NMDA Journal Summer 2020

15 nmdental.org continues on page 16  Case Selection to Optimize Success in Implant Dentistry Figure 1— Figure 2— Figure 3— an opportunity to determine the patient’s per- sonality type to facilitate better communica- tion and optimize the doctor patient relationship. This conversation provides a basis for sharing the results of the examination with the patient and helps educate the patient so theymay develop realistic expectations. This begins the process of case selection by the den- tist. The following photographs illustrate why this is such an important step in case selection. This patient presentedwith a large vertical and horizontal defect in the premaxilla (Figure 1). Figure 2 shows the appearance of two central incisors replaced by implant retained restora- tions and Figure 3 shows the restorations with the lips retracted. The patient was very pleased with the aes- thetic result in this case because her expecta- tions were reasonable considering the defect that she presented with, but that might not have been the case had the dentist not taken the time to discuss her expectations and what the dentist would be able to accomplish with the treatment that she chose prior to begin- ning her case. I can recommend two books that will help with this portion of the examina- tion: A Philosophy of the Practice of Dentistry by L.D. Pankey and William J. Davis, and People Styles atWork by Robert Bolton and Dorothy Glover-Bolton. Medical history is an important step in case selection. Fortunately, there are relatively few absolute contraindications to dental implant treatment. Dental implant placement is an elective surgery therefore any condition such as pregnancy, uncontrolled diabetes or a recent myocardial infarction that would be a contraindication to elective surgery is also a contraindication to dental implant treatment. The American Society of Anesthesiologists (ASA) classification is also useful for medical evaluation of dental implant patients. Dental implant treatment is contraindicated in patients with severe systemic disease. Patients withmild tomoderate systemic disease may be treated utilizing dental management tech- niques based upon the patient’s medical con- ditions. Pertinent discussions of medical evaluation can be found in the texts Contem- porary Implant Dentistry by Carl Misch and in Dental Management of theMedically Compro- mised Patient by James Little. There are some common medications that have been shown to have an effect on implant osseointegration. We should consider these medications in case selection and in informed consent as they may lead to a higher implant failure rate.