Deviation in the Standard of Dental Care When Treating a Patient Requesting Dental Implants

Evaluate breaches in the standard of care when evaluating whether or not there was a Deviation in the Standard of Dental Care When Treating a Patient Requesting Dental Implants

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following indications for a dental implant did the patient present?(Choose all that apply)
    Single missing tooth
    Dental gap with clear disadvantage for conventional therapy
    Free end gap in opposing jaw contraindicating removable prosthesis
    Edentulous upper and lower jaw
    Support of fixed partial prosthesis
    None of the above
    Why is this important?
    Successful implant treatment is dependent on a coordinated approach combining careful treatment planning, meticulous surgical technique, and precise prosthetic restoration.
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  • Was medical history obtained? Why is this important?
    Answer this question
    
A thorough medical history is required and must be documented for every dental patient. As with any patient planning a surgical procedure, the patient must be assessed preoperatively to evaluate his or her ability to tolerate the proposed procedure, heal, and to have a favorable prognosis. Patients can have a variety of health problems that require treatment modification or medical management before the oral surgery can be safely performed. Special measures may be needed to control bleeding, lessen the chance of infection, or prevent a medical emergency.

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  • With which of the following contraindications did the patient present?(Choose all that apply) Why is this important?
    Answer this question
    
The ultimate goal of dental implant therapy is to satisfy the patient's desire to replace one or more missing teeth in an esthetic, functional manner with long-term success. To achieve this goal, clinicians must accurately and comprehensively assess the dentoalveolar condition as well as the overall physical and mental well-being of the patient.

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  • Was the patient advised of the risk factors associated with implant placement? Why is this important?
    Answer this question
    
In situations with an enhanced risk of implant failure tooth preservation is preferred and extraction and further implant surgery is avoided.

    (2010) 104 JPRDEN 2 80-91 



  • Which of the following imaging modalities were performed prior to the procedure?(Choose all that apply) Why is this important?
    Answer this question
    
The success of dental implant surgery and restoration relies on diagnostic imaging.

    (2011) 55 EDECNA 1 141-158 



  • Were diagnostic casts and photographs obtained for treatment planning pre-operatively? Why is this important?
    Answer this question
    
Mounted study models as well as intraoral and extraoral photographs complete the records collection process. Study models and photographs are often overlooked in pre-operative record taking, but both contribute significantly to the assessment and treatment planning phases of implant dentistry.

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  • Was an informed consent obtained prior to the procedure? Why is this important?
    Answer this question
    
The laws of most states require that the dentists obtain informed consent before providing any treatment.

    (2011) 23 EOMSCA 3 475-484 



  • Was a pre-operative evaluation performed prior to the placement of implant? Why is this important?
    Answer this question
    
Implant placement surgery can be performed with great accuracy and with little complication if the case has been diagnosed, planned, and surgically performed well. But as with any surgical or clinical procedures, complications are possible. The oral examination helps assess the current health and condition of existing teeth as well as the oral hard and soft tissues. It is imperative to recognize any pathologic conditions present in any of the hard or soft tissues or the presence of acute or chronic infection.

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  • Were all the objective findings documented? Why is this important?
    Answer this question
    
The American Association Oral and Maxillofacial Surgeon parameters of care includes documentation of objective findings, diagnoses and patient management interventions.

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  • Was an implant configuration performed prior to the procedure? Why is this important?
    Answer this question
    
Implant configuration is an essential requirement for implant success. Among the related implant parameters, diameter and length play key roles in implant success, since they directly influence the primary stability, placement and removal torque values.

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  • Were prophylactic antibiotics administered? Why is this important?
    Answer this question
    
Antibiotic prophylaxis for dental procedures is reasonable only for patients with cardiac conditions associated with the highest risk for adverse outcomes from endocarditis.

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  • What type of anesthesia was administered? Why is this important?
    Answer this question
    
Profound local anesthesia is needed if the tooth is to be removed without sharp pain for the patient. Dense local anesthesia results in the loss of all pain, temperature, and touch sensations, but it does not anesthetize the proprioceptive fibers of the involved nerves. Thus, during an extraction, the patient feels a sensation of pressure.

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  • Was a sterile environment maintained? Why is this important?
    Answer this question
    
Surgeons must prevent inadvertent injury or transmission of infection to their patients or to themselves. The principle of universal precautions states that all patients must be viewed as having bloodborne diseases that can be transmitted to the surgical team and other patients. To prevent this transmission, surgical gloves, surgical mask, and eyewear with side-shields are required.

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  • Which type of dental implant surgery was performed? Why is this important?
    Answer this question
    
In a clinical situation where adequate primary stability is achieved, a single-stage, non submerged implant would be appropriate. In such a case, the implant may be loaded immediately after surgery. In areas where implant primary stability may be less, a submerged, nonloaded healing period, followed by surgical uncovering of the implant would be required (two-stage surgery).

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  • Was a post-operative radiograph obtained to evaluate the position of the implant? Why is this important?
    Answer this question
    
A radiograph should be taken post-operatively to evaluate the position of the implant in relation to adjacent structures such as the sinus and the inferior alveolar canal and relative to teeth and other implants.

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  • Which of the following medications were prescribed to the patient?(Choose all that apply) Why is this important?
    Answer this question
    
Antibiotics are prescribed for the prevention of post-operative infections. Both antibiotics and anti-inflammatory medications will offset post-extraction infection and aid in relieving pain.

    (2012) 56 EDECNA 1 75-93 



  • Were post-operative instructions provided to the patient? Why is this important?
    Answer this question
    
The clinician should provide adequate instructions to the patient regarding proper maintenance of the mouth and implant to ensure its durability and success.
127 AJOADO 6 713-722 



  • Was the patient evaluated weekly for wound healing? Why is this important?
    Answer this question
    
The patient needs to be evaluated weekly until soft tissues wound healing is complete (approximately 2 to 3 weeks). If the patient wears a tissue-borne denture over the area of implant placement, the denture can be relined with a soft liner after 1 week.

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  • Which of the following complications did the patient experience?(Choose all that apply) Why is this important?
    Answer this question
    
Immediate post-operative complications associated with implant placement are implant mobility, pain, numbness, trauma, infection and bone fractures. The healthcare professional should identify these complications and mange them appropriately.

    (2003) 15 EOMSCA 2 243-249