DEN 7226L Implant Tx Planning

Assignment
• This course includes one implant treatment planning assignment.
The date for the assignment is set and included in the syllabus. A
case-based treatment planning assignment will be assigned on the
first day of the course. Each student will complete a power point
presentation using the competency format for implant treatment
planning on a case unique to them from their own patient pool. No
patient identifiers are to be placed on the presentation. This
assignment will be due on July 22, 2019 by 8am. Faculty will grade
each case using the rubric posted on Canvas.
 Grading Criteria for Class Assignment and Final
 Medical conditions related to implant success
 Medications related to implant success
 Risks and possible interventions discussed with patient
 Hygiene level assessment
 Patient expectations assessed
 Patient understands financial obligations
 Patient prognosis/commitment to re-care assessed for:
 Risks, benefits, alternatives, prognosis
 Radiographic interpretation 2D/3D
 Mounted models and photos
 Charting (Restorative/Periodontal)
 Occlusal & space analysis
 Periodontal assessment of overall periodontal health
and conditions of soft tissue for planned implant site
 Prosthodontic wax-up or set-up
 Implant site modification recommendations
 Implant placement recommendations
• Each of the following criteria should be adequately
documented and assessed in the assignment.
• The criteria will be graded on a scale of 1-4 with the following
guidelines:
– 4: Outstanding –- assessment and treatment plan are
accurate , appropriately sequenced and well-planned
– 3: Satisfactory – assessment and treatment plan is correct
but not outstanding, meets basic protocol for implant
planning
– 2: Marginal – assessment and treatment plan are
incomplete but safe
– 1: Unsatisfactory – assessment and treatment plan are over-
or underdiagnosed, are incorrect, and potentially harmful
• The assignment will receive one grade:
– 1: Instructor evaluation
• The final will be an open-ended treatment planning
assignment graded under the same criteria by course
instructors – See Example Case
NAME:___________ Medical Hx and Risks and possible Hygiene level Patient prognosis/ Radiographic Photos and Periodontal and Implant site modification Implant placement
SID: _____________ Medications interventions assessment commitment to care interpretation models Restorative assessments recommendations recommendations
DEN 7442 _______/4 and recommendations
Assignment Rubric _______/4 _______/4 _______/4 _______/4
Total:______/36 _______/4 _______/4 _______/4 _______/4

4 The assessment of Assessment of the risks Assessment of the Assessment of patient Assessment of Photos AND Periodontal and Implant site modification Implant placement
Outstanding the patients and need for additional patients hygiene is implant prognosis and radiographs is models are restorative assessments recommendations are recommendations are
medical conditions interventions is accurate, commitment to care is accurate and present and are accurate, appropriate accurate, appropriate and accurate, appropriate and
and medications accurate, appropriate appropriate and accurate, appropriately complete with findings from recommendations have justified by the observed justified to the observed
are appropriate, and comprehensive. comprehensive – assessed and well- respect to the photos and been made and clinical findings. clinical findings and
an assessment of will include an documented. implant treatment models are sequencing with respect correlate well with the
the medical implant recall plan. discussed as to implant treatment is overall treatment plan.
conditions as they plan. they relate to well-planned.
relate to implant implant
success are treatment
reported planning.

3 Assessment of Assessment of the risks Assessment of the Assessment of patient Assessment of Photos and Periodontal and Implant site modification Implant placement
Satisfactory medical conditions and need for possible patients hygiene is implant prognosis and radiographs is models are restorative assessments recommendations are recommendations are
and medications is interventions meets correct and meets commitment to care is correct but not present but and recommendations are correct and meet basic correct and meet basic
correct, meets basic protocol but may basic protocol but correct but may not be outstanding, meets findings are not correct but may not be protocol. protocol.
basic protocol but not be comprehensive plan for implant comprehensive. basic protocol but well-discussed comprehensively
may not be as it relates to implant maintenance may may lack as they relate to assessed with respect to
comprehensive as treatment. not be comprehensive implant implant treatment plan.
it relates to comprehensive. assessment as it treatment
implant success relates to the planning.
implant treatment
plan.

2 Assessment of Assessment of risks and Assessment of Assessment of patient Assessment of Incomplete data Periodontal and Implant site modification Implant placement
Marginal medical conditions need for interventions hygiene is implant prognosis and radiographs is collection – restorative assessments recommendations are recommendations are
and medications is are incomplete but incomplete but commitment to care is incomplete but safe missing one and recommendations are incomplete but safe. incomplete but safe.
incomplete but safe. safe, a plan for incomplete. with respect to (either photos incomplete but safe.
still safe implant implant treatment or models) –
maintenance is plan. Appropriate
not included. assessment
made as it
relates to
implant
treatment
planning.

1 Assessment of the Assessment and Assessment of Assessment of Assessment of Missing photos Periodontal and Implant site modification Implant placement
Unsatisfactory medical conditions treatment plan are oral hygiene and prognosis and radiographs is AND models; or restorative assessments recommendations are recommendations are
and medications over- or plan for implant commitment is excessive, lacking, assessment of are over- or over- or underdiagnosed, over- or underdiagnosed
are over- or underdiagnosed, are maintenance is inappropriate or incorrect or photos and underdiagnosed, incorrect incorrect or potentially or potentially harmful.
underdiagnosed, incorrect and over or under- incorrect. potentially harmful. models as they or potentially harmful. harmful.
incorrect or potentially harmful. diagnosed, relate to
potentially harmful incorrect or implant tx
potentially planning is
harmful. incorrect or
potentially
harmful.
Treatment Planning Case Example

PATIENT: MR. BIKE ACCIDENT

 Patient Information
• 26 y/o male patient, South Indian descent,
presents to clinic with the CC:
– 7/21/14: “I lost my front teeth in an accident.
I have a partial denture right now, I want
implants.”
• HxCC:
– Pt lost front teeth in Oct. 2013 due to hit and
run accident on bicycle – pt was struck by
vehicle
• Was in coma for several days
• Currently in metal framework RPD on max and
mandible fabricated in UG clinic
• Restorative: Dr. Xuan Yue, Grad
Prosthodontics
• Pt denies pain or discomfort at this time
 Medical and Dental History
• Medical Problems: – Floss: 3-4x/week
– None – Daily Fluoride Rinse
• Medications: • The patient understands that implant tx will take time
– None and is cooperative.
• Allergies: NKDA – Informed and aware that several surgeries may be
needed
• BisPhos Hx: Denies
• FamHx:
– HTN: Father
– Diabetes: Father
• Psychosocial:
– Single, 0 chidlren, Motel Assistant at Parent’s Motel
– Denies any hx of tobacco, EtOH, Drug abuse
• Parafunctional Habits: Denies
• Dental History:
– Regular care throughout life
– Last Cleaning – 6/2015
• Oral Hygiene:
– Brushing: 2x/day, Soft manual toothbrush
Clinical Exam
• Extra-Oral Evaluation
– TMJ WNL, (-) MoM tenderness, (-) lymphadenopathy
• Intra-Oral Evaluation
– (-) CA screening, average biotype
– Missing teeth: #1, 8, 9, 16, 17, 22, 23, 24, 32
– Occlusion: Class III, Skeletal Class III
• Periodontal Exam:
– PPD: Gen 2-3 mm, loc 4 mm
– BOP: Minimal, loc
– Mobility: (-)
– Generalized gingival health, loc mild inflammation
– Localized reduced KAT #8-9 w/ high frenum attachment
• Restorative+Radiographic Exam:
– No caries or recurrent decay detected
– Existing composite restorations present on: #14, #19
– #7: Localized widening of PDL, pulp shows no response
– #10: PARL, pulp shows no response
FMX
 10 mm
18 mm 16 mm

10 mm
Edentulous Space Measurements
Considering these clinical and
radiographic findings, how would you
diagnose and treatment plan the UA
edentulous site for this case?
 Diagnoses
• ASA I
• Partial edentulism
– Missing #8, 9, 22-24
• #7: Pulpal necrosis, Chronic peri-apical periodontitis
• #10: Pulpal necrosis, chronic peri-apical periodontitis
• Generalized gingival health
– Localized plaque-induced gingivitis
• Localized acquired mucogingival deformity, #8-9
– Reduced KAT with crestal frenum attachment
• Class III malocclusion
 Treatment Plan
• Planned final restorations: Splinted FDPs
• RCT #7, #10
• FGG UA (8 wks)
• GBR UA (4-6 months)
• Implants #8, #9 (2-stage, 4 months)
– Possible need for additional GBR at time of implant placement
• 2nd stage procedure: #8, 9
• Additional soft tissue graft PRN
What additional diagnostic criteria would
you need to better tx plan this case?
• Mounted models?
• 3D imaging?
• Prosthodontic/Restorative consult?
Pano – November 2014
Initial CBCT
Initial CBCT
After evaluating these 3D imaging,
would you change your treatment
plan?