Principles of Treatment Planning
The surgical part of implant treatment must be preceded by a comprehensive patient evaluation, preoperative diagnostics and therapy planning. Inadequate treatment planning may cause implant loss.
One hundred percent implant success can never be guaranteed.
With respect to pediatric patients, routine treatment is not recommended until the end of the jaw bone growth has been properly documented. Pre-operative hard tissue or soft tissue deﬁcits may yield a compromised esthetic result or unfavorable implant angulation.
A careful clinical and radiological examinations of the patient has to be performed prior to surgery to determine the psychological and physical status of the patient. Special attention has to be given to patients who have localized or systemic factors that could interfere with the healing process of either bone or soft tissue or the osseointegration process (e.g., cigarette smoking, uncontrolled diabetes, oro-facial radiotherapy, steroid therapy, infections in the neighboring bone).
In general, implant placement and prosthetic design must accommodate individual patient conditions. In case of bruxism or unfavorable jaw relationships reappraisal of the treatment option may be considered.
Precautions at Surgery
Particular caution should be used when placing narrow platform implants in the posterior region due to risk of prosthetic overload. Lack of adequate quantity and/or quality of remaining bone, infection and generalized diseases may be potential causes for failure of osseointegration both immediately after surgery, or after osseointegration is initially achieved.
Besides the mandatory precautions for any surgery such as of asepsia, during drilling in the jaw bone one must avoid damage to nerves and vessels by referring to anatomical knowledge and preoperative radiographs. Failure to recognize actual lengths of step/twist drills relative to radiographic measurements or drilling beyond the depth intended can result in permanent injury to nerves or other vital structures, potentially resulting in permanent numbness to the lower lip and chin or leading to hemorrhage in the ﬂoor of the mouth.