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CAMLOG
®
Implant Position Planning
ANAMNESIS
INTRODUCTION
The medical history and diagnosis are not different from the evaluation pro-
cedures required for other dental surgery or restorative treatments. For this
reason, only the specific points for perio-implant prosthetic treatments are
described below.
The general, social and special (dental) medical history considers all general
medical contraindications and diseases that could affect the microcircula-
tion or the patient’s suitability for the proposed implant-based restoration.
Risk factors such as nicotine, alcohol and drug abuse are confidentially eval-
uated, discussed and documented. The patient’s psychological and psycho-
social situation gives an indication of the compliance that can be expected
and influences the planning of the treatment and the future prosthetic de-
sign.
GENERAL
The general medical history should include not only the disease history but
also regular medication usage and the possibility of general medical prob-
lems that could adversely affect an implant-based prosthetic treatment.
SPECIAL (DENTAL)
The special medical history must clarify the reasons for the current situation
of the oral system. It may provide information on systemic diseases that may
not have been detected, yet. If implants and/or grafts were previously
placed, this may be important for assessment of the bone quality.
EXAMINATIONS
CLINICAL
In addition to all standard extraoral examinations, the soft-tissue profile and
support of the soft tissues (especially in the maxilla) are a critical factor in
designing the prosthesis. If a large discrepancy exists between the required
labial tooth position and the proposed implant position, the use of a remov-
able denture (bar-structure, telescopic crown, ball abutment, Locator
®
) may
be necessary for loading reasons.
The results of the intraoral examinations determine which teeth can be
saved. The standard of hygiene is evaluated and a check of the soft tissue
for pathological conditions is performed for information on the patient’s
possible compliance during and after treatment.
The static and dynamic occlusion, interalveolar distance, and centric rela-
tions are checked. Temporomandibular joint disorders are addressed before
the start of treatment.
All findings indicating elevated stress on the masticatory system (e.g., brux-
ism) must be investigated, documented, and considered in the prosthetic
planning.
The status of the soft tissue in edentulous arch segments (width and thick-
ness of the attached gingiva) must be checked and the extension of the al-
veolar ridge must be evaluated for its suitability as a possible implant site.
RADIOGRAPHIC EVALUATION
DENTAL X-RAYS
Dental x-rays are sufficient for the initial assessment of bone supply with
single tooth gaps or small interdental gaps. The periodontic situation of the
remaining dentition must be closely examined, because the implant site
may be colonized by pathogenic organisms from infected pockets.
ORTHOPANTOMOGRAPH
An orthopantomograph can also be a critical instrument for gathering basic
information. Additional data required by the specific situation may be ob-
tained through dental x-rays, remote x-ray side views, or computer-tomo-
graphic scans (CT).
REMOTE X-RAY SIDE VIEW
Use for large sagittal differences and planned bone removal in the chin
region.
COMPUTER-TOMOGRAPHIC SCAN/DIGITAL VOLUME TOMOGRAPHY
The CT/DVT is used for extensive radiological diagnostics and for generat-
ing raw data for computer-based augmentation and implant planning. It
enables a 3-D evaluation of the site from its anatomical structures and can
provide information about the density of the existing bone (with DVT rela-
tive only or via calibration).
Indications must be strictly adhered to due to the increased radiation expo-
sure compared to purely two-dimensional procedures.