2. Dental implants may be considered for
any
patient in
Reasonable Health
who desires the replacement of missing
teeth and has enough bone in the area
or
can undergo a bone augmentation
procedure.

3. The survival of dental implants
may be
influenced by a number of
local and systemic conditions
affect the process
of osseointegration directly

4. The bone and soft tissue
response following dental
implant placement is
controlled by:
Wound healing
Biomechanics
Mineral metabolism

5. Reasonable Health
ASA Classification of Physical Status
P1: Normal, healthy patient
P2: Patient with mild systemic disease with no functional limiltation,
ie, a patient with a significant disease that is under good day to day
control,
eg controlled hypertension, oral agents for DM, mild COPD
P3: Patient with severe systemic disease with definite functional
limitations, ie, patient who is concerned with their health problems
each day, eg. a
DM on Insulin, significant COPD
P4: patient with severe systemic disease that is constant threat to
life
P5: Moribund patient who is not expected to survive 24hrs
P6: Declared brain dead

6. Local and Systemic Factors
Age
Increasing age has no
significant effect on
osseointegration or the
rate of crestal bone
resorption around dental
implant
Schliephake H et al, Int J OMS
Implants 1993

7. Local and Systemic Factors
Patient Expectations
Recent studies showed improved quality of life
(comfort, function, speech, esthetics, self image)
following dental implant therapy) Cibirka RM et al J Prost
Dent 1997

8. Local and Systemic Factors
Smoking
Accelerates bone resorption around
dental
implant Lindquist LW et al J Dent Res 1997
Greater risk of peri-implantitis espicially
the
maxilla Haas R et al J Prost Dent 1996
Interferes with osseointegration Kearns G
et al Oral Med
Oral Path Oral Rad Endod1999
Failure Rate?

9. Smoking
Systemic and local injury to the tissues
Decrease tissue Oxygenation
Nicotine: Decrease blood flow
Decrease collagen deposition
Increase blood viscosity
Delay wound healing

10. Smoking
Increase failure rate 20% (Moy P et al Int J OMS implant
2003)
Advice on smoking
Smoking cessation during the healing
phase
improved implant survival. Crews KM et al Gen Dent 1999
Strict OHI
Submerged implants

11. Local and Systemic Factors
OSTEOPOROSIS
A progressive systemic disease
characterized by low
bone mass and deterioration of bone mass
and
deterioration of bone tissue, leading to
bone fragility
and fracture
Long term maintenance of a rigid implant
interface
requires continual bone remodeling.
Roberts WE et al 1992
Implant Dent.
Osteoporosis can cause oral bone loss.
Baxter and Fattore J
Prosthodont 1993

12. A Bianchi and F Sanfilippo Int Periodontics
Restorative
Dent 2002
(The integration of missing teeth and the
rehabilitation of
the functional integrity of the
stomatognathic system,
have a positive influence on the local
metabolic activity
of the bone. Effective chewing; Diet)
Oppose bone resorption along the
residual ridge Von
Wowern et al 1990
Bone tissue settles specifically around the
loaded
implant. Steflik J Oral Implantol 1995
Increase density of bone around implant.
Bianchi et al 1999

13. OSTEOPOROSIS
Dental implants are not contraindicated
for
patient with osteoporosis, provided that
their
general condition is strictly controlled.
HRT.

14. Local and Systemic Factors
DIABETES MELLITUS
Between 120-140 Million people suffer
from D M
worldwide. 2025 It is expected to double.
Well controlled D.M patients are suitable
for implant
surgery under antibiotic cover. Adell R
1992
Controlled D M patients, 3 times likely to
develop
implant failure. Moy P et al 2003
Increased failure rate occurred during the
first year
following prosthetic loading. Fiorellini et
al 2000

15. DIABETES MELLITUS
Microvascular disease of the gingiva
affect blood
supply and delay wound healing and
increase
infection. Shernoff AF et al 1994
Tissue hyperglycemia affect the immune
system,
including neutrophill and lymphocyte
function,
chemotaxis and phagocytosis

16. Local and Systemic Factors
Cytotoxic chemotherapy
Chemotherapy following dental implant
therapy may have
little effect on implant osseointegration
or survival.
McDonald et al J Oral Implantol 1998
Dental patients experience complications
following
chemotherapy. Karr RA et al J Prosthet
Dent 1992
Concurrent chemotherapy is associated
with high failure
rate and contraindicates the placement of
dental
implants. Wolfaardt et al 1996

17. Cytotoxic chemotherapy
Thorough and regular implant hygiene
Delay dental implant placement following
chemotherapy until blood values
normalize

18. Local and Systemic Factors
Bone marrow transplant
Implant placement should be delayed
until
chemotherapy has ended and the marrow
graft
has taken

19. Systemic drugs
Cytotoxic chemotherapy
Peri-implant soft tissue hyperplasia
Steroids

20. Steroids
Ulcerative Colitis, Crohns disease, Asthma
Organ transplant…..
Osteoporosis
Delayed wound healing
Susceptibility to infection
Success rate 88%. Peter et al J OMS
Implant

21. Local and Systemic Factors
HIV
Risk of peri-implantitis
OHI and long term follow up
Successful results in HIV positive patients
Rajnaz
ZW and Hochestter RL J Periodontol 1998

22. Local and Systemic Factors
Hypohydrotic Ectodermal Dysplasia
Scleroderma
Sjogren Syndrome
Multiple Myeloma
Cleido-Cranial Dysplasia

23. Oral factors
Periodontitis and
periapical lesions
Past or present
periodontal disease
compromised implant
suvival. Cyril et al Int J OMS 2004
Comparable results. Cosci F
and Cosci B Compend Contin. Edn Dent
1997

24. Oral factors
Head and Neck Radiotherapy
Failure rate can range up to 30%
Wermeister R et al J
Craniomaxillofac Surg 1999
Risk of osteoradionecrosis, especially
with
irradiation dose above 50Gy.
Most implant fail in the first 2 years.

25. Head and Neck Radiotherapy
Hypocellularity, Hypovascularity,
Hypoxemia.
Xerostomia
Mucositis
Mucosal Atrophy

26. 6-12 month recovery period after
irradiation. Visch LL et al J
Ivest Surg 1994
Pre-surgical Hyperbaric Oxygen.
Granstrom G et al 1992
Long term follow up
Smoking
Minimal reflection of periosteum
Prolong healing period. Takeshita F J
Periodontol 1998
OHI

27. 6-12 month recovery period after
irradiation. Visch LL et al J
Ivest Surg 1994
Pre-surgical Hyperbaric Oxygen.
Granstrom G et al 1992
Long term follow up
Smoking
Minimal reflection of periosteum
Prolong healing period. Takeshita F J
Periodontol 1998
OHI

28. Oral factors
Oral Lichen Planus
Erosive LP has been associated with
dental implant loss,
possibly because of altered capacity of
the oral
epithelium to adhere to the titanium
surface, Lekholm U
1997
Reticular LP does not appear to influence
dental implant
survival. Lekholm U 1997
Trauma due to implant surgery may
exacerbate OLP
lesions. Katz J et al J Clin Periodontol
1988

29. Oral Lichen Planus
Patient should be warned of exacerbation
of
OLP
Risk of failure in case of Erosive LP

30. Oral factors
Oral Pre-malignant
Lesions
The effect of dental implant on
oral pre-malignant lesions is
unknown.
Sq C Carcinoma arise around
dental implant. Clapp C et al Arch
Otolaryngol Head Neck Surg 1996
Radiotherapy

31. Diseases Relevant to Surgical
Procedure
Bleeding Disorders
Liver Disease
Pregnancy
D.M.
Asthma
Renal disease
Hypertension
Peptic Ulcer

32. Diseases Relevant to Surgical
Procedure
Cardiac diseases
Cardiomyopathy
Pericarditis
Coronary heart disease
Rh heart disease
Do not contribute to implant failure.
Smith RA et al Int J OMS
implants 1992
Assess risk of endocarditis

33.  It is the evaluation of all circumstances that
can affect the outcome of a therapeutic
intervention.
 In the case of dental implants the
assessment is to identify variables that
increase the risk of complications leading to
implant loss.

34.  Risk assessment should be performed:
1) Before placement of implants (designed to
avoid high failure rates by identifying suitable
candidates for implant treatment).
2) During the phase of implant placement and
osseointegration (designed to identify and
avoid technical issues that can affect implant
survival).
3) During the phase of implant maintenance
(designed to minimize failure by heading off
problems).
4) After an implant has failed and been removed
( to identify the causes of failure ) .

35.  It is an environmental, behavioral, or
biological factor.
 If present directly increases the
probability of a disease occurring and, if
absent or removed, reduces that
probability.

36.  In the case of risk assessment for implant
failure, risk factors can be broadly
categorized as
1) Local risk factors.
2) Systemic risk factors.
3) Behavioral risk factors.

37. 1. Taking thorough medical/dental histories.
2. Complete examination of the prospective
candidate for dental implants.

38.  A comprehensive evaluation of the patient
should contain a review of past dental
history including:
1) Earlier periodontal treatment.
2) Reasons for tooth loss.
3) How extraction sockets were treated at the
time of extraction.
4) History of increased susceptibility to
infection.

39. 5) Awareness of parafunctional habits such
as clenching and grinding.
6) Evaluation of the patient’s socioeconomic
status.
7) Dissatisfaction with earlier dental
treatment may indicate an increased risk
for complications during implant therapy.
 The comprehensive medical history should
include past and present medications and
any substance abuse.

40.  A complete intraoral examination should be
performed to determine the feasibility of placing
implants in desired locations.
 This examination includes:
1. Oral hygiene status.
2. Periodontal status.
3. Jaw relationships.
4. Occlusion.
5. Signs of bruxism.
6. Temporomandibular joint conditions.

41. 7. Endodontic lesions.
8. Status of existing restorations.
9. Presence of non-restored caries.
10. Crown-root ratio.
11. Interocclusal space.
12. Available space for implants.
13. Ridge morphology.
14. Soft and hard tissue conditions.
15. Prosthetic restorability.

42.  Radiographic evaluation of the
quality and quantity of available bone
is required in order to determine the
optimal site(s) for implant placement.

43. 1. Periapical radiographs.
2. Panoramic projections.
3. Cross-sectional tomographic images give
accurate estimation of bone height and
width.

44.  A comprehensive radiographic evaluation
minimizes the risk of injuring vital
anatomic structures during the surgical
procedure and is also helpful in
determining which cases require bone
augmentation surgery before implants can
be placed.

45.  An evaluation of the quality and quantity
of peri-implant soft tissues at the
proposed implant site will help determine
how closely this tissue will mimic the
appearance of gingival tissue once the
implant has been inserted.

46.  The presence of keratinized mucosa around
a dental implant is an important part of an
esthetically successful dental implant.
 It is important to evaluate the patient’s
perception of esthetics prior to implant
placement especially in situations with
compromised hard and soft tissues.

47.  Diagnostic casts and intraoral photographs
can be helpful in evaluating potential esthetic
outcomes as well as in the overall treatment-
planning process.
 In general, to minimize the risk of implant
complications and failure, any diseases of
the soft or hard oral tissues should be
treated before implant therapy.

48.  Post-operative infections increase the risk of
early implant failure.
 It is important to perform implant surgeries
with a strict hygiene protocol to minimize
bacterial contamination of the surgcial site.

49.  The incidence of post-operative infection
associated with implant placement is only about
1% (Powell et al. 2005), some clinicians attempt
to reduce this risk by prescribing pre-operative
systemic antibiotics (Dent et al. 1997; Laskin et
al. 2000).
 In addition, the results of several case-control
studies indicate that there is no advantage in
using antibiotics in conjunction with implant
placement (Gynther et al. 1998; Morris et al.
2004; Powell et al. 2005).

50.  Surgical techniques that are designed to
avoid unnecessary tissue damage should be
used.
 Thermal damage to bone can be caused
during the drilling sequence if dull drills are
used or if osteotomy is performed without
using enough liquid coolant.

51.  Post-insertion stability lowers the risk of
implant complications or failure.
 The presence of good-quality bone with a
sufficient amount of cortical bone at the
implant site is desirable to achieve this
objective.

52.  In situations where there are less than
optimal bone conditions. (thin cortect, low
trabecular density), increased initial
stability can still be established by using
implants with rough surfaces, parallel
walls, and optimal height and width.

53.  Anatomic structures that are at risk of
damage during the placement of implants
include:
 Nerves,
 Blood vessels,
 Floor of the mouth,
 Nasal cavity, maxillary sinuses,
 Adjacent teeth.

54.  It is important to remember that the drills
used for osteotomies penetrate further
than the depth indicators on the drills.
 In certain situations radiographic
indicator methods should be performed
during surgery to help determine direction
of the implant and its proximity to vital
structures.

55.  For implants that are to be placed in the
mandible, the distance from the
edentulous alveolar crest to the upper
border of the inferior alveolar canal
should be assessed from cross-sectional
tomographic radiographs.

56.  The safety zone between the tip of the
implant and the border of the canal should
be at least 1-2 mm.
 Patients with compromised vertical bone
dimension can sometimes be treated by
placing multiple shorter implants of optimal
width followed by splinting the prosthetic
crowns together during the restorative phase
of therapy.

57.  The position of the mental formen should
be identified and located when implant
surgeries in the premolar and molar areas
of the mandible are performed.
 In some situations a loop of the nerve can
be found to extend mesially.

58.  In one report the anterior loop of the
mental neurovascular bundle extended
mesially from 1.1 - 3.3 mm and a safety
zone of 4 mm was recommended to avoid
damaging the nerve during implant
placement (Kuzmanovic et al.2003)

59.  When placing an implant in the anterior
part of the maxilla the size and location of
the incisive papilla need to be determined.
 In addition, it must be established if there
is enough bone in the area to place an
implant or if the area needs to be grafted.

60.  Anatomic concavities are frequently found
on the lingual side of the mandible.
 It is important to avoid perforating the lingual
plate during preparation of the implant site
since perforations in this location can result
in extensive and even life-threatening
bleeding (Bruggenkate et al. 1993)

61.  A safe way of performing surgery in this
area is to reflect a lingual flap at least to a
level corresponding to the length of the
implant to be placed.

62.  Poor oral hygiene and microbial biofilms are
important etiologic factors leading to the
development of peri-implant infections and
implant loss.
 Therefore any risk assessment for implant
survival should include an evaluation of the
patient’s ability to perform oral hygiene
procedures.

63.  There are several reasons to believe that
untreated or incompletely treated
periodontitis increases the risk for implant
failure.
1) There are case reports that suggest an
association (Malmstrom et al. 1990,
Fardal et al. 1999)

64. 2) A similar subgingival microbiota has
been found in pockets around teeth and
implants with similar probing depths.
3) Evidence exists that periodontal
pockets might serve as reservoirs of
pathogens that hypothetically can be
transmitted from teeth to implants.

65.  Peri-implant infections are caused by multiple
microorganisms living on the implant surface in
a biofilm.
 Peri-implant infections are not simply caused by
Gram-negative anaerobic bacteria.
 This group of bacteria is important, but yeasts
and Gram-positive bacteria as Micromonas
micros and Staphylococcus species are often
implicated in peri-implant infections.

66.  Subgingival sites are the natural or preferred
habitat of a diverse group of oral
microorganisms.
 In an interesting study of 15 patients, Devides
and Franco (2006) sampled mucosa-associated
biofilms of edentulous sites with paper points
and analyzed the specimens using polymerase
chain reaction (PCR) methods to detect certain
periodontal pathogens.

67.  At the edentulous sites Aggregatibacter
actinomycetemcomitans was detected in 13.3% of
subjects, Prevotella intermedia was detected in
46.7% of subjects, and Prophyromonas gingivalis
was not detected.
 Six months after placement of endosteal implants
at the same sites, subgingival plaque samples
taken from around the implants were positive for
A. actinomycetemcomitans in 73.3% of subjects,
Pr. Intermedia in 53.3% of subjects, and P.
gingivatis in 53.3% of subjects.

68.  None of the implants showed any clinical
signs of either failure or peri-implantitis.
 These results indicate that healthy
subgingival sites around implants are
readily colonized by periodontal
pathogens without any development of
clinically detectable disease.

69.  It is important to remember that the
microbiota adjacent to failing implants will
differ depending on the cause of the failure.
 For example, the microbiota associated with
implants failing because of traumatic loads
was different to that found around implants
failing because of infection.

70.  There are several reports that the survival
rate of implants is decreased when the
patient has a history of periodontitis.
 Patients who have had periodontitis might
also be more susceptible to peri-implant
infections.

71.  However, this is clearly not always the
case since it has also been demonstrated
that periodontally compromised patients
who have lost a considerable amount of
alveolar bone can be successfully treated
with dental implants based on post-
insertion implant maintenance program.

72.  The presence of untreated or unsufficiently
treated endodontic infections adjacent to the
site of implant placement can adversely
affect the outcome.
 There are numerous reports of retrograde
peri-implantitis in which it is hypothesized
that a periapical infection on a tooth spreads
to an adjacent implant.

73.  It is clear that implants can be quite
successful when placed in patients who are
in their eighth and ninth decades of life.
 Several reports indicate that there is not a
statistically significant relationship between
age of the patient and implant failure.

74.  However, a thorough risk-assessment
process involves evaluation of multiple
possible risk factors.
 It is possible that some older patients might
have been excluded for medical reasons.
 Older individuals included were healthy
enough to be good candidates for implant
placement.

75.  A potential problem associated with the
placement of dental implants in still-growing
children and adolescents is the possibility of
interfering with growth patterns of the jaws.
 Osseointegrated implants in growing jaws
behave like ankylosed teeth in that they do
not erupt and the surrounding alveolar
housing remains underdeveloped.

76.  It is highly recommended that implants
not be placed until craniofacial growth
has almost complete.

77.  Cigarette smoking is often identified as a
statistically significant risk factor for implant
failure.
 The reasons that smokers are more
susceptible to both periodontitis and peri-
implantitis, but usually involve impairment of
innate and adaptive immune responses and
interference with wound healing.

78.  Smoking is such a strong risk factor for
implant failure that some clinicians
highly recommend smoking-cessation
protocols as part of the treatment plan
for implant patients.

79.  Bisphosphonates are drugs used for the
treatment of osteoporosis.
 These drugs are potent inhibitors of osteoclast
activaty, have a high affinity for hydroxyapatite
and have a very long half-life.
 An uncommon complication associated with the
use of bisphosphonates is the increased risk of
developing osteonecrosis of the jaws (ONJ) after
implant placement.

80.  Since bisphosphonates tightly bind to
hydroxyapatite and have a very long half-life,
it is likely that the length of time a patient has
been taking oral bisphosphonates is
important in determining the level of risk.
 In general, it is not recommended that
implants be placed in patients who have
been on the drug for more than 3 years.

81.  It has been suggested by some that
prolonged use of bisphosphonates is a
contraindcation to implant placement.
 It is important to remember that bone-
remodeling processes are severly inhibited
in patients who have been chronically taking
oral bisphosphonates for osteoporosis.
 Because of this such patients are poor
candidates for bone-grafting procedures and
sinus lift operations.

82.  Gingival enlargement has been reported
around dental implants in individuals taking
either phenytoin or a calcium-channel
antagonist.
 When there is significant gingival
enlargement around teeth or implants, oral
hygiene and maintenance procedures can
become quite difficult.

83.  Antimitotic drugs used as chemotherapy
for oral cancer might affect wound healing
and suppress certain components of the
immune system, it is important to know if
these drugs interfere with osseintegration
and success of dental implants.

84.  It has also been reported that some cancer
patients who received cytotoxic
antineoplastic drugs experienced infections
around existing transmucosal or endosteal
dental implants (Karr et al. 1992).
 Patients who are receiving cancer
chemotherapy should have thorough
periodontal and implant maintenance care to
minimize the development of adverse events.

85.  Patients who have blood-coagulation
disorders or are taking high doses of
anticoagulants are at an elevated risk of
post-operative bleeding problems after
implant surgery.

86.  In such patients, local bleeding after the
placement of dental implants can usually be
well controlled by conventional hemostatic
methods.
 The risk of developing life threatening bleeding
or bleeding that cannot be controlled by using
local measures following placement of dental
implants is so low so no need to stop oral
anticoagulant therapy.

87.  Corticosteroids can interfere with wound
healing by blocking key inflammatory events
needed for satisfactory repair.
 In addition, through their
immunosuppressive effects on lymphocytes,
they can increase the rate of post-operative
infections.

88.  In the early years of the AIDS epidemic
placement of dental implants was ill advised
since affected patients developed major life-
threatening oral infections.
 With the advent of effective HAART (highly
active anti-retroviral therapy) regimens, most
HIV-positive patients who take their
medications live for many years without
developing severe opportunistic infections.

89.  Low T-helper (CD4) cell counts (i.e.<200/L)
do not appear to predict increased
susceptibility to intraoral wound infections or
elevated failure rates of dental implants
(Achong et al. 2006).
 Although more studies are needed, it appears
that it is safe to place dental implants if the
patient’s HIV disease is under medical control.

90.  Patients who have received radiation to the
head and neck as part of the treatment for
malignancies are at an increased risk of
developing osteoradionecrosis (ORN).
 Implant failure rates of up to 40% have been
reported in patients who have had a history of
radiation therapy.

91.  It has been recommended that oral surgical
procedures in patients at risk of ORN be
performed in conjunction with hyperbaric
oxygen (HBO) therapy.
 From the perspective of risk- assessment
procedures for implant placement, patients
who have a history of irradiation to the jaws
should be considered at high risk or implant
failure and HBO interventions will probably
lower that risk.

92.  In the risk evaluation of diabetics it is
important to establish the level of
metabolic control over the last 90 days is a
blood test for glycosylated hemoglobin
(HbA1C).
 Normal values for a non diabetic or a
diabetic under good metabolic control are
HbA1C 6-6.5% and fasting blood glucose
(110 mg/dl ).

93.  Diabetics with HbA1C values of ≥8% are
under poor control and have an elevated
risk of encountering wound healing
problems and infection if dental implants
are placed.

94. Osteoporosis is a skeletal conditions
characterized by low bone mineral.
There are multiple case reports that
conclude that osteoporosis alone is not a
significant risk factor for implant failure (Dao
et al. 1993; Freiberg 1994; Fujimoto et
al.1996; Freiberg et al. 2001).

95. Implants placed in individuals with
osteoporosis appear to successfully Osseo
integrate and can be retained for years.
However, in cases of secondary
osteoporosis there are often accompanying
illnesses or conditions that increase the risk
of implant failure (e.g. poorly controlled
diabetes mellitus, corticosteroid
medications).

96.  Long-term success of dental implants
requires that the patient is able to
comply with the recommended post-
insertion maintenance procedures
required for long-term survival and
success of implants.

97.  Since poor oral hygiene is a documented
risk factor associated with failure of
implants, it is critically important that
patients understand this and are taught
the skills necessary to perform plaque
removal on a daily basis.

98.  In addition, since patient-performed oral
hygiene does not adequately remove disrupt
dental plaque biofilms at subgingival
locations, periodic maintenance visits are
needed.
 It is recommended that these visits be at 3-
month intervals.
 The patient’s compliance with the
recommended maintenance schedule is a
major key to long-term success.

99.  Patients who have addictions to alcohol and
drugs are usually poor candidates for dental
implants.
 Since the success of implant therapy
requires a considerable amount of patient
cooperation at all stages of care, individuals
with substance-abuse problems should
receive prosthetic care that does not
depend on implants.

100.  In general, Patients who have severe mental
health problems or exhibit psychotic
behavior are not good candidates for dental
implants.
 The cooperation needed for successful
implant therapy is missing.
 However, people with medically controlled
mental health problems, such as depression,
can be successfully treated with implants.

101.  It is important that the practitioner determine if
the information they tried to convey was
understood.
 One of the best ways to do this is to convey the
information in easily understood (nontechnical)
language and in small increments.
 Patients who understand what is being done are
usually quite cooperative and this cooperation
leads to the increased probability of successful
therapeutic outcomes.

102.  Daily self-care (oral hygiene) and
adherence to a maintenance-recall
schedule is absolutely required for long-
term success.
 This is best discussed to the patient at the
consultation visit.

103.  An effective way to reduce the risk of
implant complications and failure is to
stress the importance of the patient’s
role as and active participant in the
overall therapeutic program.
 Long-term success of both periodontal
and implant therapy depends on an
effective partnership between the patient
and practitioner.

104. 1. A Key part of implant therapy is the risk-
assessment process that includes thorough
medical and dental histories, a complete
clinical examination, and an appropriate
radiographic survey.
2. The presence of one risk factor alone is
usually insufficient to cause the adverse
outcome. It is the combination of multiple
risk factors that the has clinical importance.

105. 3. To minimize the risk of implant complication
clinicians can use a number of technical
procedures, such as adhering to a strict
hygienic surgical protocol, performing the
osteotomies with sharp drills, achieving early
implant stability, and avoiding damage to vital
anatomic structures during surgery.
4. Any endodontic, periodontal, and other oral
infections be treated prior to implant
placement.

106. 5. Existing evidence does not support the
routine use of pre-operative systemic
antibiotics in implant therapy.
6. Most of the systemic risk factors for implant
complications are those that increase the
patient’s susceptibility to infections or those
that interfere with wound healing.