CHAPTER 2
Assessment
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2.1 INTRODUCTION
Successful outcomes in dental implantology necessitate the realistic management of the usually high expectations of patients for dental implant treatment. These expectations are fundamentally related to an improvement in function, aesthetics and longevity. The objective of the dental implant treatment is to replace the missing/failing teeth with prostheses that restore function as well as dental aesthetics. To provide consistently predictable and satisfactory treatment outcomes of the highest standard, the dental team is required to perform a highly skilled assessment and examination process, including diagnostic imaging and other investigations, before formulating the most suitable treatment plan to meet the needs and expectations of each individual patient [1]. The treatment plan should consider the systemic and local condition of the patient, the clinician‐ and patient‐related risk factors, the patient’s wishes and desires, as well as the prosthodontics, occlusal, aesthetic and long‐term maintenance requirements of the case (Figure 2.1) [2] (B).
FIGURE 2.1 Treatment plan decision‐making tree for implant dentistry. The patient‐, implant‐ and clinician‐related risk‐factors are considered together with the current evidence to formulate the best treatment for the patient. Careful evaluation of the risk factors and formulation of treatment strategies to mitigate these are essential for delivery of the highest standard of treatment with good long‐term prognosis.
It should be noted that any primary dental disease needs to be assessed, diagnosed and managed prior to embarking on dental implant surgery [3].
2.2 DENTAL HISTORY
| Aspirational | Basic | Conditional |
|---|---|---|
| Evaluate the reason for seeking treatment for tooth replacement and the importance of aesthetics, function and psychological factors. (ii) | Ascertain the patient’s main complaint in their own words. (i) | Question if the patient is aware of grinding and clenching habits or bruxism. (ii) |
| Evaluate, in the patient’s own words, their wishes, hopes and expectations regarding the outcome of treatment. (ii) | Obtain accurate and relevant social and dental histories. (i) | Liaise with the patient’s doctor when medical history necessitates further information (e.g haemoglobin a1c results). (i) |
| Determine if the current dental condition is affecting speech, eating habits, chewing and social life. (i) | Obtain the specific history of any cardiovascular, haematological, respiratory, renal and liver disorders, as well as immunosuppression. (i) | Obtain the history of any sinus diseases. (ii) |
2.3 MEDICAL HISTORY
| Aspirational | Basic | Conditional |
|---|---|---|
| Assess the influence of systemic disease or related conditions on the maintenance of oral health and delivery of treatment. (i) | Obtain a written medical history and record the contact details for the patient’s GP. (i) | Evaluate medically compromised patients and discuss their dental management with their GP or medical specialists. (i) |
| Assess if the patient’s physical condition may restrict the delivery of prolonged or multistage surgical and restorative treatment or any further remedial treatment that may be necessary if complications were to arise. (i) | Analyse the patient’s written medical history and determine their general fitness and health (e.g. ASA classification). Check for any medical devices (e.g. pacemakers) or prosthesis or body parts. (i) | Obtain details of any specialist treatment the patient may currently be receiving. (i) |
| Check allergies to medicines and medical products such as latex. (i) | ||
| Obtain a full list of the patient’s medication and analyse the impact on the proposed treatment, including any drug interactions. (i) | ||
| Obtain a history of recent illnesses and operations and evaluate potential problems, including bleeding and bruising tendency. (i) | ||
| Question the patient’s smoking habit, alcohol use and use of any recreational drugs. (i) | ||
| Obtain a list of any non‐medicinal allergies (e.g. nickel). (i) |
2.4 INTRAORAL AND EXTRAORAL EXAMINATION
Intraoral and extraoral examinations are important components of dental care, especially in cases where a patient is considering dental implant treatment. Dental implants require careful planning and assessment to ensure their success [2–4].
During an intraoral examination, the dentist will examine the patient’s teeth, gums and other structures inside the mouth to determine if they are suitable for dental implant treatment. They will check for the presence of tooth decay, gum disease or other issues that could affect the success of the implant.
An extraoral examination is also important in assessing the suitability of dental implant treatment. The dentist will examine the jawbone and surrounding structures to ensure that they are healthy and strong enough to support the implant.
By performing both intraoral and extraoral examinations, the dentist can create a comprehensive treatment plan that takes into account the patient’s individual needs and circumstances. This includes selecting the appropriate type of dental implant, determining the optimal location for the implant and assessing the overall health of the patient’s mouth [4–7].
Intraoral and extraoral examinations are crucial for successful dental implant treatment planning. They help dentists identify potential issues that could affect the success of the implant and allow them to develop a customized treatment plan that is tailored to the patient’s needs. By undergoing regular dental examinations, both intraoral and extraoral, patients can ensure the long‐term success of their dental implant treatment.
Dental charting is a crucial aspect of dental implant treatment planning because it provides dentists with a comprehensive understanding of a patient’s dental health status. The process involves documenting the condition of the patient’s teeth, gums and other oral structures using a dental chart, which helps dentists and dental hygienists keep track of any existing dental problems or issues that could impact the success of the implant treatment (Figure 2.2).
During dental implant treatment planning, dentists use dental charting to identify areas of concern and create a customized treatment plan tailored to the patient’s needs. By measuring the depth of each tooth’s gum pockets, recording any signs of decay, cavities or gum disease, and noting any previous dental work done, dentists can assess the suitability of the patient for dental implant treatment and identify any potential issues that could affect the success of the implant.
FIGURE 2.2 Sample dental chart showing the detailed documentation of a patient’s dental health status.
Effective communication between dental professionals is crucial in dental implant treatment planning, with dental charting playing a key role. Detailed documentation through dental charts allows for the clear sharing of a patient’s dental health status among the dental team. This ensures that all professionals involved in the implant treatment are informed and aligned, which is essential for creating a customized treatment plan that maximizes the success of the implant and leads to better patient outcomes.
| Aspirational | Basic | Conditional |
|---|---|---|
| Record smile and lip line. (ii) | Perform and record a comprehensive extraoral examination, including the temporomandibular joint (TMJ) apparatus and muscles. (i) | Check palatal vault height and denture‐bearing area morphology if applicable. (ii) |
| Record smile and lip line. (ii) | Record TMJ findings such as mouth opening, muscle tenderness, pain, clicks, crepitus and deviation on opening/closure. (i) | Check condition, stability and retention of partial dentures. (ii) |
| Record the presence of any facial weakness, neurosensory disturbances or facial asymmetry. (ii) | Check head and neck lymph glands. (i) | |
| Carry out full‐mouth six‐point periodontal charting and examination, including tooth mobility and bleeding. Assess plaque control and general oral hygiene and periodontal health. Record gingival recession values. (i) | Perform a full‐mouth charting and evaluate the general condition of existing restorations and teeth. Record the status of adjacent natural teeth. Determine the strategic value of each tooth and quantify the prognosis of compromised teeth (e.g. heavily filled, periodontally involved). (i) | |
| Carry out a full occlusal examination. Record centric occlusion, any slide from retruded contact position, static and dynamic occlusal contacts, anterior and canine guidance, excursions, and working and non‐working side interferences in lateral excursions. (i) | Assess and diagnose any existing pulpal disease or endodontic conditions that may warrant investigation, treatment or referral to a specialist. (i) | |
| Check and record alveolar bone atrophy. (ii) | Assess hard and soft tissue abnormalities and diagnose primary dental disease or other conditions that may require investigations, treatment or referral to another colleague or a specialist. (i) | |
| Check soft tissue morphology and exclude the presence of any soft tissue pathology. (ii) | Assess the patient’s oral hygiene and their ability, motivation and commitment to promote the necessary improvements. (i) | |
| Check muscle attachments and sulcus depth. (ii) | Assess and record dental, skeletal and occlusal relationships. (i) | |
| Record the quality and quantity of gingival tissues. (ii) |
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