Weighing Patient Risks and

the Rewards of Implant Treatments

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Today’s implant treatments provide patients with many benefits, such as higher treatment satisfaction, improved esthetics, and enhanced oral function. With high survival rates, implant success is typically between 90% to 95% or higher.

However, complications can occur due to bone loss, improper placement, reduced stability, and soft tissue loss. Many of these complications are avoidable with proper diagnosis, thorough patient risk assessment, and comprehensive treatment planning in collaboration with a DSG Laboratory to determine if implants are indicated and, if so, whether or not bone and/or tissue grafting is required.

Fortunately, a variety of technologies—including digital radiography, intraoral impression scanners, CBCTs, and computer assisted design and manufacturing (CAD/CAM)— are invaluable for rendering an accurate diagnosis, identifying risk factors, and ultimately planning, placing, and restoring implants both accurately and precisely. Simultaneously, they enable dentists and their DSG Laboratory to provide these treatments in simpler, more efficient, and more predictable ways. Combined, they can help make implant treatments more profitable for the practice by reducing chair and working time, eliminating the need for some materials, and enhancing patient comfort and convenience.

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Because these technologies are only tools, dentists must still know and understand a patient’s condition; functional, biological, structural, and esthetic risks; and the prognosis of planned treatments. For example, when patients present with functional risks—such as parafunctional activity, tooth fractures, and/or excessive wear—dentists must plan their treatment with DSG in order to prevent implant failure, restorative damage, unhappy patients, and lost revenue. Because parafunctional activity can return after implant treatment, dentists typically increase the number of implants required in order to ensure that the overall implant/restoration complex can withstand fracture.

Regardless of the number of implants to be placed, CBCT technology enables dentists to more accurately evaluate a patient’s bone height, width, and density in order to determine the ideal number, size, and shape of implants. The availability of adequate occlusal-apical bone height and buccal-lingual width/angulation are among the factors essential for successful outcomes. When combined with implant treatment planning software, CBCT images also facilitate identification of the ideal implant position and angulation, as well as the fabrication of computer-generated surgical guides at the DSG Laboratory.

When patients present with high biological risks—such as periodontal disease or systemic conditions—surgery, healing, bone loss, and stability complications could occur. Further, these patients may be more susceptible to peri-implant disease, so on-going monitoring is required. A combination of systemic health questionnaire/medical history and thorough oral examination can help dentists determine if a patient is at greater risk for biological complications following implant placement and restoration.

Structural risk—which influences such implant treatment considerations as material selection and occlusal design—focuses on ensuring overall restoration and oral cavity stability. Because patients with high structural risk often present with ill-fitting restorations, active decay, and previously endodontically treated teeth, addressing the cause of these issues can help to enhance the prognosis for implant treatments.

Although more subjective, esthetic risk encompasses shade and shape, tooth position, gingival symmetry, and lip mobility—all of which are implant treatment planning considerations that will affect patient satisfaction. In particular, a patient’s esthetic risk will influence the number and distribution of implants, the type of abutment and material selected, whether or not bone and tissue grafting is required, and the overall restorative design.

Therefore, incorporating digital technologies and processes—as well as closely collaborating with DSG—is essential for first visualizing ideal implant treatment outcomes, and then planning and performing the necessary surgical and clinical procedures that will mitigate patient risk. In particular, the combination of virtual wax-ups, digital implant treatment planning, and 3D printing and CAM fabrication enable dentists and their DSG laboratory to realize greater accuracy, precision, and efficiency.

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