CLINICAL EVALUATION IN IMPLANT PATIENT

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Questions and Answers

What is the primary goal of inviting patients to bring their spouses or family members to consultation and treatment-planning visits?

To review the patient's health history

To educate the patient about realistic outcomes for each treatment option

To ensure realistic expectations for treatment outcomes

To have an independent observer in the discussion of treatment options (correct)

What is a crucial aspect of a patient's medical history that should be carefully considered in implant therapy?

History of dental anxiety

History of frequent dental cleanings

History of smoking

Any disorder affecting bone metabolism (correct)

What is a potential indication of a patient's susceptibility to infections or diabetes?

History of dental restorations

History of recurrent or frequent abscesses (correct)

History of frequent dental visits

History of dental phobia

What is the purpose of requesting laboratory tests, such as coagulation tests?

To evaluate any conditions that may affect the patient's ability to undergo surgery Signup and view all the answers

Why is it important to review a patient's dental history?

To identify potential risk factors for implant therapy Signup and view all the answers

What is the primary goal of identifying past problems in dental treatments?

To elucidate contributing factors for patient education Signup and view all the answers

What may indicate that a patient may have similar difficulties with implant therapy?

A history of dissatisfaction with past dental treatment Signup and view all the answers

What is the significance of intraoral examination in dental implant therapy?

To diagnose and treat any pathologic conditions present in the oral cavity Signup and view all the answers

What is the purpose of taking diagnostic study models in dental implant therapy?

To assess potential implant sites and evaluate available space for prosthetic tooth replacement Signup and view all the answers

What is the importance of evaluating the mesial-distal and buccal-lingual dimensions of edentulous spaces?

To plan the placement of implants and prosthetic tooth replacement Signup and view all the answers

What is the significance of orthodontic tooth movement in dental implant therapy?

To create space for implant placement and prosthetic tooth replacement Signup and view all the answers

What is the primary advantage of using mounted study models with diagnostic wax-up in dental implant therapy?

To evaluate available space and potential limitations of the planned treatment Signup and view all the answers

What is the range of implant survival rates in diabetic patients reported in the short-time group studies?

96.4% to 100% Signup and view all the answers

How many studies in the long-time group compared diabetic survival rates to a healthy population?

7 Signup and view all the answers

What is the range of relative risk for implant failure in diabetic patients reported in the studies?

2.75 to 4.8 Signup and view all the answers

What is the proportion of studies in the short-time group that had a healthy control group?

71.4% Signup and view all the answers

What is the range of time periods in the long-time group studies?

1 to 20 years Signup and view all the answers

What is the conclusion about implant survival rates in diabetic patients compared to healthy individuals?

There is no difference in implant survival rates between diabetic patients and healthy individuals. Signup and view all the answers

What is the percentage of implant failure in type II diabetic patients when CHX was not used?

13.5 % Signup and view all the answers

What is the primary reason why psychological disorders can be a contraindication to dental implant treatment?

Patient's uncooperativeness and behavioral problems Signup and view all the answers

What is the range of patients who undergo head and neck radiation and develop spontaneous or traumatic osteoradionecrosis?

3% to 35% Signup and view all the answers

What is the effect of cytotoxic anticancer drugs on granulocyte and thrombocyte counts?

Rapid granulocytopenia followed by thrombocytopenia Signup and view all the answers

What is the percentage of implant survival in non-type II diabetic patients when CHX was used?

94.3 % Signup and view all the answers

What is the primary effect of ionizing radiation and chemotherapy on the host defense mechanisms?

Disruption of host defense mechanisms Signup and view all the answers

What is a crucial factor in determining the risk of bisphosphonate-related osteonecrosis of the jaw?

Current or previous treatment with a bisphosphonate Signup and view all the answers

Which of the following is a characteristic of intravenous bisphosphonate administration?

Higher risk of osteonecrosis compared to oral route Signup and view all the answers

What is the estimated prevalence of bisphosphonate-related osteonecrosis of the jaw?

Between 1 in 10,000 and 1 in 100,000 Signup and view all the answers

What is a potential factor contributing to the increased risk of osteonecrosis of the jaw with oral bisphosphonate therapy?

Frequent prescription of alendronate Signup and view all the answers

Which of the following is a criterion for considering a patient to have bisphosphonate-related osteonecrosis of the jaw?

Exposed bone in the maxillofacial region that has persisted for more than eight weeks Signup and view all the answers

What is the significance of the duration of oral bisphosphonate therapy in relation to the risk of osteonecrosis of the jaw?

Longer duration of treatment increases the risk of osteonecrosis Signup and view all the answers

Study Notes

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.

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Description

Discussing treatment options with patients, including the importance of involving family members and managing patient expectations. Based on Perry R. Klokkevold and David L. Cochran's 2017 publication.