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Patient assessment anddiagnosis in implant

treatmentRanuch TAK ID: 555130017-3

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Objective

Analyzing available evidence on patient assessment for

implant treatment

Special consideration type Single implant

Partial edentulous

Edentulous jaw

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Introduction

Implant treatment we have to evaluate implant are indicated

Particular patient

Specific oral situation

Framework of comprehensive reconstructive tx plan

Even implant is increasing in practice

The incidence of failure also reports & lawsuits

Peri-implantitis is highly associated smoking

previous periodontal disease

Micro-organism

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Literature search strategy

Search Medline via PubMed

Implant tx – end of Septemper, 2007

Handsearch 2000 up

Inclusion criteria

Implant indications & contraindications

How to examine the implant patient

Diagnostic techniques of implant patient

Totally 20 articles from PubMed, 22 from handsearch

20 articles are selected

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Pt’s history & Implant Contra

Indication

Initial medical questionnaires

Past and current disease

Temporary/ long term medication

Smoking Special dietary features

Dental questionnaires and examination

Recurrent caries

Perio history/peri-implantitis Trauma

Insufficient bone quality

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General Contra Indication

Poor general health (required medical supervision)

Young age still in growth

Other

High risk caries

Alcoholism, smoking

ASA score

Bone diseases (osteonecrosis)

Receiving radiation, chemotherapy, biphosphonate

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Clinical examination

Extra-oral examination

Correct facial proportion (divided into 3 thirds)

Facial asymmetry

Lip and cheek support

Facial skeletal classification

Intermaxillary relation

Incisal edge position of the maxillary centrals & occlusal plane

Neurologic test of areas innervation TMJ movement

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Upper lip length

It measures from base of the column (subnasal) – philtrum in

rest and determine central incisal visible

Short length 10-15mm & 4mm incisal

Average length 21-25mm & 2 mm incisal

Long length 31-35mm & 0.25mm incisal

Smile line

Prevalence of low smile line 75%

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Intra-oral examination

Dental examination

Edentulous regions

Quality/quantity of the mucosa & contour of underlying bone

Existing prosthesis

Occlusal status & functional exam

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Aspects of tx planning

Implant tx plan should be considered during Extra & Intraexamination

Single tooth case

Related to adjacent teeth & neighboring structure

Partial edentulous case

Extraction questionable teeth

Implant-implant > implant-tooth

Edentulous case

Pt desired & expectation are priority

Speech , food entrap

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Diagnosis aids

Diagnosis wax up

Tx plan, provisional

Radiologic diagnosis Underlying vital structures

Bone quality & quantity

Study casts

Diagnosis

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Anatomic and topographic structures

Quality and quantity- Good- Insufficient but

mainly good- Poor

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Conclusion

Pt evaluation and assessment: tx planning

Advantages and disadvantages of recommended therapy

and alternative treatment are explained to the pt

Final treatment decision and informed consent are selected

by patient themselves.