Implantology and Pre-prosthetic Surgery
This domain tests site assessment, biomechanics, grafting and complication prevention.
Core rules
- Assess bone volume, density, soft tissue, occlusion and medical risk. Use CBCT with a radiographic stent.
- Primary stability depends on bone density and implant macrogeometry. Avoid vital structures: inferior alveolar canal, mental foramen, lingual nerve and maxillary sinus.
- Grafting options include autograft, allograft, xenograft and alloplast. Guided bone regeneration and sinus lift, crestal or lateral, expand sites.
- Loading can be immediate, early or conventional; control micromotion.
- Peri-implantitis presents with plaque, bleeding, pocketing and bone loss. Treat with debridement, hygiene instruction and surgery when needed.
- Pre-prosthetic surgery includes tuberosity reduction, vestibuloplasty, frenectomy and ridge augmentation.
Worked example
A posterior maxilla has 4 mm of bone below the sinus. Options include short implants, lateral sinus lift with delayed placement, or a crestal approach if anatomy allows. Choose based on residual bone, sinus anatomy and restorability.
Traps
Placing implants in the posterior mandible without CBCT; ignoring smoking and uncontrolled diabetes; immediate loading without stability; failing to check occlusion.