Treatment Planning

Treatment Planning Patient Evaluation And Selection
Several important factors must be considered when evaluating a patient prior to implant surgery. The presurgical evaluation must include a careful and detailed assessment of the patient’s general health, medical history, oral hygiene, motivation and expectations. If the patient’s medical history reveals an existing condition or signals a potential problem that may compromise treatment and/or the patient’s well being, consultation with a physician is recommended. In addition, the clinician should determine if the patient presents with an acceptable anatomical foundation that is conducive to implant placement. An extensive intraoral examination should be performed to evaluate the oral cavity for any potential bone or soft-tissue pathology. The clinician should also determine the periodontal status of the remaining teeth, the health of the soft tissue, the presence of occlusal abnormalities or parafunctional habits, such as bruxism or crossbite and any other conditions that could adversely affect the restorative outcome.

Pre-Operative Planning
Proper treatment planning includes selection of appropriate implant lengths, diameters and locations. The number of implants is a fundamental consideration for the long-term success of an implant supported restoration. Before an implant is placed, the anatomical foundation of the treatment area must be carefully assessed.

During the presurgical restorative planning phase, it is important for the surgeon, restorative dentist and laboratory technician to participate in determining the type of prosthesis and restorative components that will be used. Such decision making is critical for determining the location of implants and should be finalized prior to implant surgery. A top-down treatment planning approach is recommended, whereby the final prosthesis is designed, implant locations determined and restorative components selected prior to initiating implant surgery.

Clinical information necessary for determining appropriate treatment options includes but is not limited to: determining vertical dimension, evaluating the space available between the alveolar crest and the opposing dentition to confirm that available space exists to accommodate the proposed abutment and final restoration, locating the position of important anatomic structures and determining bone dimensions where implants are to be placed. The height required by the restorative components varies with the type of abutment. Therefore, the surgeon and restorative dentist should carefully evaluate abutment dimensions. Diagnostic casts should be used pre-operatively to evaluate the residual ridge and to determine the position and angulation of all implants. These casts allow the clinician to evaluate the opposing dentition and its effect on implant position. A surgical guide is helpful in determining the precise intraoral position and angulation of the implants and should be included in the pre-operative treatment plan.

By visualizing the final design of the prosthesis prior to implant surgery, both restorative and surgical clinicians have the opportunity to identify potential restorative problems. They can then make the necessary modifications to implant selection, location and the overall treatment plan prior to actually placing the implants, thus improving treatment predictability and success.