12 Patient evaluation: the patient at risk for surgery


Patient evaluation: the patient at risk for surgery

Absolute Contraindications1

ASA P5 and P6 Patients

Chemotherapies in Malignancies

The potential side-effects, including immunosuppresion and myelosuppression, prevent any dental implant surgery during the active phase of chemotherapy.


The risk of osteoradionecrosis exists, even 6 months after the treatment (Brasseur et al., 2006). Hyperbaric oxygen therapy does not seem to offer an evident clinical benefit (Esposito, 2008).

Cardiac Conditions

The most critical risk is infective endocarditis, which is a life-threatening infection. The following cardiac conditions associated with the highest risk of adverse outcomes from endocarditis prohibit any dental implant surgery:

  • Prosthetic cardiac valve or prosthetic material used for cardiac valve repair
  • Previous infective endocarditis
  • Congenital heart disease (CHD)
    • Unrepaired cyanotic CHD, including palliative shunts and conduits
    • Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first 6 months after the procedure
    • Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)
  • Cardiac transplantation recipients who develop cardiac valvulopathy.


After a transplant, patients are given immunosuppressive medications to prevent the body from rejecting the new organ. Therefore, they may have an increased risk of infection, especially during the first months when dosages are higher because of the increased risk of rejection. The dental implant surgery must be postponed, and the dental implant indication must be discussed at a later time with the specialists.

Dialysis Catheters

Catheter-related infection is one of the major causes of morbidity in dialysis patients such as those treated for end-stage renal disease (ESRD). Thus, any non-vital surgery that may potentially induce bacteremia must be postponed.

Intravenous Bisphosphonates

These are administered to patients with breast cancer, multiple myeloma, hypercalcemia of malignancy, bone metastasis in breast, prostate, lung, and other cancers. Nowadays, dental implant surgeries are contraindicated for patients who take intravenous bisphosphonates because they have been associated with the onset of bisphosphonate-related osteonecrosis of the jaws (BRONJ). The prevalence of BRONJ in patients receiving IV bisphosphonates is 5–12% (Sanz & Naert, 2009). When bisphosphonate treatment has started before dental implant placement, it has been shown that clinical signs of BRONJ may appear more than 1 year after dental implant surgery (Lazarovici et al., 2010).

Relative Contraindications

Jan 7, 2015 | Posted by in Implantology | Comments Off on 12 Patient evaluation: the patient at risk for surgery
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