This is the most frequently asked question in our dental practice. Although the answer is pretty simple in each case, it is important to explain which factors contribute to the decision whether to recommend or not to recommend the implant procedure. A careful analysis of patients dental health will help the doctor and the patient to formulate the best possible strategy in order to fix all the patients problems, and the proper planning is the most important part of the whole procedure, because a good understanding on start of the treatment will ensure there will be no problems later (patients wishing one thing and the doctor recommending another).
A detailed plan of the therapy will include the number of implants which will be placed and the number of dental crowns needed for full rehabilitation of the patient. The best practice is to first determine the number, shape and position of dental crowns and only than to calculate the number of required implants (screws). This approach is also very beneficial for the patient, as it makes it easier to plan the expenses and to precisely schedule visits to the dentists.
Already during the first meeting we try to chart all the factors important for a detailer therapy plan.
Patients wishes are always the first imperative, so my first question always is “What are your wishes?”. Most of the patients are well informed about dental implants, and they usually have formed expectations considering the treatment. If the patient is definitely sure he/she wants implants, has no reservations about the use of artificial bone to strengthen the jaw and has enough spare time and has the money, than the therapy plan can be formulated very quickly.
Analysis of 3D orthopan. This is absolutely necessary, as CBCT image will shows is there enough of the jaw bone to receive the implants. If the answer is yes, then the implant procedure can take place without any reservations. It is often the case, though, that there is not enough of the bone, so the jaw bone must be reinforced reservations concerning that procedure.
Visual examination is next, including a study of relative positions of upper and lower jaw, with a special attention to presence of bruxism and periodontitis. All the natural teeth which will remain in the jaw will be treated for plaque and caries and periodontitis put under control before implant therapy may begin.
Age of life. If the patient is healthy, age of life is not an important factor for success of implant therapy. We consider every person without severe illnesses, without bad habits and with satisfactory blood test to be generally healthy.
Bad habits. It is a fact that passionate smokers have reduced chance for successful implant integration, so immediate stop to the smoking habit is strongly advised. If the patient cannot stop to smoke, a solution other than implants is needed.
Health issues. Any chronic disease will reduce the chances for successful implants treatment, although, it is important to note there are many ways to make implant treatment work even in the presence of many serious illnesses.
So, after the examination, the interview and the analysis of 3D orthopan image we have to answer the crucial question:
Here we must once again return to the question of therapy planning. Why? It is often the case that after the loss of one teeth, adjacent teeth are moving in to partially fill the empty space, so there is no place left to place the dental crown, even if it is possible to find a room for implant. To escape any possible misunderstandings in cases such as this, a good therapy plan is essential. The same is true when several teeth are missing, as such a condition completely changes the bite pattern and jaw function. A detailed examination will take all these circumstances into account, so in the same space where once there were four teeth just three crowns may fit and the number of crowns determines the number of implants needed for full rehabilitation.
I personally perform both parts of implant procedure: making of crowns and the insertion of implants, which is very advantageous for the patient, as mistakes can happen if one doctor is making crowns and the other one in placing them, and those mistakes are later very hard to correct.
Dr. Srdjan Cvejanovic has more than a decade-long experience in dental implantology. He is a member of European associations of dental implantologists EAO and ITI. He specializes in implantology and prosthetics.