Evaluating the suitability of a patient for tooth implants: The dental examination.

Before a dentist can determine that a patient is a suitable candidate for the placement of a tooth implant they will need to perform a clinical examination. This examination will need to include radiographs (x-rays) of the patient's teeth and jawbones.

The tooth implant examination: Evaluating the soft tissues of the mouth.

A portion of the dentist's clinical examination of the dental implant candidate will involve the evaluation of the soft tissues of their mouth. The dentist must determine that these tissues are free of pathology and appear to be health. They must also evaluate both the quantity and type of the gum tissue in the immediate area where the tooth implant will be placed so to determine if it is adequate.

The dental implant examination: Evaluating the patient's oral home care habits.

The dentist's clinical examination must also involve making a judgement about the effectiveness of the patient's oral hygiene habits. Some dental research has reported an association between ineffective tooth brushing and flossing and dental implant failure. This association, however, has yet to be definitively established.

It is known that if bacteria are allowed to colonize in the gum tissue surrounding an implant their presence can lead to an inflammatory response called peri-implantitis. If this condition is left untreated it can lead to a loss of supporting bone, a loss of implant osseointegration and ultimately implant failure. A failure to practice good oral hygiene may be due to a simple lack of motivation or, at the other extreme, a true deficit in the patient's manual dexterity, possibly due to advanced age or a debilitating medical condition.

The tooth implant examination: Evaluating the patient's jawbones.

The long-term success of a dental implant will be highly dependent upon the bone in which it is placed. Because of this the treating dentist will need to examine the patient's jawbones so to determine that both the quantity and quality of the bone in the region where the tooth implant will be positioned is adequate.

This examination will need to be twofold. One aspect will involve the visualization, palpation, and measurement of the jawbones. The other will involve the use of dental radiographs (x-rays). In many cases a combination of a panoramic and multiple periapical radiographs (the type of x-rays typically taken in dental offices) will be satisfactory for this examination. In some cases, however, the dentist may feel that they need the information that only a CT (computed tomography, CAT scan) can provide.

The patient's jawbone must offer an adequate quantity and quality of bone.

The dentist must find that there is an adequate quantity of bone in the region of the planned tooth implant and that this bone is of sufficient quality. Making this determination involves evaluating the shape of the bone (both width and height). It also involves evaluating the density of the bone (both outer cortical and inner medullary bone).

There can be situations where the treating dentist will find that the bone in the region of the planned implant is not adequate. This deficiency can be naturally occurring, such as that bone resorption (bone loss) that takes place in those regions where teeth have been extracted. This type of defect is most common in those cases where multiple teeth were extracted many years previously.

In other cases the bone deficiency can be attributed to dental disease, such as bone loss due to the effects of advanced periodontal disease (gum disease). Since the success of a dental implant will be greatly dependent upon the bone in which it is placed, the treating dentist may feel that it is necessary for them to perform a bone grafting procedure for their patient (such as a sinus lift) so to replace missing bone or add to existing bone.

As the dentist examines the patient and reviews their x-rays, they will search for other potential complications. The location of various anatomical structures, such as sinuses, nerves, blood vessels and the roots of adjacent teeth must be identified. This is important because tooth implants must be positioned in a fashion where they are suitably distant from these objects.

The dentist must also evaluate for evidence of pathology within the jawbone (such as tumors, cysts or bone disease). Impacted teeth and the presence of tooth root fragments (remnants of past extractions) need to be identified and removed as the dentist feels is indicated.