If you are considering having a dental implant, you must consult first if you are suitable for the procedure. A dental professional will help you determine if you can be a candidate for a dental implant. After understanding everything, you and your dentist will decide if to proceed or not with the implant, and if negative, the dentist will offer the best alternative according to your treatment needs. This illustrates how important interaction between the patient and the dentist is.
Patient Evaluation
A dental professional will evaluate the patient’s medical and oral health.
Systemic health conditions are considered to adversely impact dental implants, some of these conditions are:
- Diabetes
- Hemophilia
- Immunological disorders
- Lupus and lichen planus
- Malabsorption syndromes
- Osteoporosis and osteopenia
- Paget’s disease
- Polycythemia vera
- Prolonged bisphosphonate treatment
- Radiation treatment of head and neck cancer
- Rheumatoid arthritis (RA)
- Sjögren’s syndrome
- Uncontrolled diabetes
- Uncontrolled hypertension
Oral health factors in implant success or failure:
- Bone quality and availability at the implant site
- Periodontal disease
- Infection
- Rampant dental caries
- Implant placement adjacent to an existing lesion, e.g., a cyst
- Immediate implant placement if extraction necessitated by infection or periodontal disease
- Poor oral hygiene
- Patient age and gender
- Systemic or jaw osteoporosis
Oral infections hazardous to dental implants:
- Pathology at or near the implant site
- Infected tooth sockets
- Acute or chronic periodontitis
- Placement adjacent to an undiagnosed endodontically‐involved tooth
A dentist will be vigilant in checking the clinical situations of the patient, especially regarding bacterial infections, notably apical lesions, periodontal disease, and dental caries, all of which have to be addressed before undertaking any implant procedure. Although implant failure or impaired osseointegration is not inevitable, the prognosis may be compromised when it is placed adjacent to an existing lesion, e.g., a cyst, or when rampant caries or periodontal (chronic or acute) disease exists in adjacent teeth.
There are numerous risk factors for dental implant failure, these include:
- poor bone quality,
- chronic periodontitis,
- certain systemic diseases,
- smoking, and
- unresolved caries or infection.
Clinical predictors of implant success or failure include:
- implant location,
- short implants,
- acentric loading,
- an inadequate number of implants,
- parafunctional habits and
- absence/ loss of implant integration with hard and soft tissues.
The inappropriate prosthetic design also may contribute to implant failure. Nevertheless, after infection, bone quality appears to be the most important factor in implant success and failure.
Type of bone and its characteristics
- Type I Entire jaw comprises homogenous compact bone
- Type II Core of dense trabecular bone surrounded by a thick layer of compact bone
- Type III Thin layer of cortical bone surrounding a core of dense trabecular bone
- Type IV Core of low-density trabecular bone surrounded by a thin layer of cortical bone
Ideally, the patient should have Type I or Type II bone if the highest rate of success is to be achieved. A patient with Type III or IV bone is less likely to be a good candidate for dental implants. A patient suffering from osteoporosis has a greater risk for implant failure.
Immediate implant placement is justified following tooth extraction because of trauma or tooth cracking provided that there is good or satisfactory bone quality and quantity at the extraction site. Under these circumstances, placing an immediate implant should be straightforward.
The condition of the jawbone is both ages‐ and site‐specific although increased age does not affect the clinical potential for osseointegration. In contrast, the jaw site is related to osseointegration potential with such integration tending to be more successful with mandibular sites than maxillary sites.
Provided the patient meets these health criteria, the dentist can initiate a discussion of what treatment the patient wants to have and, in turn, what can be provided. Then the Dentist will inform the patient of their options and let them and their desires lead to the best treatment plan.
Patient’s factors
Clinical studies indicate that many patient factors such as age, gender, body mass index (BMI), or, indeed, the implant site, and even smoking should have a little significant impact on implant survival.
A patient’s attitude and expectations of implants might have an impact on the success of implants. A patient is unhappy and often downhearted to learn that there might be a long period between implant placement and fabrication of a restoration. The dental professional needs to assess the patient in all the aspects of placing implants so that the patient understands what the procedure involves before treatment are initiated.
Post‐placement patient factors such as poor oral hygiene, gingivitis, plaque, and calculus accumulation around the implant will trigger gingival recession around the implant. With the continued build-up of plaque and calculus around the implant, pockets will deepen, leading to bone loss. As the latter progresses, the stability of the implant will steadily decrease and might potentially lead to failure. Thus, patients who have dental implants must be encouraged to have a routine (at least six months) follow‐ups and dental hygiene appointments to avoid the accumulation of plaque and calculus around their implants.
In addition, chewing on pens or pencils and other para-functional activities, including bruxism, can overload the implant or cause lateral stresses. Lateral displacements of implants will inevitably result in the loosening of the implant, eventually failing. For this reason, patients subject to bruxism should be encouraged to wear a custom‐fitted nightguard to avoid undue stress being placed on the implant.
Please note, that the factors that do affect implant survival are often those related to the implant itself, notably length and type (cylindrical or tapered) and the surgical technique followed during placement.
The patient must agree to certain commitments during patient-dentist consultation, some of these are:
- A significant financial investment.
- Time commitment.
- Complete trust and reliance on the dentist.
- Several visits to the practice for CT scans, radiographs, impressions, etc.
- Some discomfort is possible during the osteotomy.
- A potential delay of weeks or months during osseointegration for edentulous sites.
- The need for temporization if teeth were extracted.
Conclusion
During the patient consultation, the practitioner must discuss the different treatment options as they relate to masticatory forces, cleavability, esthetics, and longevity. The patient-dentist interaction is an important aspect of any process, the patient will present motivating factors and these will help the dentist to arrive at a customized treatment plan.