This document discusses factors to consider when selecting patients for implant retained prostheses. It outlines general patient factors like medical history and motivation that should be assessed. A thorough dental evaluation including extraoral and intraoral exams, various radiographs, and bone density assessment is important. Patients should provide informed consent and understand expectations, risks, and commitments. Clinical indications for implants include missing teeth due to congenital defects, trauma, or being edentulous. Contraindications include conditions that could compromise bone healing or the patient's ability to maintain implants. A multidisciplinary approach may be needed for complex cases.

1. Selection of Patient
for Implant Retained
Prosthesis
Dr. Shah MD. Shafiul Mahboob ( shahroj )
Internee Doctor (IS-34 )
Dept. Of Prosthodontics
Sapporo Dental College & Hospital

2. INTRODUCTION
The use of dental implants to provide support for replacement of missing teeth or tooth is
becoming an important component of modern dentistry. As a result of advances in research
on implant design, materials, and techniques the use of these devices has increased
dramatically in the past few years and is expected to expand further in the future. Many types
of implants are now available for application to different clinical cases, and an increasing
number of dentists have become involved in this form of treatment for missing tooth or teeth.

3. General factor
Patient factors
Dental evaluation
Informed consent
Clinical
indications/contraindications
Indications
General
contraindications
Local contraindications
FACTORS AFFECTING THE SELECTION OF
PATIENT FOR IMPLANT RETAINED PROSTHESIS

4. PATIENT FACTOR
An understanding for patient’s needs, socioeconomic background, general medical
condition etc., is a prerequisite for successful therapy. There should be a complete
assessment of the patient’s chief complaint and expectations, dental history, motivation
and compliance, habits . Optimal individual treatment results may only be achieved if the
patient’s demands are in balance with the objective evaluation of the condition and the
projected treatment outcomes.

5. DENTAL EVALUATION
1.Extra oral examination: Assessment of mouth opening should be done, as instrumentation involved with
implant therapy need sufficiently wide mouth opening. Aesthetic characteristics like smile line, lip line, and
facial midline should be evaluated in patients needing tooth replacement in aesthetic zone .
2.Intra oral examination : Residual infections in the alveolar bone (e.g. failed endodontic treatment), non-vital
teeth especially those adjacent to edentulous space, caries, overhanging restoration margins etc., should be
treated before considering implant therapy as a treatment option. Analysis of static and dynamic aspects of
patient’s occlusion should be analyzed . These include adequacy of vertical dimension of occlusion, maxilla-
mandibular relationship, overjet, overbite, stability in habitual occlusion, centric relation, canine guidance etc
.

6. DENTAL EVALUATION
3.Radigraphic assessment :
a) Periapical radiograph: it gives a detail picture about the amount &
quality of bone remaining .
Indications :1.Evaluation of small edentulous space
2. Alignment and orientation during surgery
3. Recall / Maintenance evaluation .
Limitations: 1. Distortion & magnification
2. Minimal site evaluation
3. Lack of cross sectional imaging

7. DENTAL EVALUATION
4.Radigraphic assessment :
b)Occlusal radiograph:
Indications :They provide information about the facio lingual width of bone
Limitations: 1. Does not revealtrue buccolingual width in mandible
2. Difficult in positiong
Fig :A, Occlusal radiographs have been postulated to show the width of bone in the anterior region. B, However, occlusal
radiographs actually show the widest buccolingual distance (red arrows) not in the same plane. Actual width of bone (green arrow).

8. DENTAL EVALUATION
4.Radigraphic assessment :
c)Paranomic radiograph:
Indications :It is the most frequently used radiograph . Vertical height of the bone can be
evaluated .
Limitations: 1. distortion inherent in the paranomic system .
2. Doesn’t demonstrate the bone quality .
3. Errors in patient positioning .
Fig: Paranomic
radiograph

9. DENTAL EVALUATION
4.Radigraphic assessment :
d)Lateral cephalometric radiograph: It is uesd to determine and evaluation the loss
of vertical dimension, skeletal interarch relationships and crown implant ratio.
Indications :1. Used in combination with other radiographic techniques for anterior
implants
2.Symphysis bone graft evaluation.
Limitations: 1. Availability
2Image informatiuon limited to midline
3. Reduce resolution and sharpness .
Fig : lateral cephalogram

10. DENTAL EVALUATION
4.Radigraphic assessment :
e)Computed tomography : It gives a detailed view of cross sectional
anatomy
of the alveolar ridge
Indications :1. Determination of bone density
2.vital structure loction
3.Subperiosteal implant fabrication .
Limitations: 1. Cost
2. Technique sensitive. Fig :Cross-sectional images of maxillary alveolar
ridge taken using dentascan software to calculate the
ridge height and desired angle of inclination at the
planned implant site

11. DENTAL EVALUATION
Fig : 39-year-old male with mandibular edentulous posterior region. CT of
the edentulous area of the mandibular posterior region for the evaluation of
bone for implant placement. a) Various sections of CT (arrow); b) shows the
inferior alveolar nerve (arrow); and c) shows the arbitrary implant placement
(arrow).
Fig :30-year-old female patient with edentulous mandibular anterior region.
CBCT shows implant placement site in the mandibular anterior region.

12. DENTAL EVALUATION
Bone density measurement :
Bone
Density
Description Tactile
Analog
Typical anatomic location Choice of implant
D1 (Dense
compact bone)
Dense cortical Oak or maple Anterior mandible Ti implant & most of the other implant
D2(Porous
compact bone)
Porous cortical
& course
trabecular
White pine or
spurce
Anterior mandible Anterior maxilla.
Posterior mandible
Threated Ti implant; Ti plasma coated press fit cylinder
implant
D3( coarse
trabecular bone)
Porous cortical
& finetrabecular
Basal wood Anterior maxilla, posterior maxilla ,
posterior mandible
Implant coated with hydrooxyapatite
D4(fine
trabecular
bone)
finetrabecular Styrofoam Posterior maxilla

13. DENTAL EVALUATION
4.Radigraphic assessment :
f)Magnetic Resonance Imaging :
Indications :1. Evaluation of vital structure when CT scan is notconclusive.
2.Evaluation of infection
Limitations: 1. Cost
2. Technique sensitive.
Fig :MRI ( magnetic resonance imaging

14. FACTORS AFFECTING THE SELECTION OF
PATIENT FOR IMPLANT RETAINED PROSTHESIS
.
c)Informed Consent: Patients should be fully informed of all treatment options
including treatment alternatives with the advantages and disadvantages of each
approach. In addition patients should be made aware of:
• The likely outcome and success rates.
• Any potential complications.
• Long-term care implications.
• Commitment to long term maintenance.
The patient should be motivated, have realistic expectations and be able and
willing to care for the restoration after being discharged from hospital care.

15. CLINICAL INDICATIONS
1.Age : There is no upper age limit providing the patient is capable of undergoing the surgical phase and the
subsequent self maintenance. In contrast implant treatment should be delayed in young individuals until
growth is complete. Patients should be at least 18 years of age with sufficient bone volume and maturity to
prevent any related post operative complications linked to further bone growth.

16. CLINICAL INDICATIONS
2.Hypodontia/Oligodontia/Anodontia: This category ranges from young patients with 1 or 2developmentally
missing anterior teeth to those who have very few permanent teeth. In these latter cases the few permanent
teeth are often small and conical, providing poor retention for conventional bridges or dentures.
3.Cleft palate: Repaired clefts with sufficient bone are often amenable to implant placement. Unrepaired clefts
and those requiring bone grafts are more complex and are likely to require a multidisciplinary approach.
4.Ectopic teeth : Patients presenting with ectopic teeth that have failed to respond to conventional
orthodontic/surgical approaches should be considered for implant provision for replacement of the ectopic
tooth or teeth rendered unrestorable due to collateral damage.

17. CLINICAL INDICATIONS
Fig. A series of radiograph pictures of the patient . A, Radiograph before alveolar graft. Bilateral alveolar clefts are seen; B, Radiograph after
autogenous particle cancellous bone marrow (PCBM) grafting to alveolar cleft; C, Radiograph after mandibular ramus onlay graft (RBOG); D,
Radiograph of prosthesis at 2 years after implant installment. The radiolucent area of the right incisor is a periapical lesion, which is not related to
the implant surgery

18. CLINICAL INDICATIONS
5.Congenitally malformed teeth and supporting structures:
• Patients presenting with structural defects in dentine and enamel (e.g.
dentinogenesis imperfecta and amelogenesis imperfecta) that are
unrestorable despite previous attempts or have a hopeless long term
prognosis.
• Patients presenting with complex root canal morphology that has rendered
anterior teeth nonvital(such as dens invaginatus Type II and III). Root canal
treatment should be attempted in the first instance and if unsuccessful only
then should an implant be considered.
The above list is not exhaustive, any condition whereby teeth are congenitally
malformed (or their supporting structures) that are otherwise unrestorable
should be considered for implant replacement.

19. CLINICAL INDICATIONS
6.People who are edentulous in one or both jaws:
• The provision of two implants in the mandible to retain an overdenture is
now widely recognized as the first choice treatment in the completely
edentate. The provision of this type of prosthesis has been shown to
improve oral health related quality of life, function, satisfaction and is
considered a cost effective approach when compared to conventional
dentures.
• Those patient presenting with an intact and stable dentition in one arch
opposing an edentate arch can also be considered for implants especially if
they fall into one of the other categories detailed in this document

20. CLINICAL INDICATIONS
7.People who have lost teeth due to trauma :
Loss of one of more anterior teeth in cases where the alveolar bone is mostly intact can be readily treated.
Patients who have suffered major bone loss in addition to multiple teeth through trauma may require
bone grafts
Fig:The trauma impacted primarily the central anterior teeth (two front teeth) and his lower lip. Swelling is still evident in this
picture, as well as the sutures. An existing bridge was destroyed along with a central incisor, which was partly anchoring the bridge.
The incisor required extraction. Of the different treatment plans recommended by doctors, the patient elected to have both front teeth
replaced with dental implants.

21. CLINICAL CONTRAINDICATIONS
Absolute contraindications.
1.Heart Diseases
2.Active cancer, certain
bone diseases.
3.Certain
immunological diseases
4.Strongly irradiated
jaw bones
Relative contraindications
1.Diabetes
2.Significant
consumption of tobaco
3.Drugs & alcohol
dependency
4.Pregnancy
1.General contraindications

22. CLINICAL CONTRAINDICATIONS
2.Local contraindications
• The alveolar bone where the implants would be positioned, shows chronic
infections, has an inadequate structure or an insufficient height or width.
• Anatomical structures such as the maxillary sinus , the inferior alveolar nerves
has an abnormal position interference with the dental implant .
• Poor oral hygiene
• Bruxism or involuntary growing of the teeth .

23. THANK YOU