Views: 283 Author: Kaylee Publish Time: 2023-12-11 Origin: Site
There are several patient treatment choices, including bar retained dentures, overdenture implants, direct to fixture implants, and multiunit dental implants.
A well-made dental implant replacement will resemble real teeth in terms of appearance, texture, and function. It will help stabilise the remaining teeth, stop bone loss, and last for many years. Your patients' quality of life will be enhanced and premature face ageing can be avoided with the use of an overdenture or multiunit abutment.
The truth is that not all patients will benefit from a multi-unit implant abutment, even though it is a great course of treatment for some.
According to Dentsply Sirona's Ruben Gurie, an expert in implantology, "implants are not for everybody." "There are definitely situations in which it is necessary to inform the patient that an alternative course of treatment is preferable and that you are unable to place an implant."
According to Gurie, effective patient selection and assessment are essential to getting the most out of a therapy plan. He says, "You can't just say, Let's do full-mouth implants without doing a thorough assessment of the patient." "You'll succeed if you conduct a thorough pre-clinical evaluation."
If you choose the incorrect patient for a multi-implant restoration, you may be facing a disastrous outcome. For this reason, before beginning any patient's multi-unit implant abutment restoration therapy — whether it involves overdenture implants, a straightforward direct-to-fixture implant, or a more intricate implant restoration — dentists should implement a five-step patient assessment approach.
The first step in the process is to evaluate the patient's general health. First and foremost, lifestyle issues like alcohol and tobacco usage should be taken into account.
Alveolar bone repair can be altered by excessive alcohol consumption. This may worsen osseointegration and raise the possibility of implant failure. Although a patient's alcohol use may not disqualify them from therapy on its own, it is crucial to take into account their drinking patterns in relation to other health-related concerns. For instance, a patient with diabetes who consumes large amounts of alcohol might not be a good candidate for multiunit abutment procedures.
Smoking may also be problematic. It is commonly acknowledged that smoking can harm sensitive oral tissue and impede healing. Actually, using tobacco could make implant failure twice as likely. Once more, evaluate a smoker's suitability for multiple unit implant procedures in light of the other general health considerations covered below.
According to Gurie, dentists must also be aware of any underlying medical issues that could have a detrimental effect on a patient's case. He believes osseointegration issues may also arise in patients with osteoporosis.
The process by which bone growth reacts to dental implants is known as osseointegration. Inadequate osseointegration may result in deficiencies in both the structure and functionality of the bond between the implant and the growing bone. This may result in inadequate anchoring surrounding the implant, which could lead to disastrous implant failure.
However, it has been demonstrated that there is only a weak correlation between jaw decalcification and long bone decalcification associated with osteoporosis. Because of this, patients who have osteoporosis may not necessarily need to be excluded from multi-unit implant procedures, such as Hader Bar implant dentures and overdenture implants.
Patients who already have osteoporosis should still have a thorough evaluation to make sure no further extraoral or intraoral problems exist that could raise their risk factor.
Additionally, patients using anticoagulant drugs for hypertension or heart disease need to be closely monitored. For a clear image of the patient's suitability for potentially difficult multi-unit implant procedures, you might need to discuss any planned dental surgery with the patient's cardiologist or primary care physician.
According to Gurie, individuals with uncontrolled diabetes, cancer or sepsis, autoimmune disorders, or those receiving radiation therapy might not be the best candidates for multi-unit implant therapies.
An intraoral examination is the next stage, according to Gurie. In addition to evaluating the quality of the bone, you should also take the mouth's anatomy into account and the possible placement of the multiunit implant abutment.
"It's time to look at the anatomy of the mouth once you've completed the pre-clinical extraoral evaluation and checked the box indicating they are healthy to proceed," he explains. "We need to determine whether we will be able to place the implants where we want them in addition to evaluating the condition of the bone and unstable teeth. If this isn't feasible, our care might be jeopardised.
Evaluating dental caries is a smart place to start. Before moving on to an implant restoration, this is a good time to assess the condition of the remaining teeth and determine whether any more treatments are needed. Assessing oral caries is another helpful method for figuring out how well the patient takes care of their teeth overall and how well-informed they are about good oral hygiene.
Additionally, the dentist needs to look for periodontitis symptoms. Individuals who suffer from periodontitis may be more susceptible to peri-implantitis, a condition that can weaken the bone around the implant and ultimately cause it to fail.
Gums that are sore, swollen, or puffy may indicate periodontitis. Periodontitis can also be indicated by receding gums, bright red or purplish gums, pus between teeth and gums, loose teeth, new spaces forming between teeth, or a shift in bite.
Before beginning any implant treatment, any infections in the alveolar bone should also be found, addressed, and completely healed.
Dentists should carefully consider the anatomy of the implant site or sites at this time before proceeding with radiography. This entails assessing the implant site's anatomy, looking at the soft tissue's condition, and going over any aesthetic concerns there.
In order to stabilise the implant, measure the implant site, evaluate the health of any teeth nearby, and make sure there is at least 1.5 mm of bone between the implant and the neighbouring tooth.
At this stage, the thickness of the mucosa at the implant site can also be measured and defined by periodontal probing performed under anaesthesia. In addition to other risk factors that may have been found in the patient, a thin mucosa is another factor that increases the likelihood of implant failure.
It is also important to thoroughly examine any neighbouring or surrounding teeth for colour, health, and the integrity of any previous restoration treatment. Achieving stability and aesthetic value at the implant site requires doing this.
By now, the patient ought to have passed both the general extraoral and intraoral exams, and the implant site or sites ought to have been approved for further use.
It's time to do a radiographic examination to investigate further. This will help evaluate the health of any remaining teeth in more detail and guarantee that there is enough bone for a stable implant in terms of both height and width. You can also make sure the implants can be implanted without endangering nearby structures by having a radiological evaluation.
Gurie advises sending the patient for a CBCT scan at this time. This allows us to examine the bone density closely and determine if further augmentation is necessary. Additionally, the CBCT scan will indicate if our course of therapy may be jeopardised or if we can place the implants where we want them.
When it comes to evaluating patients for multi-unit dental implants, such as overdenture implants and multi-unit abutment treatments, CBCT (dental cone beam computed tomography) scans provide a number of important advantages.
CBCT scans yield more accurate and high-quality images. With their 3D capabilities, dentists can observe the implant site from a variety of angles and inspect areas as small as a single tooth root, giving them a far clearer picture of whether the patient is a good candidate for the implant.
More detailed evaluation of the soft tissues and bone is also possible by the dentist using a cone beam CT scan than with a conventional X-ray. Once more, this provides the dentist with a far better idea of the patient's general oral health and anticipated reaction to a dental implant.
In comparison to conventional X-rays, CBCT scans are also less painful for the patient. They take less time to do a full-mouth scan, and they use a lower radiation dosage.
Virtual treatment planning software can enhance the level of accuracy and precision that CBCT scans provide the dentist with about soft tissue health and bone structure.
According to Gurie, one software programme that can assist dentists in determining whether a patient is a good candidate for implant treatment and will guarantee a high chance of success is called Simplent.
"With Simpliant, the dentist can virtually place the implant in the bone, letting you know what to expect," the dentist explains. "You're taking a close look at the anatomy and bone that lie beneath the oral tissue."
According to Gurie, using Simplant for virtual treatment planning will make it easier to find any hidden concerns that might preclude a patient from receiving multi-unit implant treatments as well as any abnormalities that might have gone unnoticed during previous intraoral exams.
Dentists had to use two-dimensional X-rays to determine implant placement before this type of technology. Because of this, dentists could only see the patient's anatomy in its whole during the process, and unforeseen events could jeopardise the efficacy of the treatment plan.
This issue is resolved by virtual treatment planning software such as Simplant, which enables dentists to virtually plan each step of the procedure and maybe modify the plan or choose a different course of action before beginning actual patient care.
Additionally, Simplant will produce a personalised surgical guide tailored to your patient's anatomy. This significantly improves precision, which is crucial for several reasons.
It is much simpler to preserve the maxillary sinuses in the upper jaw and mandibular nerves. As the implant angle is also determined by the surgical guide, you will know as much as possible about the likelihood of treatment success before you even admit the patient.
The most important lesson to be learned from this guide is undoubtedly how crucial accuracy is. Working together with your dental lab on the diagnostic denture, surgical guide, and accuracy or verification jig can ensure perfect precision and assist you take significant steps towards providing the best possible treatment outcome, regardless of whether you're capturing digital scans or analogue impressions.
At Yagu, our experts collaborate closely with dentists at every stage of the process to guarantee that each task is finished to the greatest possible degree. By having restorations that are on par with or better than the patients' natural teeth, the dentist is supported in exceeding patient expectations and has predictability throughout the multi-unit implant workflow.
