PREOPERATIVE MEDICAL EVALUATION OF IMPLANT PATIENT
As with any surgery, the implant patient must be assessed preoperatively to evaluate patient ability to tolerate the proposed procedure. The predictable risk and the expect- . ed benefit should be weighed for each patient. Surgical
. placement of dental implants may be associated with certain risks. –
, One ‘Set of concerns is, tlle’ Immediate .surgical and .anestnenc risks associated With implant placement. Because implant placement is a relatively atraumaticprocedure, little immediate surgical risk exists. Absolute confraindicatlons- to implant placement on the, basis of
immediate surgical and anesthetic risks are limited ~o patients who are acutely ill, those with uncontrolled metabolic disease, and pregnant patients. These con traindications are applicable to virtually all elective surgtcal procedures. These conditions are also generally limited in duration; once the illness resolves, the pregnancy is over, or the metabolic disorder controlled, the patient may become a good implant> candidate. Relative contraindications may also exist. Many implant patients are
elderly and have preexisting chronic systemic medical conditions, such as diabetes mellitus. The presence of a chronic medical condltion is rarely a contraindication to surgical placement of implants, Each patient must be
evaluated for anesthesia and surgery in lig~ of the pre-existing disease process, as discussed in Chapter 1.0 Local and systemic conditions that threaten long-term retention of the implants must be evluated. Implants
may be contraindicated in patients with abnormal bone metabolism, poor oral hygiene, and previous radiation to the implant site Although osteoporosis is prevalent in the geriatric female population, these patients show no documented decrease in the success of implants. Other metabolic bone disorders, including osteopetrosis, fibrous dysplasia, chronic diffuse sclerosing osteomyelitis, and florid osseous dysplasia, may contraindicate implant placement. One systemic consideration, smoking, has been conclusively linked with increased implant failure. Although smoking is not an absolute .contraindication, patients who smoke should be counseled on cessation and informed of the increased risk of failure .
. ‘ Most patients who present for implant .placement became edentulous from caries and periodontal disease resulting from poor oral hygiene. Suspicion that inadequate hygiene is likely to continue is’ a· relative contraindication to implant placement. Patients must be • motivated and educated in oral hygienlc techniques as part of their preparation for implants. Some patients maynot be able to improve their hygiene, such as those suffering from paralysis of the arms, debilitating arthritis, cerebral palsy, and severe mental retardation. ‘Implants. are contraindicated in these patients, unless caregivers will provide adequate hygiene. A summary of contraindications to implant placement is presented in Box 14-5. I
Lastly, several previous authors have recommended extensive diagnostic laboratory testing as part of patient evaluation for implant placement. Blood indices and chemistry and even urinalysis have been recommended.
Rather than genercally recommending laboratory testing, rational approach is preferred; that is, no laborato- ~tests are generally indicated unless dictated by specificunderlying medical conditions for which laboratory testing will assist in safe patient management.