Basic information on the SURGICAL PROCEDURE - Straumann

2. PrinciPLes of treatment PLanninG
Indications and contraindications for implant placement
treatment planning is essential for the long-term success of oral rehabilitation using
dental implants. from the very beginning, indications and contraindications
must be carefully balanced for each patient, who is eligible for implant therapy.
indeed, proper patient selection is one of the most important steps in treatment
planning (Blanchaert 1998). therefore, the implant surgeon must have a sound
knowledge of the indications and contraindications for implant placement.
General and medical aspects (Table 3.1)
Prior to any dental or surgical procedure, a medical history must be obtained from the
patient. the knowledge of former and current diseases, surgeries, and medications
helps to identify patients who are “at risk“. When there are doubts, the physician or
medical specialist treating the patient must be consulted for further clarification.
a general prerequisite for implant placement is that the patient must have an undisturbed
wound healing capacity. in addition, implants should not be inserted before jaw
growth is complete (cronin et al. 1994; thilander et al. 1994). however, implants
might be installed before end of growth in special indications, e.g. for orthodontic
reasons (Bergendal et al. 1996; Wehrbein et al, 1996).
in the following, general medical contraindications have been arranged in two
groups: “risk factors“ and “high risk factors“.
High risk factors
p serious systemic diseases like rheumatoid arthritis or osseous disorders like
osteomalacia or osteogenesis imperfecta are considered high risk factors.
however, osteoporosis does not contraindicate the use of dental implants (Baxter &
fattore 1993; Dao et al. 1993).
p Patients who are immunocompromised due to viral infection (hiv) or medication
(cortico-steroids, oncologic chemotherapy or other immunosuppressives) have
a clearly reduced wound healing capacity and an inappropriately responding
immune system.
p alcohol and drug abusers as weil as patients with psychological or mental
disorders are not reliable with regard to compliance, home care and follow-up
appointments (uncooperative patient) (hogenius et al. 1992).