CAMLOG ROOT-LINE 2 Surgical Procedure

12 CAMLOG ® ROOT-LINE 2 IMPLANT SPECIFIC (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. EXAMINATION 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 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 alveolar 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. ORTHOPANTOMOGRAM An orthopantomograph can also be a critical instrument for gathering basic information. Additional data required by the specific situation may be obtained through dental x-rays, remote x-ray side views, or computer-to- mographic scans (CT). If implant positions (implants approximating the former tooth positions) cannot be implemented for a fixed denture for whatever reason – functional (implant loading, crown length), esthetic (soft tissue support) or hygienic – a removable denture must be planned. A. ACTUAL SITUATION/PROSTHETIC INITIAL SITUATION Find out and document the ACTUAL situation by taking a general and spe- cial (dental) history and performing intra- and extraoral clinical, functional and radiographic examinations. Together, these findings are the basis for a description of the initial situation of the oral-maxillofacial system. B. INDIVIDUAL TREATMENT GOAL A full analysis is conducted with the patient, including a cost/benefit, work/ benefit, and risk/benefit analysis. The final result will be a treatment goal customized to the desires and options of the patient. C. TREATMENT SEQUENCE With the individualized treatment goal as guide, prosthetically oriented im- plant positioning is defined and verified clinically and radiographically. Then, a treatment sequence is set up. It includes the planning of accompa- nying measures, augmentation, and any required pre-treatment. ANAMNESIS INTRODUCTION The medical history and diagnosis are not different from the evaluation procedures 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 evaluated,discussed and documented. The patient’s psychological and psychosocial situation gives an indication of the compliance that can be expected and influences the planning of the treatment and the future pros- thetic design. 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. IMPLANT POSITION PLANNING