The medical evaluation of patients considering dental implant treatment is an important and vital aspect of the treatment planning process. The primary goal of the preoperative medical evaluation is to assess the risks associated with the dental implant treatment. Patients presenting for implant treatment may appear to be in a healthy state when they actually have serious underlying systemic diseases or are on medications that could predispose them to complications and increased treatment morbidity. Older patients today, even those with life-threatening diseases, are more socially active and have a better quality of life because of advancements in medical care. Therefore, these higher risk patients are increasingly seeking rehabilitation for edentulous areas with implants because of the high success rate and increase in dental function.
Numerous studies have been conducted evaluating the relationship between patients’ medical condition and dental implant morbidity. Scully concluded that 30% of patients seeking dental treatment have some type of relevant medical condition. 1 Silverman et al. evaluated dental patient medical histories and reported 15%–25% were described as “medically complex,” which includes a history of systemic diseases, multiple medications or age-related health issues. 2, 3 Medically compromised patients with diseases such as diabetes, osteoporosis and hypothyroidism have been reported through various studies to have significantly lower dental implant survival rates compared to healthy subjects. 4, 5
In addition to evaluating systemic diseases, clinicians must also take into consideration the relationship of prescription and over-the-counter (OTC) medication. For patients aged 60 and over, approximately 40% are taking five or more prescription medications, 15% are taking 10 or more prescription medications, and 67% are taking a combination of five or more prescription and OTC medications. 6 Many of these medications have a direct impact on the healing and success of dental implants.
Because many of our patients have underlying medical conditions and are taking medications that may impact dental implant treatment, it is imperative that implant clinicians have a thorough understanding of the medical evaluation process. This article is the first of three on the topic of the medical evaluation of dental implant patients. Part 1 will discuss the significance of the medical history, the differences between relative and absolute contraindications, and the importance of obtaining proper medical consultation/clearance for medically complex patients. Part 2 of this series will include a detailed overview of various systemic diseases that directly have an effect on the implant treatment, and Part 3 will discuss medications that directly impact the surgical and healing phases of implant treatment.
For patients considering dental implant treatment, medical evaluation is an important part of the treatment planning process.
