6
Treatment Planning and Evaluating Implant Sites
Patient desires/perceptions regarding seeking dental implant therapy are based predominantly on the following criteria:
- Function
- Esthetics
- Success rate
- Ability to properly cleanse
Addressing these patient concerns and requirements involves several common scenarios that take advantage of the versatility of dental implants. These are discussed in Chapter 7. However, the first issue that must be addressed by the practitioner is treatment planning. With experience, the average practitioner will undertake this exercise automatically but for the less experienced dentist, Fig. 6.1 indicates the treatment planning steps that should be taken with a new patient.
The first task of the clinician when facing a new patient is a comprehensive systemic and oral health evaluation, as discussed in Chapters 4 and 5. If there are no oral or other (systemic) health issues that could adversely affect the surgical treatment of the patient, then the next task is to determine what the perceived needs and desires of the patient are seeking treatment.
The next issue to be addressed is evaluation of the implant site. The site is evaluated both radiographically and visually. Ideally, both two‐dimensional (2D) (traditional radiography) and three‐dimensional (3D) cone beam computed tomography (CBCT) are utilized. If CBCT is not available, then “ridge mapping” is a good alternative. Ridge mapping is the process of bone sounding to create a “map” of the bony structure. Both the vertical and the horizontal dimension of bone must be assessed to determine if implant therapy is practical. The basic limitation to implant placement is outlined by “the rule of 6’s.” This states that there must be 6 mm of vertical and horizontal bone. There must be 6 mm of space from mesial to distal and there must be 6 mm of inter‐occlusal space. If these criteria are not met, bone augmentation can be performed.