Australian Dental Journal 2008; 53:(1 Suppl): S3–S10

doi: 10.1111/j.1834-7819.2008.00036.x

Patient assessment and diagnosis in implant treatment

NU Zitzmann,* MD Margolin,  A Filippi,à R Weiger,* G Krastl*
*Clinic for Periodontology, Endodontology and Cariology, University of Basel, Switzerland.
 Private Practice, Zurich, Switzerland.
àDepartment of Oral Surgery, Oral Radiology and Oral Medicine, University of Basel, Switzerland.

ABSTRACT
As in any dental treatment procedure, a thorough patient assessment is a prerequisite for adequate treatment planning
including dental implants. The literature was searched for references to patient assessment in implant treatment up to
September 2007 in Medline via PubMed and an additional handsearch was performed. Patient assessment included the
following aspects: (1) evaluation of patient’s history, his ⁄ her complaints, desires and preferences; (2) extra-and intra-oral
examination with periodontal and restorative status of the remaining dentition; (3) obligatory prerequisites were a
panoramic radiograph and periapical radiographs (at least from the adjacent teeth) for diagnosis and treatment planning.
Additional tomographs are required depending on the anatomic situation and the complexity of the planned restoration;
(4) study casts are needed especially in more complex situations also requiring a diagnostic set-up, which can be tried-in and
transferred into a provisional restoration as well as into a radiographic and surgical template. The current review clearly
revealed the necessity for a thorough, structured patient assessment. Following an evaluation, a recommendation is given for
implant therapy or, if not indicated, conventional treatment alternatives can be presented.
Key words: Dental implants, patient assessment, implant indication.
Abbreviations and acronyms: ASA = American Society of Anesthesiology; BON = bisphosphonate-associated osteonecrosis; FDP = fixed
dental prostheses; OVD = occlusal vertical dimension; RDP = removable dental prostheses; VAS = visual analogue scale.

risk of treatment failure and complications is required

INTRODUCTION
as implant treatment outcomes are not as predictable
When considering implant treatment in a particular as that of the conventional therapies with fixed (FDP)
case, the practitioner has to evaluate whether oral or removable dental prostheses (RDP), particularly in
implants are indicated: (i) for this particular patient; circumstances where aesthetic considerations are the
(ii) in this specific oral situation; and (iii) within the overriding concern. The application of a systematic
framework of a comprehensive reconstructive treat- patient assessment and a straightforward diagnostic
ment planning. During the last decade the use of planning procedure facilitates an optimal treatment
implants has widely spread among practitioners with recommendation and helps to avoid failures and
increasing demand from patients and heavy marketing complications.
by the companies. However, reports about alarming In the following review the current literature has
implant failures are emerging in the literature which are been examined in order to analyse the available
mainly related to implant malpositioning as a result of evidence on patient assessment for implant treatment.
poor treatment planning.1 In addition, the number of Special consideration is given to three typical situations:
late implant failures associated with peri-implantitis is single tooth replacement, partial endentulism and
increasing. Since peri-implantitis is caused by microbial edentulous jaws.
biofilm, and patients with a periodontal history are at
higher risk, patient selection, personal oral hygiene and
Literature search strategy
professional maintenance become important factors
when trying to determine from the outset an optimized The literature was searched for references to patient
prognosis for a particular patient. The increasing assessment in implant treatment up to the end of
number of malpractice lawsuits2 means a thorough September 2007 in Medline via PubMed. An additional
evaluation of patient history and an awareness of the handsearch of references in the retrieved articles was
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performed and the first author’s own research material

and personal collection of relevant publications were
used for the analyses. The PubMed search was restricted
to articles published in 2000 or after. The keywords used
in the database search were ‘‘patient assessment’’ and
‘‘dental implants’’ retrieving 222 references, as well as
‘‘dental implants’’ and ‘‘implant indication’’ and ‘‘diag-
nosis’’ leading to 28 additional references. Titles and
abstracts of the selected articles were then all screened
and considered for inclusion in the current review if the
following criteria were met: (1) information concerning
implant indications and contraindications; (2) informa-
tion given on how to examine the implant patient;
(3) information relevant to diagnostic techniques in the
implant patient. Applying these inclusion criteria, full
texts were examined from 20 articles retrieved from
PubMed, and from 22 articles retrieved by handsearch-
ing. Of those, 20 references were selected for data
extraction related to assessment and diagnosing of the
prospective implant patient.

Patient’s history and implant contraindications

During the first consultation, possible implant contra-
indications should be ruled out during the course of the
examination. A medical questionnaire will aid in the
initial interview and includes past and current diseases,
temporary and long-term medication, smoking status
and special dietary features. Additional questions
address the age of any existing prosthesis and the
presumed reason for tooth loss (caries, periodontal
disease, trauma or others; Fig 1). Recurrent decay
indicates a high caries activity, which might be — in
addition to the required diet recommendations — a
decisive factor as to whether to maintain or replace a
questionable abutment tooth. Patients with a periodon-
tal history are at higher risk for potential peri-implan-
titis leading to late implant failure.3 This knowledge
may also affect treatment planning. Anterior tooth loss
following accidental trauma is frequently associated
with advanced alveolar ridge defects and potential
involvement of adjacent teeth has to be ruled out.
In general, insufficient bone quantity for implant
stabilization is no longer regarded as a contraindication
due to the successful application of augmentation
procedures using guided bone regeneration.4 The
additional effort, however, should be within reason
and the patient must be willing to take upon him ⁄
Fig 1. Checklist for patient’s assessment.
herself the surgical burden especially when two-staged
procedures with bone grafts from extra-oral sites are
needed.
General contraindications for implant treatment are supervision (Table 1). The chronological age per se is
rare and mainly related to an increased risk for not a contraindication for implant placement but,
patients undergoing the surgical procedure, e.g., particularly in older patients, the decision should
patients in poor general health, which could interfere depend on the treatment necessity and patient’s ability
with the surgical treatment and ⁄ or require medical to tolerate the procedure.
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 Patient assessment and diagnosis

Table 1. Contraindications and increased risk for implant failures

Disease Assessment

Medical • acute infectious diseases – absolute, but temporarily; wait for recovery
contraindications • chemotherapy – absolute, but temporarily; reduced immune status
• systemic bisphosphonate medication – risk of bisphosphonate-induced osteonecrosis (BON)
(‡2 yr)
• renal osteodystrophia – increased risk for infection, reduced bone density
• severe psychosis – absolute; risk of regarding the implant as foreign body and
requesting removal despite of successful osseointegration
• depression – relative
• pregnancy – absolute, but temporarily; to avoid additional stress and
radiation exposure
• unfinished cranial growth with – relative, but temporarily; to avoid any harm to the growth
incomplete tooth eruption plates, to avoid inadequate implant position in relation to
the residual dentition; utilize hand-wrist radiograph to
evaluate end of skeletal growth single tooth implants
in the anterior region not before 25th yr of age.5
Intra-oral • pathologic findings at the oral soft- – temporarily; increased risk for infection, wait until healing is
contraindications and ⁄ or hard tissues completed
Increased risk • post head and neck radiation therapy – reduced bone remodelling, risk of osteoradionecrosis, implant
for implant failure placement 6–8 weeks before or ‡1 yr after radiotherapy
• osteoporosis – reduced bone to implant contact;6 consider calcium substitution,
prolong healing period and avoid high torque levels for abutment
screw fixation
• uncontrolled diabetes – eventually wound healing problems (impaired immunity,
microvascular diseases)
• status post chemotherapy, – eventually wound healing problems, medical advice required
immuno-suppressants or steroid (consider corticosteroid cover)
long-term medication, HIV infection
• alcohol and drug abuse, heavy – eventually wound healing problems, locally reduced
smoking ‡20 cig ⁄ d vascularization7
• history of aggressive periodontitis – increased risk to develop peri-implantitis

In young adults requiring single tooth replacement smoking, a high American Society of Anesthesiology
in the anterior region, implant placement should be (ASA) score, periodontal disease and radiation therapy
postponed after the age of 25 due to the prolonged (Table 1).10 Osteonecrosis of the jaw as observed in
changes in anterior face height and posterior rotation of patients following radiation therapy of the head and ⁄ or
the mandible, particularly in women.5 neck has also been found in patients receiving intra-
Until the 1990s several general diseases were consid- venous bisphosphonates. This medication has been
ered as strict contraindications, such as metabolic introduced as a treatment modality in patients with
disorders (e.g., diabetes, hyperthyroidosis), cardiovas- metastatic bone disease, in severe hypercalcaemia of
cular diseases (e.g., hypertension, cardiac insufficiency, malignancy, and for treating bone-resorption defects in
ischaemic heart disease), systemic bone diseases (e.g., multiple myeloma. Bisphosphonates are also used for
osteomalacia, ostitis deformans, osteoporosis), or dis- the management of Paget’s disease of the bone, severe
orders of the haematopoietic system (e.g., anaemia, osteoporosis and for the treatment of heterotopic
haemorrhagic diathesis). Today, these conditions indi- ossification following total hip replacement and spinal
cate implant treatment under medical supervision and trauma.11 Under bisphosphonate therapy, bone resorp-
particular precautions should be considered, such as tion and normal bone turnover remodelling is inhibited
antibiotic prophylaxis, calcium-substitution, or substi- by suppressing the recruitment and activity of osteo-
tution of coagulation factors.8,9 Erosive disorders (e.g., clasts. Patients taking intravenous drug medication for
epidermolysis bullosa, lichen planus) and hyposaliva- more than two years and those also using glucocortic-
tion with the symptoms of xerostomia (e.g., in patients oids, chemotherapeutics or receiving radiation of bone
with Sjögren-Syndrome or rheumatoid arthritis), are metastases in the jaw are particularly at risk of
not a contraindication for implant treatment.9 On the developing bisphosphonate-associated osteonecrosis
contrary, since patients with hyposalivation are at a (BON), while those taking low-dose oral bisphospho-
higher risk of developing caries lesions due to the nates for a short period expose less risk. According to
decreased salivary buffer capacity and reduced remin- the Council of Scientific Affairs,12 implant placement in
eralization of enamel and dentine, implants may be patients taking bisphosphonates should be carefully
favourable over teeth with questionable prognoses. considered, especially when extensive surgery with bone
Different conditions and medications interfere with augmentation or regeneration is required. A clear
an uncomplicated wound healing and place the patient contraindication for implant placement is given in those
at higher risk for implant failure, e.g., alcoholism, patients who have already experienced BON.
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(6) incisal edge position of the maxillary centrals and

Patient’s complaints and expectations
occlusal plane:14 the incisal edge position of the centrals
During the initial consultation, it is advisable to have slightly surpassing the occlusal plane (about 1–2 mm
the patient elicit his or her chief complaints, major below) is a key point for evaluating the adequate
concerns and treatment requests. These factors are position of the occlusal plane and the bite relation. The
associated with the expected improvements and can be position of the centrals is evaluated in rest and related
evaluated using a written questionnaire in which to the upper lip length, as well as during smiling in
patients place their mark on a visual analogue scale relation to the height of the smile line. The upper lip
(VAS) at a point corresponding to their level of satisfac- length is measured from the base of the column
tion or discontent with each criterion (Fig 1). The (subnasal) to the philtrum in rest and determines the
percentage given by the location of the cross (X) at the amount of the incisal edges of the maxillary centrals
10 cm horizontal beam is then related to the correspond- visible during rest. With short lip length (10–15 mm)
ing values between 0 and 100 using a gauge with scales about 4 mm are visible, average length (21–25 mm)
from 0 to 100 mm.13 In case of missing anterior teeth, expose approximately 2 mm, and in long upper lip
aesthetic and psychosocial reasons may play a major role, length (31–35 mm) the incisors are barely visible
while patients requesting tooth replacement in the (0.25 mm). Patients with a high smile line generally
posterior are most likely impaired by reduced function. expose the entire clinical crown with surrounding gum
Partially edentulous and edentulous patients might be tissues, while with an average smile line, the central
asked, if they prefer fixed (FDP) or removable restora- incisors are mainly visible, and with a low smile line less
tions (RDP), whether a palatal coverage with the than 75 per cent of the incisors’ length is exposed.
prosthesis base is accepted and whether phonation When the alveolar ridge is displayed in patients with a
problems or an excessive gag reflex exist (Fig 1). high smile line, special consideration has to be given
to the aesthetic aspects and the predictability of the
outcome of a possible implant treatment;
Clinical examination
(7) neurologic test of areas innervated by the
The clinical examination comprises several extra-and trigeminal nerve to ascertain any sensitivity anomalies
intra-oral aspects giving special attention to the alveolar to serve as a baseline assessment in case of intra-
bone and soft tissue contour and the possible implant operative nerve lesions;
reconstruction. A systematic approach is advisable and (8) temporomandibular joint movement and func-
addresses the following extra-oral parameters (Fig 1): tion, contraction or hypertrophy of the facial muscu-
(1) correct facial proportions (divided into 3 thirds: lature as an indicator of parafunctional habits (together
from hairline to eyebrow, to the subnasal point, to the with abrasion and wear facets on the occlusal surfaces).
chin);
(2) facial symmetry on front and in profile: parallel-
Intra-oral examination
ism among bipupilar line, smile line, occlusal plane and
camper’s plane; The intra-oral examination comprises:
(3) need for lip and cheek support: patients with (1) dental examination including existing restora-
removable prosthesis should be evaluated with and tions and reconstructions, decayed and filled teeth, oral
without the existing restoration in place so that a hygiene assessment, periodontal exam and dental pulp
prosthesis flange for adequate support can be planned if test; detection of malpositioned teeth (elongation,
deemed necessary; intrusion, ectopic tooth position); midline between
(4) facial skeletal classification (normal, prognathic, upper central incisors corresponding to the philtrum
retrognathic), need for compensation of a concave position;
profile: check relation of the upper and lower lip to the (2) edentulous regions: ridge defects (vertical, hori-
aesthetic plane (line from the end of the nose to the chin) zontal, combined), crown to bone relationship (distance
for ‘‘best balance of lips’’, which is given with equal between the ideal position of the clinical crowns and
distances or the lower lip slightly closer to this plane; the underlying bone), defect compensation with soft
(5) intermaxillary relation: occlusal vertical dimen- and ⁄ or hard tissue feasible or prosthesis basis required;
sion ‘‘OVD’’ (correct, reduced, increased); interocclusal (3) quality ⁄ quantity of the mucosa and contour of the
distance ‘‘ID’’ in rest (correct with 2–4 mm, reduced, underlying bone: any pathologies and pressure spots are
increased). In situations with a reduced occlusal vertical recorded and the magnitude of the alveolar ridge
dimension, it is important to evaluate whether the resorption is examined. The mucosal quality and
interocclusal distance is increased and the OVD can be quantity with the underlying bone can be assessed by
raised up to the desired dimension, or whether a palpation and ⁄ or sounding. A thick keratinized mucosa
muscular adaptation has occurred and ID decreased is easier to mould for a papillary-like inter-implant
concurrently so that a staged rise of OVD is required; trigonum than a thin, flappy, non-keratinized ridge
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 Patient assessment and diagnosis

tissue. Sufficient mucosal thickness helps to hide the tion. Within the frame of a comprehensive treatment
abutment margin and better facilitates correct emer- planning, extraction of such questionable teeth may
gence profile of the clinical crown; be preferable in order not to interfere with the long-
(4) existing prosthesis: prosthesis basis, inter- ⁄ intra- term prognosis of the reconstruction and ⁄ or to
maxillary relation, size ⁄ form ⁄ position ⁄ colour of den- facilitate strategic implant placement and reasonable
ture teeth. Depending on further planning, a decision is planning of the superstructure. In some situations,
made whether the existing restoration is sufficient and this ‘‘restoration-related’’ decision to extract a ques-
tooth arrangement is applicable to the new restoration, tionable tooth enables short-span fixed dental pros-
whether this restoration can serve as provisional, or theses at lower risk, preferably implant-borne fixed
whether an additional diagnostic set-up and an interim dental prostheses rather than combined implant-
prosthesis is required; tooth-supported fixed dental prostheses.
(5) occlusal status and functional exam: the diagnosis In the partially edentulous case planned for a remov-
of parafunctional habits (bruxism, clenching) can be able appliance, additional retention can be derived from
deduced from clinical findings of muscular tension and implant abutments. Implants used as additional retain-
hypertrophy, dental abrasion, attrition and wear facets. ers of a removable denture prosthesis facilitate an
Although parafunction itself is not a contraindication increase in prosthesis stability and retention, and aid in
for implant placement it can, if uncontrolled, cause enhancing the patient’s comfort when the extension of
technical complications such as screw or framework the prosthesis bases can be reduced.
fractures due to overloading. Therefore, initial therapy (3) Edentulous case: especially in restoring the eden-
of temporomandibular disorders is indicated presurgi- tulous jaw, it is important to evaluate and specify the
cally to reduce the eventual occlusal stresses and patient’s desires and expectations related to implant
provide better chances of long-term success.15 therapy, which may vary greatly. In the edentulous
mandible, for instance, a majority of patients suffer from
poor retention of their existing complete denture and
Aspects for treatment planning
just expect a better prosthesis stabilization, which can be
For the three different starting points, specific aspects derived from two interforaminal implants and a com-
for implant treatment planning have to be considered bined implant-retained and soft tissue-supported over-
during extra-and intra-oral examination: denture prosthesis. Others suffer from recurrent sore
(1) Single tooth replacement: the decisive aspects and pressure spots on frail soft tissues and benefit from
whether a single tooth implant is indicated or a fixed solely implant-supported prostheses (removable or
dental prosthesis is preferable are related to the fixed).16 Especially in the edentulous maxilla, some
condition of the adjacent teeth and the neighbouring patients refuse to consider complete denture status when
anatomic structures. Decayed or filled adjacent teeth transitioning from partially edentulous state to edentu-
and those in need of recontouring in form and ⁄ or lism.15 Fixed restorations are also preferred, when an
colour, insufficient mesiodistal space and unpredictable increase in comfort similar to those given with the
outcome of the soft tissue contour in the aesthetic zone natural dentition is desired. Facial support plays an
are clear indications for a conventional fixed dental important role in patients with advanced alveolar bone
prosthesis. On the other hand, sound tooth structure of resorption resulting in a retrognathic appearance of the
adjacent teeth, converging root alignment, sufficient maxilla. The need for compensation of a concave
bone quantity and thick soft tissue quality are good profile or prognathism with a prosthesis flange is
predictors for a successful implant therapy. decisive for a removable prosthesis rather than a fixed
(2) Partially edentulous case: a major indication for restoration.14 With difficulties in personal oral hygiene,
implant placement is the free-end situation when expected speech problems in the maxilla or food
removable appliances should be avoided. Another entrapment in the mandible with a high floor of the
important indication is given in the reduced dentition, mouth, a removable denture prosthesis is preferable
when the risk of long-span fixed dental prostheses and offers more flexibility in the tooth arrangement and
should be minimized, especially when abutment prosthesis design.
prognosis is compromised. Abutment teeth may be
classified as questionable due to advanced attachment
Diagnostic aids
loss in periodontal cases, persisting apical lesions in
endodontically treated teeth or prosthetic impairment In addition to the diagnosis and definition of any
with reduced tooth structure and insufficient ferrule. treatment needs, the prognosis of every single tooth of
While maintaining a questionable tooth in a given the residual dentition is classified as good, questionable
situation may be reasonable, including this tooth as and hopeless. Based on these aspects a treatment plan
decisive abutment in an fixed dental prosthesis would is made that includes the different treatment options
increase the risk for failure of the entire reconstruc- with any pretreatment necessities. In complex cases
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NU Zitzmann et al.

requiring several extractions of hopeless teeth and dimensional overview, facilitate detection of patholo-
provisionalization of the remaining dentition, a re- gies in the jaw bone and assessment of bone quantity in
examination is generally needed following periodontal, the vertical and the mesiodistal dimension. Panoramics
operative and ⁄ or surgical pretreatment in order to are therefore considered as standard radiographic
evaluate the response to the first phase of treatment. examination for the initial diagnosis and implant
This initial phase is required for resolution of peri- treatment planning.18 For single tooth spaces, addi-
odontal inflammation and caries lesions, for endodontic tional periapical radiographs made with a parallel-cone
treatment, to facilitate proper interproximal cleaning, technique facilitate an adequate evaluation of the
and to establish an adequate inter-and intramaxillary orientation of the neighbouring roots in most instances.
relation and occlusal scheme. In addition, the provi- In the partially edentulous, periapical radiographs of
sional fixed or removable prosthesis helps to determine the entire dentition are recommended to facilitate a
the appropriate tooth contour and position as to fulfil comprehensive treatment planning. For diagnosing the
the aesthetic and phonetic requirements. During this edentulous patient, the panoramic radiograph with a
re-examination the prognosis of any questionable tooth magnification factor of mostly 1:1.3 enables planning
has to be revisited and adequate implant number and of the implant length and position in uncomplicated
position determined.17 situations such as two interforaminal implants in the
mandible. But also in this presumably simple situation,
a three-dimensional orientation can be difficult to
Radiologic diagnosis
ascertain due to morphologic changes occurring during
Pre-operative radiographs are required not only to long-term edentulism and leading to varying degrees of
evaluate the existing bone quantity but also to identify resorption (Fig 3).
neighbouring anatomic and topographic structures Whether or not additional cross-sectional imaging
which have to be preserved (Fig 2).18 Important techniques are required depends on the complexity of
anatomic structures are the roots of the adjacent teeth, the anatomic situation and ⁄ or planned augmentation
the course of the inferior alveolar nerve, the floor of the procedures, as well as the difficulty of the intended
nose, the diameter of the incisal canal, and the restoration and the practitioner’s experience.18,19 The
morphology of the maxillary sinus including bony tomography produces a third dimension in a second
septi. Panoramic radiographs provide a good two- plane, i.e., the parasagittal plane, and facilitates the

Anterior maxilla:
– canine fossa Posterior maxilla:
– nasal floor – maxillary sinus
– nasopalatine nerve

: quantity and quality mainly good

: quantity frequently insufficient, quality mainly good
: quantity and quality mainly problematic

Anterior mandible: Premolar region: Molar region:

– mental fossa – sublingual, submental artery – facial, ascending pharyngeal artery with tonsil rami
– minor vessels, muscles with mental rami – lingual, mylohyoid, inferior alveolar nerve
– inferior alveolar nerve
Fig 2. Assessment of bone quality and quantity, anatomic and topographic structures.
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 Patient assessment and diagnosis

complexity underlying tissues, moderate to severe resorption of the

maxilla anterior and/or posterior
impRDP
sinus lift
impFDP single-stage with
edentulous ridge area may have occurred and defect
implant localization
pros. reconstruction
interforaminal anterior and posterior
immediate loading
compensation by bone augmentation procedures or
mandible
impFDP or RDP impFDP or RDP
with a prosthesis flange has to be considered.
bone quantity

Rx-diagnosis panoramic (ev. with Rx template) CONCLUSIONS

tomography (with Rx template) Although only few absolute contraindications to
planning conventional/ implant treatment exist, there are numerous protocols,
CAD
manually
recommendations and educational material to properly
surgical template inform the patient about implant treatment, the asso-
clinical use surgical template with drilling guides
(CAD or CAD/CAM) ciated risks and possible complications. These attempts
obligatory in patient information are far beyond those endeavours
optional
made over decades for conventional reconstructive
Fig 3. Implant diagnostics in the edentulous jaw.
therapies, and are at least in part, a result of the
increasing number of medico-legal problems. The
evaluation of the bone quantity in the bucco-oral current review clearly revealed the necessity of a
dimension, better orientation for the identification of thorough, structured procedure for patient assessment.
anatomic structures and ⁄ or optimal implant position- Consequently, this assessment has to end up in a
ing. Depending on the size of the edentulous segment recommendation for implant therapy or, otherwise,
and the intended clinical procedure, conventional tomo- conventional treatment alternatives are preferable.
graphies or computer-assisted tomographies (spiral- Despite all the benefits associated with implant therapy,
computer tomography or digital volume-tomography) a more predictable outcome seems to be associated with
are used. With the latter, data are reformatted into the conventional therapies, at least in some complex
secondary reconstructions and transferred to the dentist situations when aesthetics are paramount. This under-
for implant planning as a digital file and ⁄ or printed on standing implies the need for a discriminating patient
paper or radiographic negative (Fig 3). assessment and a comprehensive treatment plan that
When fixed restorations and single-stage surgery with includes the different treatment options with any
immediate loading are intended, the computer-assisted pretreatment necessities. The practitioner’s role, giving
implant planning facilitates the pre-operative produc- an honest treatment recommendation based on his ⁄ her
tion of biomodels with surgical templates. These specialization and experience, is of upmost importance.
templates allow exact drilling and immediate insertion Advantages and disadvantages of the recommended
of a prefabricated provisional restoration.20 therapy and treatment alternatives, including non-
replacement, are explained to the patient. Costs, efforts,
expected outcome, possible risks and complications,
Study casts
long-term results and maintenance efforts including
The clinical situation is normally analysed with the aid their own responsibility in treatment are described and
of study models. If removable appliances are present, the final treatment decision is taken with consent of the
situation casts can be made with and without the informed patient.
prostheses in place and mounted when used for further
diagnostics. Anticipated changes in tooth position or
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S10 ª 2008 Australian Dental Association