The pretreatment phase
The First Appointment
The patient’s chief complaint determines the main objective of the treatment and is the cornerstone of the prosthetic plan. An in-depth interview is required to identify the patient’s profile. The functional and esthetic demands are carefully documented. Patients with unrealistic demands should be excluded from implant therapy. In addition, because some implant procedures are irreversible, time-consuming, and expensive, patient compliance is required during and after implant therapy (see Appendix E).
Information is provided to the patient regarding the limitations of dental implant therapy. This information is personalized according to the patient’s medical and dental conditions. At this stage, the patient should be made aware of the overall cost of the therapy, including the surgical procedure(s), imaging, and restoration fees. The patient should also be verbally informed of the overall length of the treatment.
Panoramic radiography should be sufficient for this preliminary approach. Dental impressions are made in order to obtain diagnostic casts.
The Prosthetic Evaluation
The prosthetic evaluation should precede the surgical evaluation.
The temporomandibular joint status is carefully evaluated. Information is gathered on facial musculature and facial harmony. Attention should be paid to the masticatory muscles (hypertrophy, masticatory forces, bruxism, and parafunctions), the loss of occlusal vertical dimension, and the lip support in the frontal and sagittal planes. Esthetic evaluation of the lip–teeth relationship present in the smile, during speech and at rest is mandatory.
The clinical examination in dental implant therapy does not differ from the basic preprosthetic examination (Belser et al., 2008a,b). Special attention should be paid to the signs and symptoms of bruxism (tooth wear, indentation of the tongue, etc.).
A thorough clinical examination at the implant site evaluates the following features:
- shape of the residual ridge, including the degree of horizontal and verti/>