Cr iter ios de selecci贸n del paciente candidato a implantes par te 1 Alejandro Kleinman DDS.
Patient’s selection criteria
Patient D esir e Dental Evaluation Systemic Evaluation
oCost oTime oOptions Note: Always diagnose every patients with optimum treatment option, fallowed by alternative treatment options.
Patient’s selection criteria
Patient Desire Systemic Evaluation Dental Evaluation
•Metabolic bone disease •Osteoporosis ? •Radiation •Liver disease (Cirrosis) •Psicologic problems •Diabetes •Smoke •Non realistic expectations •Adolescence •Pregnancy •Immunocompromised Patients
Patient’s selection criteria
Patient Desire Systemic Evaluation D ental Evaluation
Occlusion Maximum intercuspation Centric Relation Occlusal interferences Parafunctional habit & wear facets Anterior guidance Occlusal plane
Patient’s selection criteria
Patient Desire Systemic Evaluation D ental Evaluation Arch shape and size Interarch relationship Adjacent teeth evaluation Esthetic evaluation
Patient’s selection criteria
Patient Desire Systemic Evaluation D ental Evaluation Arch shape and size Interarch relationship Adjacent teeth evaluation Esthetic evaluation
Patient’s selection criteria
Patient Desire Systemic Evaluation D ental Evaluation Arch shape and size Interarch relationship Adjacent teeth evaluation Esthetic evaluation
Soft & hard tissue evaluation Tissue health Attached gingiva Perio biotype Residual bone Smile line
Patient’s selection criteria Soft & hard tissue evaluation Tissue health Attached gingiva Perio biotype Residual bone Smile line
Patient’s selection criteria Soft & hard tissue evaluation Tissue health Attached gingiva Perio biotype Residual bone Smile line
Patient’s selection criteria Soft & hard tissue evaluation Tissue health Attached gingiva Perio biotype Residual bone Smile line
Immediate provisionalization
Patient’s selection criteria Soft & hard tissue evaluation Tissue health Attached gingiva Perio biotype Residual bone Smile line
Immediate provisionalization
Patient’s selection criteria Soft & hard tissue evaluation Tissue health Attached gingiva Perio biotypoe Residual bone Smile line
Final crown
Patient’s selection criteria •Health assesment Clinical examination •X-rays •Pictures •Mounted study models •Diagnostic wax-up •Interdisciplinary consultation
D I AGN OST I C T OOL S
Patient’s selection criteria Pictures
Patient’s selection criteria •Diagnostic set-up
Patient’s selection criteria Diagnostic wax-up Surgical guide
Patient’s selection criteria Diagnostic wax-up Surgical guide
Patient’s selection criteria Diagnostic wax-up Surgical guide
Patient’s selection criteria Diagnostic wax-up Surgical guide
Patient’s selection criteria Diagnostic wax-up Surgical guide
Patient’s selection criteria Diagnostic set-up X-ray guide
Patient’s selection criteria X-ray examinations Routi ne Rx. Especi a l Rx.
Per i a pi ca l Pa nor a mi c T omogr a phy CT sca n Cone bea m tomogr a phy
Patient’s selection criteria Lekholm and Zarb, 1985
X-ray examinations
Horizontal
Quantity of bone Vertical
Quality of bone
Patient’s selection criteria
X-ray examinations
Effect of Poor Bone Quality #Implants Type 1-3 Bone
Engquist '88 van S.ghe '90 Jaffin '91 Johns '92 Fugazzotto '93 Smedberg '93
141 491 952 453 851 53
% Failure relative to # Implants placed 2,938
Failures (%)
Type 4 Bone
Failures (%)
15 19 29 16 12 0
198 67 102 57 512 33
52 4 36 16 22 12
91 (3)
969
143 (15)
97%
85%
Patient’s selection criteria X-ray examinations Single Missing Tooth
Template fabrication
Patient’s selection criteria X-ray examinations Single Missing Tooth Evaluation of the osseous edentulous ridge. Probing technique using a measuring guide. (Ridge mapping)
Patient’s selection criteria X-ray examinations
Partially Edentulous
X-ray examinations
Partially Edentulous
Patient’s selection criteria
Patient’s selection criteria Partially Edentulous
Partially Edentulous
Patient’s selection criteria