Diagnosis and

Treatment Planning of
Implant Patient

Dr. Gotam Das

F.C.P.S;
Assistant Professor Prosthodontics
AS08951.ppt
 Content
 Pretreatment evaluation
 Medical & Dental history

 Clinical examination

 Radiographic examination

 Osseointegration

 Parts of Implant

 Conclusion

AS08952.ppt
Pre Treatment Evaluation

Chief complaint:
 Patient’s concern

 Patient’s expectation

AS08953.ppt
 Medical History
 Thorough medical history should be
documented.
 Review for conditions that might pose
a risk for adverse
reactions/complications.
 Laboratory tests to rule out conditions
that might be contraindication/risk
factor.
 Medical clearance from treating
physician. AS08954.ppt
 Habits and Behavioral Considerations
 Smoking & tobacco use
*Adversely affects implant success through
its effect on bone metabolism
 Para functional habits

* Repeated lateral forces can be detrimental

to osseointegration process.
 Substance abuse

* Psychological problems, non

compliance
* Impaired organ function
AS08955.ppt
 Dental History

 Oral hygiene status and

practices
 Compliance with past dental
recommendations
 Previous experience with
surgery and prosthetics
 Attitude and motivation
towards implants
AS08956.ppt
 Clinical Examination
 Facial proportions
 Facial symmetry
 Facial convexity
 Lip and cheek support
 Intermaxillary relation
 Lip length and incisal show
 TMJ condition

AS08957.ppt
 Intraoral Examination
 Infections , lesions and
pathologic conditions
 Overall dental & periodontal
health
 Occlusion
 Jaw relation
 Mouth opening

AS08958.ppt
 Soft Tissue Evaluation
 Quality( keratinized/ non keratinized)
 Quantity

 Location

 Frenum attachments

AS08959.ppt
 Hard Tissue Evaluation
 Clinically and radiographically
 Palpate for anatomical defects, concavities and

undercuts
 Bone mapping

AS089510.ppt
Model of lower, sectioned at the center and mapped

AS089511.ppt
 Evaluation of Implant Sites
 Alveolar bone
 Atleast 1.0 to 1.5mm of
 bone around implant
 Interdental space
 Tooth-implant 1.5mm

 Implant-Implant 3mm

 Buccolingual width > 6mm

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Interocclusal Space

AS089513.ppt
 Diagnostic Study Models
 Evaluate space available
 Determine potential limitations of planned treatment
 Useful while replacing multiple teeth or in case of
malocclusion.

AS089514.ppt
Evaluate study model for ridge width, alignment of adjacent
teeth, if a dental implant can be placed using
uncomplicated techniques.

AS089515.ppt
Radiographic Examination
 Quality, quantity and location and volume of alveolar
bone
 Identify vital structures: floor of nasal cavity, maxillary
sinus, mandibular canal, mental foramen
 Radio opaque markers can be used to evaluate
relation of alveolar ridge to existing teeth

AS089516.ppt
 INDICATIONS ADVANTAGES LIMITATIONS
PERIAPICAL Small edentulous Low radiation dose ; Minimal site
RADIOGRAPHY spaces, alignment inexpensive evaluation; distortion
and orientation & magnification
during surgery

OCCLUSAL none Evaluation of Does not reveal true

RADIOGRAPHY pathology buccolingual width:
Difficulty in
positioning

CEPHALOMETRIC Used with other Low magnification; Limited to midline;

RADIOGRAPHY radiographs for Height/width in reduced sharpness
anterior implants anterior region & resolution

PANORAMIC Commonly used Initial assessment of Distortion; does not

RADIOGRAPHY vertical bone height; demonstrate bone
Gross anatomy & quality
pathology evaluation

COMPUTED Determination of Negligible Cost; technique

TOMOGRAPHY bone density; vital magnification; high sensitive
structure location; contrast image; 3D;
determination of Various views
pathology AS089517.ppt
 Bone Density – A Key Determinant for
Treatment Planning

 Available bone is particularly important in implant

dentistry and describes the external architecture or
volume of the edentulous area considered for
implants.
 The internal structure of bone is described in terms of
quality or density - biomechanical properties like
 Strength

 Modulus of elasticity

AS089518.ppt
 Bone Classification
Lekholm and Zarb’s four bone qualities for the
D1
jaws:
 Quality 1: Composed of homogenous
compact bone D2
 Quality 2: Thick layer of cortical bone
surrounding dense trabecular bone.
D3
 Quality 3: Thin layer of cortical bone
surrounded by dense trabecular bone of
favorable strength. D4
 Quality 4: Thin layer of cortical bone
surrounding a core of low-density trabecular
bone. AS089519.ppt
Bone Density Classification by Misch & Judy
Bone Density Description Tactile Analog Typical Anatomical
Location

D1 Dense Cortical Oak or maple wood Anterior mandible

D2 Porous cortical and White pine or spruce Anterior mandible

coarse trabecular wood Posterior mandible
Anterior maxilla

D3 Porous cortical (thin) Balsa wood Anterior maxilla

and fine trabecular Posterior maxilla
Posterior mandible

D4 Fine trabecular Styrofoam Posterior maxilla

D1 D2 D3 D4 AS089520.ppt
 Laboratory Tests
 Complete blood count
WBC- 4,000 to 11,000 cells/mm3
RBC- 4-6 million/mm3
Platelet- 1,50,000- 4,00,000cells/mm3
MCV- 80-100 fL
MCHC- 32 to 36 g/dL
hemoglobin- 11- 16 g/dL
 Prothrombin time- INR (normal range- 0.8 to 1.2)

 Glycemic control- HbA1c (4 to 6%)

 Thyroid function tests- T3- 60 to 175 µg/dl

T4- 4-11 ng/dl

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 Osseointegration

“A direct structural and functional connection

between ordered living bone and the surface
of a load carrying implant”
P-I Branemark

AS089522.ppt
 Osseointegration
(A) Hematoma occurs near screw threads

(B) After 3 weeks – Osteoblasts begin forming spongy bone

(C) After 4 months – spongy bone replaced by compact bone
Lamellar bone – strongest type of bone, most desired next
to implant
(D) Osseointegration failure

AS089523.ppt
Factors Affecting Osseointegration

1. Implant biocompatibility
2. Implant design
3. Implant surface
4. Implant bed
5. Surgical technique
6. Loading condition
AS089524.ppt
 1. Implant Biocompatibility
Materials used are:
1. Cp titanium (commercially pure titanium)
2. Titanium alloy (titanium-6aluminum-
4vanadium)
3. Zirconium
4. Hydroxyapatite (HA), one type of calcium
phosphate ceramic material
5. Plasma sprayed coating

AS089525.ppt
2. Implant Design (root-form)
 Cylindrical Implant
 Threaded Implant

Threaded implants have demonstrated maintenance of a

clear steady state bone response.
To enhance initial stability and increase surface contact,
most implant forms have been developed as a serrated
thread.

AS089526.ppt
 3. Implant Surface
The Pitch is the number of threads per unit length, is an
important factor in implant osseointegration.

Reactive implant surface by anodizing (Oxide layer) , acid

etching or HA coating enhanced osseointegration

AS089527.ppt
 5. Surgical Technique
Minimal tissue violence at surgery is essential for proper
osseointegration.
 Careful cooling while surgical drilling is performed at low
rotatory rates, temp <43 degree C
 Use of sharp drills
 Proper drill geometry is important, as intermittent
drilling.
 The insertion torque should be of a moderate level
because strong insertion torques may result in stress
concentrations around the implant, with subsequent
bone resorption.

AS089528.ppt
 6. Loading condition
 Delayed loading:
1. A tow-stage surgical protocol
2. One-stage surgical protocol

 Immediate loading:
1. Immediate occlusal loading (placed within
48 hours postsurgery)
2. Immediate non-occlusal Loading (in
single-tooth or short-span applications)
3. Early loading (prosthetic function within two
months) AS089529.ppt
 Parts
of
Implant
AS089530.ppt
AS089531.ppt
 Implant Body Regions
3 parts
1. crest module ( cervical geometry )
2. body
3. apex

crest module ( cervical geometry )

body

apex
AS089532.ppt
 Prosthetic Attachment
Abutment
portion of the implant that supports or retains a prosthesis
or implant superstructure
Superstructure
metal framework that attaches to the implant abutment
and provides either retention for removable prosthesis
or framework for fixed prosthesis

prosthesis
superstructure

abutment

Implant body
AS089533.ppt
 Categories of Implant Abutment

Based on method by which prosthesis or

superstructure is retained to the abutment

1. Screw retention

2. cement retention

3. for attachment
• attachment device to retain a removable
prosthesis AS089534.ppt
 Conclusion

 The success and predictability of

dental implants have changed
philosophy and practice of dentistry.
 However, proper pre treatment
evaluation, and a treatment plan are
imperative for its success.

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