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Comprehensive treatment planning is essential with every patient. But when it comes to complex implant treatment planning or even planning for a single implant, it becomes that much more critical. Three major steps must be addressed and addressed well. These are a thorough evaluation of the patient's medical history, proper diagnosis, and appropriate treatment planning.
Thorough medical history evaluation
A 2013-2014 survey from the National Center for Health Statistics showed that 69.6% of adults aged 45–64 and 90.8% of those aged 65 and over reported taking at least one prescription drug during the past month.(1) For the segment of adults aged 65 and over, 42.2% reported taking five or more prescription drugs during the past month. As a clinician, you must know what medications your patients take and for which conditions. Basic knowledge of these drugs and drugs you may prescribe pre- or post-operatively is essential. You need to understand how various medical conditions may affect the outcome of your implant surgeries. It's not sufficient enough to just read the patient’s medical history; you need to ask questions that may give you valuable information that the patient forgot or didn’t think there was a need to include in his or her medical history.
Other studies have shown a direct correlation between a patients’ medical status (e.g., ASA I, II, III, etc.) when it comes to implant failure. You must be aware of both surgical and implant contraindications that a patient may have. Some examples of these may include, but are not limited to, uncontrolled high blood pressure, recent myocardial infarction (MI), recent cerebrovascular accident (CVA), history of IV bisphosphonates, uncontrolled diabetes, liver cirrhosis, heavy smoker, and radiation. If there are any doubts that a patient may not be a candidate for treatment due to his or her current medical status, a medical release and/or consultation with the patient’s physician should be completed prior to implant surgery.
Proper diagnosis
Proper diagnosis comes from a collection of knowledge and experience. The more you work at yyour craft and, in this case, expand our understanding when it comes to the field of implants both from the surgical and restorative aspect, the more capable and confident you are in your diagnosis. This will further assure that you have the best long-term prognosis for our patient. Tools that help aid you in the proper diagnosis include radiographs (FMX, panoramic, CBCT), study models, and a thorough clinical examination. These are paramount to having enough information to achieve a proper diagnosis for your patients as well as assess bone quality, bone quantity, and proper and sufficient space for the restoration(s).
Treatment planning
Appropriate treatment planning can be formulated after completing a thorough medical history evaluation and receiving the necessary information from a proper diagnosis. Often the best pathway to success is to visualize the optimal end result and plan backwards. If you don't know where you want to go then how are you going to get there? This method also helps prevent you from missing any crucial steps.
A specific and clear treatment plan should be given to the patient after the person has been made aware of all treatment options and the risks and benefits of those treatments. It is also crucial to set proper expectations. Patient expectations can alter a treatment plan and/or add steps to get the result the patient desires. Many patients think that once an implant is completed no additional treatment will be needed. They must have the proper expectations and realize that proper maintenance is required. Depending on the case, a patient will need the restorative aspect replaced from normal wear and tear, and the person should be made aware of this standard maintenance.
Benjamin Franklin stated, "By failing to plan, you are planning to fail." Plan to succeed, not fail. If you take the time to plan and address each of these three steps with intention, you can provide the best possible outcomes for your patients. As you’re preparing for your next implant case, whether it be a single implant or a full mouth rehabilitation, be more aware and alert regarding your patients’ medical histories, receive sufficient diagnostic material, and present a detailed and sound treatment plan to your patients while achieving their expectations.
Jedediah V. Huss, DDS, graduated from the University of Southern California Herman Ostrow School of Dentistry in 2011 and is currently an owner dentist supported by Pacific Dental Services. He holds the status of Master with the International Congress of Oral Implantologists (ICOI). Dr. Huss can be reached via email at [email protected] or messaged via Instagram @restoredsmiles.
Reference
1. National Center for Health Statistics. Health, United States, 2016: With Chartbook on Long-term Trends in Health. Hyattsville, MD. 2017.
