide called a guidance stent. The guidance stent is manufactured prior to surgery and guides the optimal positioning of the implants.

The stent can be made following the computerized planning of a case from the CT scan.

Type

Dental implants and abutments come in a wide range of sizes and shapes. The practitioner will select the implants and the abutments that best fit the clinical application.

Most often, larger implants (and artificial abutments) are selected for the back part of the mouth due to the increased chewing forces (although this is not a general rule).

The length and diameter of dental implants ultimately depend on the bone structure and the type of prosthesis that is planned.

e. Planning the adjunctive surgical procedures

For an implant to osseointegrate, it needs to be surrounded by a healthy quantity of bone. Moreover, a band of strong, attached gingiva is required to keep the implant healthy in the long term.

When bone or soft tissue is deficient, adjunctive surgical procedures are performed to increase the amount of bone or reconstruct the soft tissues surrounding the implant.

Some clinical situations will not require adjunctive procedures. However, when the case calls for such procedures, they are essential for long-term success.

Usually, adjunctive procedures are performed before the main implant procedure, although in some situations, these may be performed during implant placement. While there are many types of adjunctive procedures, these are the most common:

• Sinus lift - is a standard surgical procedure that aims to provide sufficient bone under the maxillary (upper jaw) sinus for dental implant placement.

• Bone grafting - is a surgical procedure that replaces missing bone with material from the patient's own body, an artificial, synthetic, or natural substitute.

  In the case of dental implants, bone grafting is used to increase the amount of bone in the jaw to help with the best positioning of dental implants.

• Soft tissue reconstruction (or gum graft) - is a generic name for any of a number of surgical procedures whose combined aim is to cover an area of exposed tooth root surface or dental implant with grafted oral tissue.

• Alveolar nerve repositioning - is a surgical procedure whereby the course of the inferior alveolar nerve is redirected to allow the placement of dental implants in a mandible with extensive resorption of the posterior ridge.

Lastly, every procedure is precisely scheduled, and all essential details are clarified.

Sinus lift   >> <<  CT scan, dental X-ray