Patient Selection

All of the clinical procedures explained below are surgical interventions and the outcomes are directly related to not only clinical skills and expertise, but also to appropriate patient selection. Some examples of relative contraindications to such interventions include a medically compromised patient with conditions such as neuropsychiatric disorders and severe bleeding disorders, and patients with a history of radiation therapy, intravenous bisphosphonate therapy, uncontrolled diabetes and heavy smoking to name a few.3 These systemic contraindications may be relative or absolute depending on the severity of the disease and the ability of the team, including the patient’s physician, to manage the condition.

As a general rule patient’s dental compliance, periodontal stability, caries control, restorability and prognosis of remaining teeth should be assessed and addressed as needed before performing any grafting procedure. Deep probing depths in patients with uncontrolled periodontal disease or high plaque / bleeding on probing scores in patients who are non-compliant with oral hygiene instructions can result in poor healing post surgically and complications such as infections, graft exposure and loss of native bone.

In fact, poor oral hygiene, history of periodontal disease, smoking, uncontrolled diabetes are all proven risk factors for peri-implant mucositis and peri-implantitis.4-6 Hence, these patients are not eligible candidates for grafting and dental implant therapy.

Clinicians should be cognizant of systemic and local contraindications and be selective of patients receiving grafting and implant surgeries to avoid mishaps.