Treatment Planning Considerations for Implants
The success of implant restoration depends on the careful patient selection and comprehensive treatment plan. If the patient is a candidate for implant placement, a systematic protocol should be followed to assess the site.
Edentulous space evaluation:
Mesiodistal Width Evaluation:
The following guidelines should be used when selecting implant size and evaluating mesiodistal space for implant placement:
- The implant should be at least 1.5 mm away from the adjacent teeth. Eg: If a 4mm diameter single implant needs to be placed a 7mm mesiodistal width should be present.
- The implant should be at least 3 mm away from an adjacent implant.
Spacing is required to provide the following:
- To allow for 1.5 mm of crestal bone interproximally, this, in turn, will allow for proper development of a healthy papilla.
- To develop proper contacts and the contours in the restoration.
- To allow for an adequate width of soft tissue between implants and adjacent teeth..
- For the prosthetic components not to impact on each other..
- For the effective cleaning of the prosthesis by the patient..
- To allow for at least 1 mm space from the implant to the adjacent root.
Bucco-lingual width evaluation:
- The minimum bone width of 1 mm should be present on buccal/facial and lingual/palatal side of the implant to keep the soft tissue levels stable.
In the anterior maxilla, the facial surface should have 1.5mm of bone. This is critical on the facial side since any bone resorption will give the unesthetic appearance.
Available Bone Height:
The height of the available bone is measured from the crest of the edentulous ridge to the anatomical landmarks that limit the placement of the implant:
- The safe distance from the implant to maxillary sinus should be 1mm.
- From the inferior alveolar nerve canal to the implant a minimum of 2mm of bone should be present.
- Implant with 10mm of height is considered to have increased prognosis of implant survival.
Interocclusal Space Evaluation:
A satisfactory restorative outcome is obtained only if adequate crown height space is available. Ideally, for cement-retained prosthesis a min of 7mm crown height space is needed.
In case the crown height space is less than 7mm, a screw-retained restoration is required since it can screw directly onto the implant body. A thorough evaluation of the edentulous space and soft tissue will help make a predictive treatment plan.