Current Concepts in Dental Implants: Clinical Assessment in the Prevention of Peri-implant Mucositis, Peri-implantitis, and Implant Failure
Course Number: 514
Patient's Health Status
In conjunction with clinical assessment, the patient's current health status and successful wound healing after post-treatment implant therapy is essential for dental implant success.
Pretreatment evaluation includes a comprehensive evaluation of the patient's current medical and dental status, including systemic conditions, medications, habits (e.g., tobacco use), periodontal evaluation, and compliance with past and current preventive care. As clinicians, we know that identifying potential risk factors2 during pretreatment evaluation and any risk factors that develop after post-treatment will reduce potential complications for the dental implant patient. In a recent retrospective clinical study conducted by Hakam et al at the University of Florida College of Dentistry found patients who were prescribed antidepressants were at a higher rate of implant failure than non-users. The researchers also found that patients were at the greatest risk of implant failure when they were prescribed serotonin-norepinephrine reuptake inhibitors (SNRI) and tricyclic antidepressants (TCA), as opposed to patients prescribed selective serotonin reuptake inhibitors (SSRI), atypical antidepressants (AA), and monoamine oxidase inhibitors (MAOI) antidepressants.57 In a recent systematic review and meta-analysis Naseri et al found that patients who smoked >20 cigarettes a day had greater implant failure than patients who did not smoke. The researchers concluded an elevation in dental implant failures with the number of daily cigarettes consumed by patients.50Another recent meta-analysis conducted by Kim et al found two factors that affected dental implant failure: smoking and residual bone height.51Medical and systemic issues, such as patients diagnosed with poorly-controlled diabetes, bone metabolic diseases such as osteoporosis, radiation therapy, bisphosphate therapy, immunosuppression medications, and immunocompromising diseases are risk factors that will be discussed with the patient.18,40 A recent systematic review by Bazli et al found osteoporosis, smoking, and head and neck radiotherapy were higher risk factors in dental implant failure.52 Behavioral conditions that may interfere with treatment and post-treatment care include tobacco use, substance abuse, and parafunctional habits. Current infection such as periodontal disease or other pathologies of the oral cavity will provide a current comprehensive evaluation of the patient used to determine if the patient is an appropriate candidate for dental implants or another type of prosthesis.48