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MCG School of Dentistry Quality Assurance Manual

Implant Dentistry

General Guidelines
Since implant success involves both surgical treatment and prosthetic treatment, evaluation of a restored implant case requires use of both the implant guidelines and prosthetic guidelines sections of the Quality Assurance Manual.

Patient Evaluation:
Patient evaluation procedures are selected to help formulate treatment recommendations. When appropriate, these may include the following:

  1. Chief Complaint

  2. Medical History

    1. Current Treatment/Therapy

    2. Major Illnesses or Diseases

    3. Current Medications

    4. Past Surgical History/Past Medical History

    5. Allergies

  3. Social and Family History

    1. Tobacco and/or Alcohol use

    2. Other drug use or dependency

  4. Dental History

    1. Previous Dental Experiences

    2. Oral Hygiene

    3. Periodontal

    4. TMD

    5. Habits (bruxism, etc.)

  5. Physical Examination and Assessment

    1. Significant relevant disease cofactors

  6. Dental Examination

    1. Charting of Teeth, present and missing

    2. Appropriate Diagnostic Aids (may include the following):

      1. Panoramic and/or PA Radiographs

      2. Cephalometic Radiographs

      3. Mounted Study Models

      4. CT Scans - reformatted x-sections

      5. CT Generated Bone Models

      6. Radiographic Surgical Guide

      7. Tomograms

    3. Evaluation of bone quality and quantity

    4. Ridge Classification, Relationships and Occlusion

    5. Periodontal - probing and mobility recordings

    6. Soft tissue - attached gingiva, muscle attachments

    7. Lip line (smile line)

    8. TMD, Myofacial

    9. Evaluation of Current Prostheses

  7. Prognosis for remaining dentition

  8. Psychological Evaluation

  9. Treatment Plan

    1. Implant sites, number and type

    2. Pre-surgical Consultations

      1. Restorative Dentist

      2. Surgeon (if different from restoring dentist)

      3. Other dentists involved in completion

      4. Laboratory technician (if indicated)

      5. Dentists should consider merits and limitations of all dental implant options.

  10. Informed Consent - with treatment alternatives, risks and prognosis fully explained

  11. Explanation of treatment fees

    1. Diagnostic and radiographic

    2. Surgical

    3. Restorative

    4. Other related fees

  12. Documentation of Procedures

Evaluation Criteria - General:

  1. Indication for Implants

  2. Adequate Healing Time Before Loading

  3. Adequate Maintenance and Follow-Up Protocol

Implant Dentistry Quality Evaluation Criteria

ITEM

RATING AND EXPLANATION

 

ACCEPTABLE

NOT ACCEPTABLE

 

Operational Explanation

1.  The implant is of satisfactory quality and is expected to support the prosthesis and not damage the surrounding tissues.

1.  The implant is not of acceptable quality.  Damage to the bone and/or surrounding tissues is now occurring or is likely to occur.

Location and Placement

1.        Ideal placement, inclination, number and spacing of implants.

2.        Unavoidable off ridge placement or inclination.

3.        Asymptomatic penetration of floor of nose or sinus or inferior border of mandible.

1.        Unnecessary tipping or inclination compromising prosthetic stability, esthetics or design.

2.        Severe tipping or malposition requiring implant burial or removal (prosthetically useless)

3.        Too few implants for occlusal load requirements.

4.        Implants too close together to maintain health of surrounding bone and soft tissue.

5.        Violation of mandibular canal, symptomatic violation of sinus, nose or inferior border of mandible.

 

Mobility

No mobility of root form implant body.  Slight mobility acceptable for blades and others that heal with connected tissue integration.

Slight to progressive mobility indicating irreversible loss of integration; removal indicated.

Peri-implant Tissues

1.        Healthy sulcus

2.        Ample kerantinized gingiva where necessary, or stable mucosa otherwise.

1.        Pathologic pockets.

2.        Dehiscence, fistula, or abscess present, indicating removal of implant.

Radiographic Appearance

1.        Implant body full approximated by healthy bone, and minimal crestal bone loss.

2.        No widening implant space present.

1.        Progressive crestal cratering to untreatable vertical bone loss noted.

2.        Slight widening to progressive widening of peri-implant space.

3.        Symptomatic apical radiolucency present.

Subjective Symptoms

Lack of significant symptoms

1.        Pain with normal function to steady pain; marked with function.

2.        Dysesthesia etiologic to implant impingement on nerve.

3.        Infection

Esthetics

1.        Teeth are of acceptable form, size, position and alignment.

2.        Teeth are of suitable shade, compatible with adjacent teeth.

3.        Normal soft tissue profiles when they are visible as part of esthetic frame.

1.        Tooth form and size disproportional; teeth are malpositioned or misaligned.

2.        Shade noticeably different from adjacent or opposing teeth or inappropriate shade.

3.        In the esthetic zone, tissue heights noticeably different from those of natural teeth.

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Patient Services
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 Please email comments, suggestions or questions to:
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December 19, 2005