The AuthorsSimon Wright MBE BDS MSc PGCTLCP FHEA FDTFEd (RCSEd) SMFGDP(UK)A FCGDent is Professor of Dental Implantology at the School of Health and Society, University of Salford, UK Clinical Director of ICE Postgraduate Dental Institute and Hospital, and Principal Partner at Glencairn Practice Group.Cemal Ucer BDS MSc PhD (OMFS) MFDS RCS (Eng) FCGDent FDTFEd RCS Ed is a Specialist Oral Surgeon, Professor in Dental Implantaology at the School of Health and Society, University of Salford and Clinical Director at ICE Dental Postgraduate Institute and Hospital in the UK.Rabia Khan BDS MSc Oral Path PhD Medicine PgC Oral Surgery PgC Med Ed PgC OELP PgDip Aes Med FCGDent FICD FPFA FAoME FHEA is Education Director and Research Lead at ICE Postgraduate Dental Institute and Hospital and Professor at the School of Health and Society, University of Salford, UK.

• Foreword xi Preface xiii Acknowledgements xv Chapter 1 Standards in Implant Dentistry 1 1.1 Introduction 1 1.2 Aims for Standards in Implant Dentistry 4 1.3 Key Features and Objectives of the Standards in Implant Dentistry 5 1.4 The Legal Standard of Care 7 1.5 The Clinical Standard of Care 7 1.6 Training Standards in Implant Dentistry Domains of Competence and Clinical Application 7 1.6.1 Level of Evidence 9 1.6.2 Grading System 9 1.7 Other Sources of Guidance in Implant Dentistry 11 References 12 Chapter 2 Assessment 13 2.1 Introduction 13 2.2 Dental History 14 2.3 Medical History 15 2.4 Intraoral and Extraoral Examination 16 2.5 Provisional Diagnosis 18 2.6 Investigations and Diagnostic Imaging 18 2.7 Definitive Diagnosis 20 2.8 Treatment Planning 20 2.9 Definitive Treatment Plan 24 2.10 Complexity 26 2.11 Preparation for Surgery 26 References 28 Chapter 3 Patient Management 29 3.1 Introduction 29 3.2 Medically Compromised Patient 31 3.3 Patient Information 35 3.4 Patient Education 40 3.5 Managing Expectations 41 3.6 Patient on Referral 43 3.7 Patient Records 44 3.7.1 Implant Pro 44 References 46 Chapter 4 Risk Management 49 4.1 Introduction 49 4.2 Human Factors 53 4.3 Definition of Success 55 4.4 Evidence- Based Treatment Planning Methodology 55 4.5 Treatment Objectives and Endpoints In Implantology 56 4.6 Patient- Related Systemic Factors 57 4.7 Patient- Related Local Risk Factors 58 4.8 Clinical- Related Risk Factors 61 4.9 Surgical Risk Factors 63 4.10 Strategies for Management of Risk Factors Relating to Human Factors 66 References 67 Chapter 5 Consent 69 5.1 Introduction 69 5.2 Valid Informed Consent 70 5.3 Patient Centred 70 5.4 Patient Information and Education 71 References 71 Chapter 6 Imaging 73 6.1 Introduction 73 6.2 Imaging in Treatment Planning 74 6.2.1 Conventional Techniques 75 6.2.2 Sectional or Three- dimensional Imaging Techniques 75 6.3 Imaging During Surgery 76 6.4 Imaging Post Treatment and Review 78 References 78 Chapter 7 Pain Control 81 7.1 Introduction 81 7.2 Acute Dental Pain 82 7.3 Preoperative Prophylaxis 82 7.4 Surgical Anaesthesia 83 7.5 Postoperative Pain 84 References 85 Chapter 8 Anxiety 87 8.1 Introduction 87 8.2 Patient Management 88 8.3 Preoperative Care, Administration and Postoperative Care in Anxiety Management 88 8.4 Communication and Professionalism 89 References 90 Chapter 9 Surgical Management 91 9.1 Introduction 91 9.2 Surgical Preparation 92 9.3 Bone and Soft Tissue Management 95 9.4 Implant Placement 98 9.5 Exposure and Temporisation 101 9.6 Organisation 101 References 102 Chapter 10 Restorative Approach 105 10.1 Introduction 105 10.2 Soft Tissue Management 106 10.3 Implant Abutment and Super Structure 108 10.4 Provisional Restoration 109 10.5 Restorative Design and Materials 110 10.6 Clinical Procedures 112 10.7 Aesthetics 112 10.8 Occlusion 114 10.9 Patient Notes 116 References 116 Chapter 11 Postoperative 119 11.1 Introduction 119 11.2 Pain Control 119 11.3 Infection 120 11.4 Suture Removal 121 11.5 Review and Follow- Up 121 References 122 Chapter 12 Maintenance 123 12.1 Introduction 123 12.2 Recall Interval 123 12.3 Radiographic Review 124 12.4 Clinical Examination 125 12.5 Oral Hygiene and Patient Education 127 12.5.1 Host Susceptibility 127 12.5.2 Prosthetic Design 128 12.5.3 Patient Factors 128 References 128 Chapter 13 The Digital Workflow in Implant Dentistry 129 13.1 Introduction 129 13.2 Components and Steps of the Digital Implant Workflow 130 13.2.1 Digital Diagnostic Impression 130 13.2.2 Cone Beam Computed Tomography 131 13.2.3 Digital Implant Treatment Planning 131 13.2.4 The Digital Surgical Guide 132 13.2.5 Fabricated Temporary Prosthesis 133 13.2.6 Guided Implant Surgery 133 13.2.7 Digital Implant Impressions 135 13.2.8 Customised Prosthesis Fabrication 135 Reference 136 Chapter 14 Complications 137 14.1 Introduction 137 14.2 Patient Management 137 14.3 Documentation 139 14.4 Diagnosis 139 14.5 Surgical Complications 140 14.6 Restorative Complications 141 14.7 Peri- Implant Disease 143 14.7.1 Supplemental Treatment 145 14.7.2 Systemic Antibiotics 145 14.7.3 Non- surgical 146 14.7.4 Surgical 146 14.7.5 Modifying Factors 147 14.7.6 Summary of Peri- implant Disease 147 References 148 Chapter 15 Regulation and Legislation 151 15.1 Overview of Regulation and Legislation 151 References 153 Chapter 16 Team Management 155 16.1 Introduction 155 References 158 Chapter 17 Clinical Audit 159 17.1 Introduction 159 17.2 Decontamination 160 17.3 Treatment 160 17.4 Continuing Professional Development and Skill Assessment 161 17.5 Equipment and Devices 161 References 162 Chapter 18 Communication 163 18.1 Overview of Communication 163 18.2 Patient Education 165 18.3 Communication Barriers 165 18.4 Informed Consent 165 18.5 Interprofessional Communication 166 18.6 Conclusion 166 References 166 Chapter 19 Human Factors 167 19.1 Introduction 167 19.2 Threat and Error Management 168 19.3 Team Resource Management 168 19.4 Checklists 169 19.5 Reporting 170 19.6 Standard Operating Protocol 171 19.7 Additional Information 171 References 171 Chapter 20 Technical Procedures 175 20.1 Introduction 175 20.2 Communication 175 20.3 Restorative Design 176 20.4 Materials 176 20.5 Disinfection 177 References 178 Chapter 21 Education and Training 179 21.1 Introduction 179 21.2 Personal Development Plan 180 21.3 Mentoring 180 21.4 Qualifications, Competence and Courses 181 References 182 Appendix A 183 Appendix B: Standard Operating Procedures 187 Index 219

The AuthorsSimon Wright MBE BDS MSc PGCTLCP FHEA FDTFEd (RCSEd) SMFGDP(UK)A FCGDent is Professor of Dental Implantology at the School of Health and Society, University of Salford, UK Clinical Director of ICE Postgraduate Dental Institute and Hospital, and Principal Partner at Glencairn Practice Group.Cemal Ucer BDS MSc PhD (OMFS) MFDS RCS (Eng) FCGDent FDTFEd RCS Ed is a Specialist Oral Surgeon, Professor in Dental Implantaology at the School of Health and Society, University of Salford and Clinical Director at ICE Dental Postgraduate Institute and Hospital in the UK.Rabia Khan BDS MSc Oral Path PhD Medicine PgC Oral Surgery PgC Med Ed PgC OELP PgDip Aes Med FCGDent FICD FPFA FAoME FHEA is Education Director and Research Lead at ICE Postgraduate Dental Institute and Hospital and Professor at the School of Health and Society, University of Salford, UK.

• Foreword xi Preface xiii Acknowledgements xv Chapter 1 Standards in Implant Dentistry 1 1.1 Introduction 1 1.2 Aims for Standards in Implant Dentistry 4 1.3 Key Features and Objectives of the Standards in Implant Dentistry 5 1.4 The Legal Standard of Care 7 1.5 The Clinical Standard of Care 7 1.6 Training Standards in Implant Dentistry Domains of Competence and Clinical Application 7 1.6.1 Level of Evidence 9 1.6.2 Grading System 9 1.7 Other Sources of Guidance in Implant Dentistry 11 References 12 Chapter 2 Assessment 13 2.1 Introduction 13 2.2 Dental History 14 2.3 Medical History 15 2.4 Intraoral and Extraoral Examination 16 2.5 Provisional Diagnosis 18 2.6 Investigations and Diagnostic Imaging 18 2.7 Definitive Diagnosis 20 2.8 Treatment Planning 20 2.9 Definitive Treatment Plan 24 2.10 Complexity 26 2.11 Preparation for Surgery 26 References 28 Chapter 3 Patient Management 29 3.1 Introduction 29 3.2 Medically Compromised Patient 31 3.3 Patient Information 35 3.4 Patient Education 40 3.5 Managing Expectations 41 3.6 Patient on Referral 43 3.7 Patient Records 44 3.7.1 Implant Pro 44 References 46 Chapter 4 Risk Management 49 4.1 Introduction 49 4.2 Human Factors 53 4.3 Definition of Success 55 4.4 Evidence- Based Treatment Planning Methodology 55 4.5 Treatment Objectives and Endpoints In Implantology 56 4.6 Patient- Related Systemic Factors 57 4.7 Patient- Related Local Risk Factors 58 4.8 Clinical- Related Risk Factors 61 4.9 Surgical Risk Factors 63 4.10 Strategies for Management of Risk Factors Relating to Human Factors 66 References 67 Chapter 5 Consent 69 5.1 Introduction 69 5.2 Valid Informed Consent 70 5.3 Patient Centred 70 5.4 Patient Information and Education 71 References 71 Chapter 6 Imaging 73 6.1 Introduction 73 6.2 Imaging in Treatment Planning 74 6.2.1 Conventional Techniques 75 6.2.2 Sectional or Three- dimensional Imaging Techniques 75 6.3 Imaging During Surgery 76 6.4 Imaging Post Treatment and Review 78 References 78 Chapter 7 Pain Control 81 7.1 Introduction 81 7.2 Acute Dental Pain 82 7.3 Preoperative Prophylaxis 82 7.4 Surgical Anaesthesia 83 7.5 Postoperative Pain 84 References 85 Chapter 8 Anxiety 87 8.1 Introduction 87 8.2 Patient Management 88 8.3 Preoperative Care, Administration and Postoperative Care in Anxiety Management 88 8.4 Communication and Professionalism 89 References 90 Chapter 9 Surgical Management 91 9.1 Introduction 91 9.2 Surgical Preparation 92 9.3 Bone and Soft Tissue Management 95 9.4 Implant Placement 98 9.5 Exposure and Temporisation 101 9.6 Organisation 101 References 102 Chapter 10 Restorative Approach 105 10.1 Introduction 105 10.2 Soft Tissue Management 106 10.3 Implant Abutment and Super Structure 108 10.4 Provisional Restoration 109 10.5 Restorative Design and Materials 110 10.6 Clinical Procedures 112 10.7 Aesthetics 112 10.8 Occlusion 114 10.9 Patient Notes 116 References 116 Chapter 11 Postoperative 119 11.1 Introduction 119 11.2 Pain Control 119 11.3 Infection 120 11.4 Suture Removal 121 11.5 Review and Follow- Up 121 References 122 Chapter 12 Maintenance 123 12.1 Introduction 123 12.2 Recall Interval 123 12.3 Radiographic Review 124 12.4 Clinical Examination 125 12.5 Oral Hygiene and Patient Education 127 12.5.1 Host Susceptibility 127 12.5.2 Prosthetic Design 128 12.5.3 Patient Factors 128 References 128 Chapter 13 The Digital Workflow in Implant Dentistry 129 13.1 Introduction 129 13.2 Components and Steps of the Digital Implant Workflow 130 13.2.1 Digital Diagnostic Impression 130 13.2.2 Cone Beam Computed Tomography 131 13.2.3 Digital Implant Treatment Planning 131 13.2.4 The Digital Surgical Guide 132 13.2.5 Fabricated Temporary Prosthesis 133 13.2.6 Guided Implant Surgery 133 13.2.7 Digital Implant Impressions 135 13.2.8 Customised Prosthesis Fabrication 135 Reference 136 Chapter 14 Complications 137 14.1 Introduction 137 14.2 Patient Management 137 14.3 Documentation 139 14.4 Diagnosis 139 14.5 Surgical Complications 140 14.6 Restorative Complications 141 14.7 Peri- Implant Disease 143 14.7.1 Supplemental Treatment 145 14.7.2 Systemic Antibiotics 145 14.7.3 Non- surgical 146 14.7.4 Surgical 146 14.7.5 Modifying Factors 147 14.7.6 Summary of Peri- implant Disease 147 References 148 Chapter 15 Regulation and Legislation 151 15.1 Overview of Regulation and Legislation 151 References 153 Chapter 16 Team Management 155 16.1 Introduction 155 References 158 Chapter 17 Clinical Audit 159 17.1 Introduction 159 17.2 Decontamination 160 17.3 Treatment 160 17.4 Continuing Professional Development and Skill Assessment 161 17.5 Equipment and Devices 161 References 162 Chapter 18 Communication 163 18.1 Overview of Communication 163 18.2 Patient Education 165 18.3 Communication Barriers 165 18.4 Informed Consent 165 18.5 Interprofessional Communication 166 18.6 Conclusion 166 References 166 Chapter 19 Human Factors 167 19.1 Introduction 167 19.2 Threat and Error Management 168 19.3 Team Resource Management 168 19.4 Checklists 169 19.5 Reporting 170 19.6 Standard Operating Protocol 171 19.7 Additional Information 171 References 171 Chapter 20 Technical Procedures 175 20.1 Introduction 175 20.2 Communication 175 20.3 Restorative Design 176 20.4 Materials 176 20.5 Disinfection 177 References 178 Chapter 21 Education and Training 179 21.1 Introduction 179 21.2 Personal Development Plan 180 21.3 Mentoring 180 21.4 Qualifications, Competence and Courses 181 References 182 Appendix A 183 Appendix B: Standard Operating Procedures 187 Index 219

The AuthorsSimon Wright MBE BDS MSc PGCTLCP FHEA FDTFEd (RCSEd) SMFGDP(UK)A FCGDent is Professor of Dental Implantology at the School of Health and Society, University of Salford, UK Clinical Director of ICE Postgraduate Dental Institute and Hospital, and Principal Partner at Glencairn Practice Group.Cemal Ucer BDS MSc PhD (OMFS) MFDS RCS (Eng) FCGDent FDTFEd RCS Ed is a Specialist Oral Surgeon, Professor in Dental Implantaology at the School of Health and Society, University of Salford and Clinical Director at ICE Dental Postgraduate Institute and Hospital in the UK.Rabia Khan BDS MSc Oral Path PhD Medicine PgC Oral Surgery PgC Med Ed PgC OELP PgDip Aes Med FCGDent FICD FPFA FAoME FHEA is Education Director and Research Lead at ICE Postgraduate Dental Institute and Hospital and Professor at the School of Health and Society, University of Salford, UK.

• Foreword xi Preface xiii Acknowledgements xv Chapter 1 Standards in Implant Dentistry 1 1.1 Introduction 1 1.2 Aims for Standards in Implant Dentistry 4 1.3 Key Features and Objectives of the Standards in Implant Dentistry 5 1.4 The Legal Standard of Care 7 1.5 The Clinical Standard of Care 7 1.6 Training Standards in Implant Dentistry Domains of Competence and Clinical Application 7 1.6.1 Level of Evidence 9 1.6.2 Grading System 9 1.7 Other Sources of Guidance in Implant Dentistry 11 References 12 Chapter 2 Assessment 13 2.1 Introduction 13 2.2 Dental History 14 2.3 Medical History 15 2.4 Intraoral and Extraoral Examination 16 2.5 Provisional Diagnosis 18 2.6 Investigations and Diagnostic Imaging 18 2.7 Definitive Diagnosis 20 2.8 Treatment Planning 20 2.9 Definitive Treatment Plan 24 2.10 Complexity 26 2.11 Preparation for Surgery 26 References 28 Chapter 3 Patient Management 29 3.1 Introduction 29 3.2 Medically Compromised Patient 31 3.3 Patient Information 35 3.4 Patient Education 40 3.5 Managing Expectations 41 3.6 Patient on Referral 43 3.7 Patient Records 44 3.7.1 Implant Pro 44 References 46 Chapter 4 Risk Management 49 4.1 Introduction 49 4.2 Human Factors 53 4.3 Definition of Success 55 4.4 Evidence- Based Treatment Planning Methodology 55 4.5 Treatment Objectives and Endpoints In Implantology 56 4.6 Patient- Related Systemic Factors 57 4.7 Patient- Related Local Risk Factors 58 4.8 Clinical- Related Risk Factors 61 4.9 Surgical Risk Factors 63 4.10 Strategies for Management of Risk Factors Relating to Human Factors 66 References 67 Chapter 5 Consent 69 5.1 Introduction 69 5.2 Valid Informed Consent 70 5.3 Patient Centred 70 5.4 Patient Information and Education 71 References 71 Chapter 6 Imaging 73 6.1 Introduction 73 6.2 Imaging in Treatment Planning 74 6.2.1 Conventional Techniques 75 6.2.2 Sectional or Three- dimensional Imaging Techniques 75 6.3 Imaging During Surgery 76 6.4 Imaging Post Treatment and Review 78 References 78 Chapter 7 Pain Control 81 7.1 Introduction 81 7.2 Acute Dental Pain 82 7.3 Preoperative Prophylaxis 82 7.4 Surgical Anaesthesia 83 7.5 Postoperative Pain 84 References 85 Chapter 8 Anxiety 87 8.1 Introduction 87 8.2 Patient Management 88 8.3 Preoperative Care, Administration and Postoperative Care in Anxiety Management 88 8.4 Communication and Professionalism 89 References 90 Chapter 9 Surgical Management 91 9.1 Introduction 91 9.2 Surgical Preparation 92 9.3 Bone and Soft Tissue Management 95 9.4 Implant Placement 98 9.5 Exposure and Temporisation 101 9.6 Organisation 101 References 102 Chapter 10 Restorative Approach 105 10.1 Introduction 105 10.2 Soft Tissue Management 106 10.3 Implant Abutment and Super Structure 108 10.4 Provisional Restoration 109 10.5 Restorative Design and Materials 110 10.6 Clinical Procedures 112 10.7 Aesthetics 112 10.8 Occlusion 114 10.9 Patient Notes 116 References 116 Chapter 11 Postoperative 119 11.1 Introduction 119 11.2 Pain Control 119 11.3 Infection 120 11.4 Suture Removal 121 11.5 Review and Follow- Up 121 References 122 Chapter 12 Maintenance 123 12.1 Introduction 123 12.2 Recall Interval 123 12.3 Radiographic Review 124 12.4 Clinical Examination 125 12.5 Oral Hygiene and Patient Education 127 12.5.1 Host Susceptibility 127 12.5.2 Prosthetic Design 128 12.5.3 Patient Factors 128 References 128 Chapter 13 The Digital Workflow in Implant Dentistry 129 13.1 Introduction 129 13.2 Components and Steps of the Digital Implant Workflow 130 13.2.1 Digital Diagnostic Impression 130 13.2.2 Cone Beam Computed Tomography 131 13.2.3 Digital Implant Treatment Planning 131 13.2.4 The Digital Surgical Guide 132 13.2.5 Fabricated Temporary Prosthesis 133 13.2.6 Guided Implant Surgery 133 13.2.7 Digital Implant Impressions 135 13.2.8 Customised Prosthesis Fabrication 135 Reference 136 Chapter 14 Complications 137 14.1 Introduction 137 14.2 Patient Management 137 14.3 Documentation 139 14.4 Diagnosis 139 14.5 Surgical Complications 140 14.6 Restorative Complications 141 14.7 Peri- Implant Disease 143 14.7.1 Supplemental Treatment 145 14.7.2 Systemic Antibiotics 145 14.7.3 Non- surgical 146 14.7.4 Surgical 146 14.7.5 Modifying Factors 147 14.7.6 Summary of Peri- implant Disease 147 References 148 Chapter 15 Regulation and Legislation 151 15.1 Overview of Regulation and Legislation 151 References 153 Chapter 16 Team Management 155 16.1 Introduction 155 References 158 Chapter 17 Clinical Audit 159 17.1 Introduction 159 17.2 Decontamination 160 17.3 Treatment 160 17.4 Continuing Professional Development and Skill Assessment 161 17.5 Equipment and Devices 161 References 162 Chapter 18 Communication 163 18.1 Overview of Communication 163 18.2 Patient Education 165 18.3 Communication Barriers 165 18.4 Informed Consent 165 18.5 Interprofessional Communication 166 18.6 Conclusion 166 References 166 Chapter 19 Human Factors 167 19.1 Introduction 167 19.2 Threat and Error Management 168 19.3 Team Resource Management 168 19.4 Checklists 169 19.5 Reporting 170 19.6 Standard Operating Protocol 171 19.7 Additional Information 171 References 171 Chapter 20 Technical Procedures 175 20.1 Introduction 175 20.2 Communication 175 20.3 Restorative Design 176 20.4 Materials 176 20.5 Disinfection 177 References 178 Chapter 21 Education and Training 179 21.1 Introduction 179 21.2 Personal Development Plan 180 21.3 Mentoring 180 21.4 Qualifications, Competence and Courses 181 References 182 Appendix A 183 Appendix B: Standard Operating Procedures 187 Index 219