1、Patient Assessment and Treatment-Planning,Department of Implantology Guanghua College of Stomatology Sun Yat-sen University Hu Xiao- wen,Clinical Assessment,The first part of the assessment To define the patients requirements and expectations. Unrealistic expectations need to be identified and discu

2、ssed.,particularly important when significant hard and soft tissue has been lost. when the placement of multiple implants is critical to a successful aesthetic outcome.,Medical History,A full medical history is taken. In addition to the usual contraindications for surgery, it is important to pay par

3、ticular attention to the following: smoking uncontrolled diabetes facial pain psychological problems,Medical History,Smoking In patients that smoke, failure rates are considerably higher , with the probability that the failure rate increases with the extent of smoking.,Medical History,The risks need

4、 to be evaluated and carefully explained to the patient. Ideally he or she should be encouraged to stop smoking.,Medical History,Diabetes Implants can be placed in patients with diabetes if the condition is controlled. Uncontrolled diabetes should be stablised before contemplating implant placement.

5、,Medical History,Facial Pain Particular care must be taken with patients suffering from “atypical facial pain”, as an implant may become a focus for this pain, leading to an intractable problem,Medical History,The origin of any facial pain needs to be carefully diagnosed, with specialist help as app

6、ropriate,Medical History,Psychological Problems The suitability of patients with psychological disorders needs to be assessed most carefully before agreeing to proceed with treatment.,Dental History,A full dental history is essential. includes detailed extra- and intraoral examination Special attent

7、ion needs to be paid to progressive periodontal disease, active caries and destructive parafunctional activities.,Dental History,For Example If split roots, typically relating to post crown, are present these tend to be associated with rapid bone loss and should be removed as a matter of urgency to

8、preserve a possible implant site,Clinical Examination,Extraoral A full extraoral examination should be carried out , with particular attention being paid to the following: temporomandibular jionts(TMJ) and muscles of mastication facial profile and lip support smile line,Clinical Examination,The TMJ

9、and muscles of mastication are examined for anatomical abnormalities, signs of dysfunction and pathology.,Clinical Examination,The facial profile and lip support, with and without any existing denture, need to be carefully evaluated and any atypical features noted.,Clinical Examination,The smile lin

10、e relates to the level of the upper and lower lips in relation to the corresponding gingival margins.,Clinical Examination,The smile line is of particular importance in cases in which gingival defects and long teeth are included in the smile A high lip line may be demanding aesthetically,Clinical Ex

11、amination,Intraoral A comprehensive intraoral examination must be completed, with special attention to a number of general and site specific features as follows:,Clinical Examination,General features as follows: primary disease, parafunction, prognosis of remaining teeth, occlusal support and contro

12、l,Clinical Examination, Specific to site: - space-interdental and interocclusal - ridge thickness and shape,Clinical Examination, Specific to site: - nature, thickness and condition of the soft tissues - availability of bone, taking account of features such as concavities,Clinical Examination,Study

13、Casts It is invariably necessary to obtain articulated study casts to allow a well-considered treatment plan to be formulated.,Radiographic Examination,It is required to evaluate the quantity and, as best as possible, the quality of bone available for implant placement.,Radiographic Examination,It i

14、s also essential to identify and locate anatomical structures.,Radiographic Examination,The radiographs need to be accurate to allow for precise measurements to be made before implant placement.,Radiographic Examination,The structures of particular interest include: Maxilla - maxillary sinus - nasal

15、 floor - incisive canal - labial concavities.,Radiographic Examination,The structures of particular interest include: Mandible - inferior dental canal - mental foramen - lingual concavities.,Radiographic Examination,It is advisable to use a combination of radiographic views to reduce the chance of e

16、rror.,Radiographic Examination,The combination of an axial tomogram and periapical radiographs is normally sufficient for the majority of implant procedures,Treatment-Planning,Following the detailed examination and discussion of the patients wishes and expectations, decisions can be made and a treat

17、ment plan formulated.,Treatment-Planning,All options must be considered and presented to the patient, together with details of the advantages, disadvantages, risks, costs and anticipated success.,Treatment-Planning,It is felt by some that implants should be the last resort and teeth should be maintained at all costs. The high success rate of implant therapy questions this opinion.,Treatment-Planning,Once the decision to provide an implant-supported prosthesis has been taken, the case must be planned in detail to span all the necessary st