CLINICAL EVALUATION IN IMPLANT PATIENT

Patient Assessment and Education

• It is essential to involve patients in the treatment planning process, and inviting their spouses or family members can add an independent observer to the discussion.
• The clinician must determine if the patient has realistic expectations for the outcome of therapy and educate them about realistic outcomes for each treatment option.

Medical History

• A thorough medical history is required to identify any conditions that may put the patient at risk for adverse reactions or complications.
• The patient's health history should be reviewed for any disorder that may impair the normal wound-healing process, especially as it relates to bone metabolism.
• Appropriate laboratory tests should be requested to evaluate any conditions that may affect the patient's ability to undergo surgical and restorative procedures safely and effectively.

Dental History

• The patient's dental history should be reviewed to identify any potential issues, such as:
  • History of recurrent or frequent abscesses, which may indicate a susceptibility to infections or diabetes.
  • Number of restorations and the patient's compliance with previous dental recommendations.
  • Current oral hygiene practices and any difficulties with past dental care.

Intraoral Examination

• The intraoral examination is essential to assess the current health and condition of existing teeth, evaluate the condition of the oral hard and soft tissues, and identify any pathologic conditions present in the maxillofacial region.
• The examination should also assess the patient's habits, level of oral hygiene, overall dental and periodontal health, occlusion, jaw relationship, and temporomandibular joint condition.

Diagnostic Study Models

• Mounted study models are an excellent means of assessing potential sites for dental implants and evaluating the available space and potential limitations of the planned treatment.

Implant Survival in Diabetic Patients

• Short-term studies (up to 1 year) show that implant survival rates in diabetic patients are similar to those in healthy individuals (100% to 96.4%).
• Long-term studies (up to 20 years) have mixed results, with some showing similar survival rates to healthy individuals, and others showing a higher risk of implant failure in diabetic patients.
• The use of chlorhexidine (CHX) at the time of implant placement can improve implant survival in type II diabetic patients.

Active Cancer Therapy

• Ionizing radiation and chemotherapy can disrupt host defense mechanisms and hematopoiesis, leading to spontaneous and traumatic osteoradionecrosis.
• Mucositis and xerostomia resulting from radiation damage can contribute to a poor oral environment.

Psychiatric Disorders

• Any type of psychological abnormality can be considered a contraindication to dental implant treatment due to the patient's uncooperativeness, lack of understanding, or behavioral problems.
• Physiologically, there is no reason to suspect that implants could not become osseointegrated in these patients, but the patient's ability to tolerate the treatment process may be problematic.

Bisphosphonate Treatment

• Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a severe side effect of bisphosphonate therapy.
• The risk of BRONJ is between 1 in 10,000 and 1 in 100,000, but may increase to 1 in 300 after an oral surgical procedure.
• Intravenous administration of bisphosphonates leads to a higher drug exposure than oral administration, and osteonecrosis related to oral bisphosphonate therapy is less common than that related to intravenous forms.