Straumann® SmartMulti

Stage 1 | A ssessment and treatment planning

Step 2
Treatment planning
Straumann® SmartMulti

Assessment and treatment planning Overview

Step 2 | Treatment planning

Assessment and treatment planning

Step 1 | Patient's expectations,
history and examination

Step 2 | Treatment planning

Step 3 | Consultation and consent

Step 4 | Fabrication of the surgical drill template

Surgical procedures
Step 1 | Implant surgery
7 – 10 days

Step 2 | Post-operative review and suture removal

6 – 8 weeks
Prosthetic procedures
Step 1 | Impression-taking

Step 2 | Fabrication of the final prosthesis

Step 3 | Insertion of the final prosthesis

Aftercare and maintenance 2 weeks

Step 1 | Review visit

3 – 6 months
(or as necessary)
Step 2 | Maintenance visit

In clinic with patient   Office / Lab work

2
Straumann® SmartMulti

Assessment and treatment planning Contents

Step 2 | Treatment planning

Contents
Introduction4

Learning objectives 5

1. Contacting the patient’s physician 6

2. Study model analysis 6

2.1 Procedure 7

3. Radiographic planning  14
3.1 Outline important landmarks  14
3.2 Evaluate and assess 14
3.3 Measure the available vertical bone height and select the
appropriate implant type, diameters and lengths  16

4. Risk assessment 19

5. Visit planning and cost proposal 21

5.1 Establish a diagnosis and prognosis of the remaining
dentition to discuss with the patient 21
5.2 Elaborate a treatment plan and calculate the amount
of chairside time per visit and total number of visits
required by the patient 21
5.3 Calculate costs and write up a cost proposal  22

Appendix 23

3
Straumann® SmartMulti

Assessment and treatment planning Introduction

Step 2 | Treatment planning

Introduction
A thorough patient assessment is the basis of any dental treatment
plan. You can finalize the diagnosis and prognosis of the oral situation,
and undertake treatment planning in your office with the information
gathered from the initial visit with the patient.

Systematically carry out

treatment planning by
1. Contacting the patient’s following points 1 – 5.
­physician

2. Study model analysis

3. Radiographic planning

4. Risk assessment

5. Visit planning and cost

­proposal

Click on the graphic to go directly to the chapter.

4
Straumann® SmartMulti

Assessment and treatment planning Learning

Step 2 | Treatment planning objectives

Learning objectives
Be able to use the information gathered from the patient’s history
and examination to:

Identify and select a patient who is suitable for straightforward

implant treatment.

Complete the risk assessment considering the patient’s medical

and dental history.

Perform a thorough analysis of the study models and radiographs

to finalize the diagnosis and prognosis of the dentition, determine
which implants to use, and plan restorative options including any
necessary adjunctive therapy before implant treatment.

Use the Straumann® X-ray Template and the formula to calculate

the distortion of the radiographic image for accurate planning.

Be able to discuss with your dental technician the proposed case

and any necessary restorative planning options.

Prepare the treatment plan, costs and options for discussion with
the patient at the next visit.

5
Straumann® SmartMulti

Assessment and treatment planning 1. Contacting the

Step 2 | Treatment planning patient’s physician

1. Contacting the patient’s physician

The knowledge of former and current Confirm the medical
diseases, surgeries, and medications status with the patient’s
helps to identify patients who are physician if necessary.
at risk of complications for dental
implant treatment. If there are any
doubts, consult the physician or med-
ical specialist treating the patient for
further clarification1.

2. Study model analysis

A detailed and accurate space as-
sessment is often difficult to do in-
traorally. It is recommended to ob-
tain initial impressions to fabricate
and mount study models, in order
to properly perform diagnostic and
planning steps.

The study models may be used for: Use study models to

ѹѹ Analysis of the occlusion properly analyze and
ѹѹ Assessment of available space plan the treatment.
ѹѹ Assessment of other factors that might not be easily noted or re-
corded at the chairside
ѹѹ Creation of a diagnostic wax-up
ѹѹ Creation of an X-ray template

Video: Study model analysis

Select the implant diameters, implant type, and positions. Discuss Discuss with your
with your dental technician on how to design the restoration so dental technician about
that the necessary oral hygiene measures can be carried out. the design of the final
restoration.

6
Straumann® SmartMulti

Assessment and treatment planning 2. Study model

Step 2 | Treatment planning analysis

A few important considerations to note about planning implants and

their abutments:

ѹѹ The implant abutments should always be axially loaded. Important considerations

ѹѹ The future implants should be planned with a restoratively-driven when planning implants
implant position in mind. and final restorations.
ѹѹ The long axis of the implants should be aligned with the cusps of
the opposing tooth.

To establish the ideal topographical situation, axial orientation, and Ask your dental
choice of implants, we recommend the following to be fabricated by ­technician to create a
the dental technician: ­diagnostic wax-up and
ѹѹ A diagnostic wax-up in the edentulous area surgical drill template.
ѹѹ A resin-based surgical drill template to help determine the correct
implant position during implant surgery

2.1 Procedure
Apply the Straumann® ­Diagnostic T Use calipers and the
and calipers on the study model to Straumann® Diagnostic
obtain an initial measurement of the T on the study model to
interproximal distance of bone, for estimate the space avail-
the choice of which implant shoulder able for the future pros-
diameter and prosthetic reconstruc- thetic reconstruction.
tion to use.

Analyze the implant positions three-dimensionally on the study model. Assess the 3D space for
the implants on the study
2.1.1 Interproximal distance of bone model.
2.1.2 Bucco-lingual (or bucco-palatal) width of bone
2.1.3 Inter-occlusal distance

7
Straumann® SmartMulti

Assessment and treatment planning 2. Study model

Step 2 | Treatment planning analysis

2.1.1 Interproximal distance of bone

When planning for a 3-unit implant-supported fixed dental pros-
thesis, the interproximal bone availability is an important factor for
choosing the implant types and diameters.

SP Implants BLT Implants

≥ 1.5 mm ≥ 1.5 mm ≥ 1.5 mm ≥ 1.5 mm

In a multiple tooth gap or free-end situation, a minimal distance of Minimum distance of

1.5 mm of bone from the implant to the adjacent tooth at bone lev- bone from implant to
el (mesial and distal) is required. This will help to preserve bone and adjacent tooth at bone
soft tissue to create a restoration with adequate emergence profile level: 1.5 mm
and soft tissue attachment to support oral hygiene measures and
esthetics.

Reduced horizontal distance between tooth and implant can lead to

bone resorption at adjacent teeth and reduced ability to clean around
the restoration.

For a 3-unit implant-supported fixed dental prosthesis in the poste- For a 3-unit implant-
rior area, additional space for the pontic should be respected in the supported FDP respect
calculations². additional space for the
pontic:
ѹѹ The approximate diameter of a premolar is 7.0 mm. - approx. Ø of a premolar:
ѹѹ The approximate diameter of a molar is 11.0 mm. 7 mm
- approx. Ø of a molar:
11 mm

At least 1.5 mm
at bone level

8
Straumann® SmartMulti

Assessment and treatment planning 2. Study model

Step 2 | Treatment planning analysis

The minimum distance from the bone level of the adjacent tooth to Minimum distance from
the implant’s central axis depends on the shoulder or platform of the the bone level of adja-
implant used. These numbers have been rounded up in the calculations. cent tooth to the im-
plant’s central axis:
With Standard Plus (SP) Implants, this distance is approximately: SP Implants:
ѹѹ 4 mm for Regular Neck (RN) Implants with Ø 4.8 mm shoulder - 4 mm for RN platform
diameter. - 5 mm for WN platform
ѹѹ 5 mm for Wide Neck (WN) Implants with Ø 6.5 mm shoulder BLT Implants:
diameter. - 4 mm for RC platform

SP (RN and WN) Implants

≥ 4.0 mm 2.4 mm 2.4 mm ≥ 4.0 mm

Pontic
Example of a 3-unit implant-
diameter
supported FDP with SP Implants with
RN ∅ 4.8 mm RN ∅ 4.8 mm Regular Neck (RN) ∅ 4.8 mm shoul-
der diameter.

Chart of minimum widths of bone Chart for reference for

for planning which SP Implants (RN/ SP Implants
WN) to use

With Bone Level Tapered (BLT) Implants, this distance is approximately:

ѹѹ 4 mm for Regular CrossFit® (RC) Implants with Ø 4.1 mm or
Ø 4.8 mm shoulder diameter.

BLT (RC) Implants

≥ 4.0 mm 2.0 mm 2.0 mm ≥ 4.0 mm

Pontic
Example of a 3-unit implant-
diameter
supported FDP with BLT Implants
with Regular CrossFit® (RC) Ø 4.1 mm
RC ∅ 4.1 mm RC ∅ 4.1 mm
endosteal and shoulder diameter.

Chart of minimum widths of bone Chart for reference for

for planning which BLT Implants (RC) BLT Implants
to use

Caution: We do not recommend the use of a Ø 3.3 mm endosteal

diameter implant in the posterior region due to the strength of mas-
ticatory forces in this area.

Caution: If the space is too small for a 3-unit implant supported

bridge, consider placing two adjacent implants with a minimal dis-
tance of 3 mm between the implants at bone level.

9
Straumann® SmartMulti

Assessment and treatment planning 2. Study model

Step 2 | Treatment planning analysis

A minimal distance of 3 mm between two adjacent implants is re- Minimum distance

quired at bone level. This minimal distance is mandatory to facilitate between two adjacent
flap adaptation, avoid proximity of secondary components and pro- implants at bone level:
vide adequate space for maintenance and home-care. 3 mm

SP Implants BLT Implants

≥ 3 mm ≥ 3 mm

Step-by-step interproximal space calculation on study models:

Caution: You should ask your dental technician for a diagnostic

wax-up to be provided with the study models. This will help in the
assessment of the interproximal space available for a 3-unit implant-
supported bridge.

You may also use calipers to measure the mesio-distal width

of the corresponding teeth in the adjacent quadrant if available.
Check if this same width is present in the multiple tooth gap.

10
Straumann® SmartMulti

Assessment and treatment planning 2. Study model

Step 2 | Treatment planning analysis

1. Use the Straumann® Diag- Use the Straumann®

nostic T on the study model to Diagnostic T on the study
determine the minimal distance model to determine the
between implant and adjacent minimum distance
tooth for Straumann® Stan- between implant and
dard Plus (SP) Implants. Mark adjacent tooth.
the central position of the more
anterior implant on the study
model.

Caution: Currently, a Diagnostic T for Straumann® Bone Level

Tapered (BLT) Implants is not available.

2. You can use a pair of calipers to Use a pair of calipers

locate the position of the poste- to locate the posterior
rior implant. implant position.

11
Straumann® SmartMulti

Assessment and treatment planning 2. Study model

Step 2 | Treatment planning analysis

2.1.2 Bucco-lingual (or bucco-palatal) width of bone

The facial and palatal bone wall must be at least 1 mm thick in order Minimum thickness of
to ensure stable hard and soft tissue conditions. bucco-lingual or buc-
co-palatal bone wall in
For example, if the planned implant site has a bucco-lingual bone posterior areas: 1 mm
width of 6.5 mm, then you are able to use a 4.1 mm endosteal diame-
ter Standard Plus or Bone Level Tapered Implant.

≥ 1 mm ≥ 1 mm

For SP Implants, please refer For BLT Implants, please refer Charts for reference
to this chart for the minimum to this chart for the minimum
bucco-lingual or bucco-palatal bucco-lingual or bucco-palatal
width. width.

Caution: If the available orofacial bone is thinner than 1 mm or a

layer of bone is missing on one or more sides around the planned im-
plant site, a bone augmentation procedure is indicated. This technique Refer cases which require
should be employed only by dentists who have adequate experience GBR to more experienced
in the use of augmentation procedures. If it only becomes apparent colleagues.
during surgery that this minimum distance is not present, it is recom-
mended to close the flap and refer the patient to a specialist or col-
league with adequate experience in GBR (Guided Bone Regeneration)
procedures.

12
Straumann® SmartMulti

Assessment and treatment planning 2. Study model

Step 2 | Treatment planning analysis

2.1.3 Inter-occlusal distance

The inter-occlusal distance is the distance from the future implant Minimum inter-occlusal
shoulder to the opposing tooth. The minimum distance is about 7 mm distance required:
for cement-retained restorations and about 4 mm for screw-retained ≥ 7 mm for cement-­
restorations. retained restorations
≥ 4 mm for screw-­
Space requirements depend on the retained restorations
design of the restoration, includ-
ing the selection of abutments and
crowns. We recommend that you dis- For optimal results,
cuss with your dental technician ­discuss the final
during treatment planning in order to ­restoration with your
have a restoratively-driven orofacial dental technician.
implant position and axis. The presence of overeruption of the op-
posing dentition or the presence of cross-bites can reduce the space
available for the final restoration.

Caution: If the available space is insufficient due to overeruption

of the opposing teeth, depending on the extent of available space,
minimal enameloplasty, orthodontic intervention, elective endodon-
tics, crown lengthening, and crown in the opposing quadrant may be
indicated. Such restorative cases should be handled only by clinicians
who are experienced in treating advanced or complex cases.

13
Straumann® SmartMulti

Assessment and treatment planning 3. Radiographic

Step 2 | Treatment planning planning

3. Radiographic planning
The vertical bone availability de-
termines the maximum allowable
length of the implant that can be
placed and can be assessed on a ra-
diographic image.

3.1 Outline important landmarks

Outline important landmarks on the periapical and panoramic radio- Outline important
graph using a transparent foil or paper and a pencil. landmarks on the
radiographs.

 ideo: Treatment planning with the Straumann® X-ray

V
Template

3.2 Evaluate and assess

3.2.1 Adjacent anatomical structures when determining available
bone height

Inclination and condition of adja- Consider the anatomical

cent roots shape of adjacent tooth
Convergent adjacent roots may roots.
compromise available interproximal
space. Respect this root anatomy to
avoid injury/interference during im-
plant placement. Injury of adjacent
teeth during implant placement can
Note the proximity of this implant to the mesial
root of the molar
result in root canal treatment and/or
damage to the root that leads to fur-
ther tooth loss.

14
Straumann® SmartMulti

Assessment and treatment planning 3. Radiographic

Step 2 | Treatment planning planning

Landmarks in the maxilla such as the Maintain a minimum

sinus floor: A safety distance of 2 mm safety distance of 2 mm
is recommended from the floor of from the implant to the
the sinus to the apex of the implant. maxillary sinus floor.
Straumann® Smart users are advised
to treat straightforward cases only.
If this minimum distance of bone is
not available, the patient should be
Note the proximity of the sinus floor to the apex
of the implant
referred to a clinician with adequate
training and experience in sinus floor
elevation (SFE) procedures.

Landmarks in the mandible: Inferi- Maintain a minimum

or alveolar nerve, mental foramen safety distance of 2 mm
and submandibular fossa/concavity. from the implant to the
A safety distance of 2 mm of bone mandibular canal or
between apex of the implant and ­mental foramen.
neurovascular structures should be
respected.
Note the anatomical landmarks in the mandible

Caution: The loss of bone height due to ridge flattening during

surgery must always be considered.

3.2.2 Interproximal distance of bone at the crestal bone level

­(interradicular space)

ѹѹ The distance of bone between 2 Pay attention to the

teeth measured at bone level. ­interproximal distance of
Interproximal distance bone at bone level.
of bone

Bone
height

3.2.3 Bone quality

ѹѹ Less dense or Type-IV bone may indicate a preference to use the Bone which appears less
Bone Level Tapered Implant for better primary stability. dense in the radiograph
indicates soft bone
­quality.

15
 Straumann® SmartMulti

Assessment and treatment planning 3. Radiographic

Step 2 | Treatment planning planning

3.3 Measure the available vertical bone height and select

the appropriate implant type, diameters and lengths
This can be done with the help of Use the Straumann®
1.4 : 1 (049.076V4) = Ø 7.0 mm

the Straumann® X-ray Reference X-ray Template corre-

S S S S SP SP SP SP SP
Ø 3.3 mm Ø 4.1 mm Ø 4.8 mm Ø 4.8 mm Ø 3.3 mm Ø 3.3 mm Ø 4.1 mm Ø 4.8 mm Ø 4.8 mm
RN RN RN WN NNC RN RN RN WN

0 0 0
2 2 2
4 4 4

Sphere and X-ray Templates for sponding to the type of

6 6 6
8 8 8
10 10 10
12 12 12
14 14 14
16 16 16

1.5 : 1 (049.076V4) = Ø 7.5 mm

S
Ø 3.3 mm
RN
S
Ø 4.1 mm
RN
S
Ø 4.8 mm
RN
S
Ø 4.8 mm
WN
SP
Ø 3.3 mm
NNC
SP
Ø 3.3 mm
RN
SP
Ø 4.1 mm
RN
SP
Ø 4.8 mm
RN
SP
Ø 4.8 mm
WN
Straumann® Standard Plus Implants implants chosen.
0
2
4
6
8
10
0
2
4
6
8
10
0
2
4
6
8
10
and Straumann® Bone Level Tapered
Implants.
12 12 12
14 14 14
16 16 16
150.215 A/01

S = Straumann Standard Implant

max. 0.4 mm

SP = Straumann Standard Plus Implant

NNC = Narrow Neck CrossFit® (Ø 3.5 mm)
02/14

RN = Regular Neck (Ø 4.8 mm)

WN = Wide Neck (Ø 6.5 mm)

[Link] 4 27.02.14 09:33

Distortions can occur in X-rays, hence the implant dimensions shown

on these individual templates are designed with the corresponding
distortion factors (1:1 to 1.7:1).

Determining each magnification factor or scale is facilitated by show-

ing the X-ray Reference Sphere on the template (next to the scale ref-
erence).

Video: Treatment planning with the Straumann® X-ray Template

3.3.1 Compare the size of the X-ray Reference Sphere*

First, compare the size of each Straumann® X-ray Reference Sphere* Use the Straumann®
on the patient’s X-ray with the size of the Reference Sphere on the X-ray Template and
template (marked with arrow). Superimpose the two pictures to find compare with the
the correct scale. Then, determine the spatial relations around the Straumann® X-ray
implant. Reference Sphere in the
radiograph to determine
*The X-ray Reference Sphere has a diameter of 5 mm. The image of the sphere on the X-ray provides
the reference value for the magnification scale. the correct magnification
factor.
(049.076V4) = ∅ 5.0 mm
1.0 : 1 (049.076V4) = ∅ 5.0 mm (049.076V4) = ∅ 6.0 mm 1.2 : 1
(049.076V4) = ∅ 6.0 mm 1.2 : 1
Straumann® Bone Level Tapered Implant Straumann® Bone Level Tapered Implant Straumann® Bone Level Tapered Implant
Straumann® Bone Level Tapered Implant
∅ 4.8 mm ∅ 4.1 mm ∅ 3.3 mm ∅ 4.8 mm ∅ 4.1 mm ∅ 3.3 mm

0 0
2 2
4 4
6
8 6

∅ 4.8 mm ∅ 4.1 mm 10
∅ 3.3 mm 8
∅ 4.8 mm ∅ 4.1 mm ∅ 3.3 mm

Example:
12 10
14 12
16 14
18
16
18
0
2

Scale 1.2 : 1 = R
 eference Sphere
1.1 : 1 (049.076V4) = ∅ 5.5 mm (049.076V4) = ∅ 6.5 mm 1.3 : 1
4
Straumann® Bone Level Tapered Implant Straumann® Bone Level Tapered Implant

∅ 4.8 mm ∅ 4.1 mm ∅ 3.3 mm ∅ 4.8 mm ∅ 4.1 mm ∅ 3.3 mm

6
0
2
0
2 8

∅ 6.0 mm
4 4

10
6
6
8
10 8
12 10
14
16
18
12
14
12
16

14
025.0003/B/00 01/16

18

8
16
0.4 mm 18

3.3.2 Bone availability (X-ray):

(049.076V4) = ∅ 5.5 mm (049.076V4) = ∅ 6.5 mm 1.3 : 1
On the X-ray, measure the height ofStraumann®
Straumann® Bone Level Tapered Implant
the available bone from the crest
Bone Level Tapered Implant

∅ 4.8 mm
of the edentulous ridge to the anatomical landmarks that limit the
∅ 4.1 mm ∅ 3.3 mm

0
∅ 4.8 mm ∅ 4.1 mm ∅ 3.3 mm

placement of the implants. Make sure you do this measurement in the 2

4
6

line of the axis of the proposed implants. 8

10
12
14
8
16 16
/B/00 01/16

18
Straumann® SmartMulti

Assessment and treatment planning 3. Radiographic

Step 2 | Treatment planning planning

Calculation of bone availability

To calculate the effective vertical bone availability, use the following
formula:

Use this formula to

X-ray Reference Sphere 5 mm × ­calculate the available
bone availability (X-ray*) vertical bone.
Effective bone
availability
Reference Sphere diameter
on the X-ray

* Taking into consideration all implant-related anatomic structures (e.g. mandibular canal, sinus max-
illaris, etc.)

For example, if the measured bone

5 mm × 13 mm availability and Reference Sphere di-
= 10,8 mm
6 mm ameter on the X-ray are 13 mm and
6 mm (+ 20 % distortion), respectively:

The effective bone availability would be 10.8 mm, therefore you would
choose an implant length of 10 mm.

Caution: The loss of bone height due to ridge flattening during

surgery must always be considered.

3.3.3 Consider the additional length of the drill tip

Due to the construction and function The tip of the drill is up to

of the drills, the drill tip is a maximum 0.4 mm longer than the
of 0.4 mm longer than the implant in- implant insertion depth.
max. sertion depth. This additional length
0.4 mm
must be taken into consideration
during the planning phase.

17
Straumann® SmartMulti

Assessment and treatment planning 3. Radiographic

Step 2 | Treatment planning planning

3.3.4 Consider the coronoapical (vertical) implant position

The Standard Plus Implant with Consider the implant’s

its smooth neck collar of 1.8 mm vertical position in the
should be submerged in the bone as bone.
far as the margin of the rough im-
plant surface. It can be placed slight-
ly deeper, but the preparation depth
must be increased accordingly.

The Bone Level Tapered Implant is best placed with the outer rim
of the small 45° sloping edge (chamfer) at bone level.

18
Straumann® SmartMulti

Assessment and treatment planning 4. Risk

Step 2 | Treatment planning Assessment

4. Risk assessment
After collecting all relevant information of the patient history and af-
ter performing a comprehensive clinical and radiographic examination
and study model analysis, assess the complexity and risks associated
with placing an implant in your patient’s mouth.

The SAC classification system developed by the ITI (International Team Use the SAC classification
for Implantology) differentiates between straightforward, advanced tool to determine if the
and complex cases. The assessment for the surgical and restorative case is straightforward.
part of implant placement takes into consideration the patient, the
site of implantation and the processes involved.

You can perform this risk assessment

with the help of the online SAC Tool
which you can find at the ITI On-
line Academy.

This free and helpful tool allows you

to decide whether to treat the case
by yourself, or whether a referral is
required.

19
Straumann® SmartMulti

Assessment and treatment planning 4. Risk

Step 2 | Treatment planning Assessment

Straumann® Smart users are advised to treat straightforward cases

only, such as:

ѹѹ Multiple tooth gaps (including free-end situations) in the posterior Ensure that the prerequi-
non-esthetic zone sites of a straightforward
ѹѹ Healthy patient (ASA³-1: a normal healthy patient; or ASA³-2, a pa- implant case are fulfilled.
tient with mild systemic disease) with undisturbed wound healing
capability
ѹѹ Good patient motivation and compliance, preferably a non-smoker
ѹѹ No active periodontitis or occlusal parafunction
ѹѹ Healed ridge (≥ 5 months post-extraction) with sufficient bone vol-
ume
ѹѹ Conventional loading protocol (≥ 3 months after implant place-
ment)
ѹѹ Sufficient mesio-distal width of bone for the regular neck platform
(RN or RC) implants or wide neck platform (WN) implants
ѹѹ Sufficient bucco-lingual or bucco-palatal bone width and height for
placing implants without the need for bone augmentation
ѹѹ Sufficient inter-occlusal distance for the prosthetic restoration
ѹѹ Minimum vertical oral opening space of 30 mm to allow access with
surgical instruments

Caution: Any pathologic condition such as caries, periapical in-

fections, temporomandibular joint disorders or oral mucosal lesions
should be treated prior to implant placement.

In cases of residual probing depths (PD) ≥ 5 mm with concomitant

bleeding on probing, full-mouth plaque scores > 20 %, and associated
risk factors, pre-treatment and periodontal re-evaluation are man-
datory before implant placement.

20
Straumann® SmartMulti

Assessment and treatment planning 5. Visit planning

Step 2 | Treatment planning and cost proposal

5. Visit planning and cost proposal

The goal of the treatment is to sat-
isfy the patient’s demands regarding
chewing comfort and esthetics, with
a favorable long-term prognosis of
the restoration. To reach this goal,
you will need to:

5.1 Establish a diagnosis and prognosis of the remaining Prepare a diagnosis and
dentition to discuss with the patient treatment plan for the
discussion with your
­patient.
5.2 Elaborate a treatment plan and calculate the amount
of chairside time per visit and total number of visits
Include chairside time
required by the patient
and total number of
ѹѹ All diseases in the oral cavity (hard and soft tissue) have to be ­patient visits in the
treated before implant placement starts. ­treatment plan.
ѹѹ In case of insufficient oral hygiene or active periodontal disease,
additional dental treatment may be needed before starting with
the implant procedure, and should be calculated into the cost pro-
posal. Consider this when:
‒‒ the patient presents with poor oral hygiene
‒‒ there is active periodontal disease, requiring professional plaque
removal along with scaling and root planing
‒‒ there are teeth with hopeless prognosis which have to be
extracted
‒‒ there is active caries
‒‒ there are failing endodontically treated teeth
‒‒ there are stomatological lesions

At the end of the proposed additional dental treatment, you should

re-evaluate and make a decision regarding the subsequent steps for
implant treatment.

21
Straumann® SmartMulti

Assessment and treatment planning 5. Visit planning

Step 2 | Treatment planning and cost proposal

5.3 Calculate costs and write up a cost proposal

Analyze and calculate the approximate total costs for the surgical A cost estimate is
treatment in comparison to alternative treatment modalities. ­important for discussion
ѹѹ Dental implants are a cost-effective alternative to conventional with the patient.
restorations and improve the quality of life of the patient⁴.

22
Straumann® SmartMulti

Assessment and treatment planning Appendix 1

Step 2 | Treatment planning

Chart of minimum widths of bone for planning which

SP Implants (RN/WN) to use

SP (RN and WN) Implants

L min(mm)
D1 D2
Amin Cmin D1 D2
(mm) Bmin(mm) (mm) Bmin = + min. width of pontic +
2 2

Shoulder Shoulder Amin(mm) Bmin(mm) Bmin(mm) Cmin(mm) Lmin(mm) Lmin(mm)

diameter diameter premolar molar pontic premolar molar
D1(mm) D2(mm) pontic
∅ 4.8 (RN) ∅ 4.8 (RN) 4 12 16 4 20 24
∅ 4.8 (RN) ∅ 6.5 (WN) 4 13 17 5 22 26
∅ 6.5 (WN) ∅ 6.5 (WN) 5 13.5 17.5 5 23.5 27.5

Assuming min. width of pontic is 7.0 mm for premolar and 11.0 mm for molar, calculations have been rounded up to nearest 0.5 mm.

23
Straumann® SmartMulti

Assessment and treatment planning Appendix 2

Step 2 | Treatment planning

Chart of minimum widths of bone for planning which BLT

Implants (RC) to use

BLT (RC) Implants

L min(mm)
D1 D2
Amin Cmin D1 D2
(mm) Bmin(mm) (mm) Bmin = + min. width of pontic +
2 2

Shoulder Shoulder Amin(mm) Bmin(mm) Bmin(mm) Cmin(mm) Lmin(mm) Lmin(mm)

diameter diameter premolar molar pontic premolar molar
D1(mm) D2(mm) pontic
∅ 4.1 (RC) ∅ 4.1 (RC) 4 11 15 4 19 23
∅ 4.1 (RC) ∅ 4.8 (RC) 4 11.5 15.5 4 19.5 23.5
∅ 4.8 (RC) ∅ 4.8 (RC) 4 12 16 4 20 24

Assuming min. width of pontic is 7.0 mm for premolar and 11.0 mm for molar, calculations have been rounded up to nearest 0.5 mm.

24
Straumann® SmartMulti

Assessment and treatment planning Appendix 3

Step 2 | Treatment planning

Chart for the minimum bucco-lingual or bucco-palatal

width of bone for SP Implants

Endosteal Shoulder
diameter (mm) diameter (mm)

Bucco-lingual or
Implant type Shoulder bucco-palatal Recommended use for
(endosteal diameter) ­diameter (mm) width of bone Straumann® SmartMulti cases
(mm)
For narrow interdental spaces and narrow partially or
fully edentulous bone ridges.

Caution/Precaution:
Small-diameter implants are not recommended for
the posterior region.

SP ∅ 3.3 mm RN 4.8 5.5 Specific indications for Titanium SLA® ∅ 3.3 mm

­Standard Plus RN Implants:
These implants are to be used only in cases for the
following indications:
• Partially dentate jaws with implant-borne, fixed
constructions: Combine with implants ∅ 4.1 mm and
splint the suprastructure.

For use in the maxilla and mandible, for restoration of

SP ∅ 4.1 mm RN 4.8 6
partially or fully edentulous patients.

SP ∅ 4.8 mm RN 4.8 7

For use in the maxilla and mandible, for restoration of

partially or fully edentulous patients in wide interden-
tal spaces and bony ridges.

SP ∅ 4.8 mm WN 6.5 7

25
Straumann® SmartMulti

Assessment and treatment planning Appendix 4

Step 2 | Treatment planning

Chart for the minimum bucco-lingual or bucco-palatal

width of bone for BLT Implants

Endosteal Shoulder
diameter (mm) diameter (mm)

For BLT Implants, the shoulder diameter is the

same as the endosteal diameter at bone level.

Bucco-lingual or
Implant type Shoulder bucco-palatal Recommended use for
(endosteal ­diameter) ­diameter (mm) width of bone Straumann® SmartMulti cases
(mm)
For narrow interdental spaces and narrow partially or
fully edentulous bone ridges.
BLT ∅ 3.3 mm NC 3.3 5.5 Caution/Precaution:
Small-diameter implants are not recommended for
the posterior region.

For use in the maxilla and mandible, for restoration of

BLT ∅ 4.1 mm RC 4.1 6
partially or fully edentulous patients.

For use in the maxilla and mandible, for restoration of

BLT ∅ 4.8 mm RC 4.8 7 partially or fully edentulous patients in wide interden-
tal spaces and bony ridges.

26
Straumann® SmartMulti

Assessment and treatment planning

Step 2 | Treatment planning

REFERENCES

1 Buser D, von Arx T, ten Bruggenkate C, Weingart D. Basic surgical principles with ITI implants. Clin
Oral Impl Res 2000: 11 (Suppl.): 59–68. C Munksgaard 2000.
2 Major M. Ash, Stanley Nelson. Wheeler’s Dental Anatomy, Physiology and Occlusion. 10th Edition,
2010 Saunders/Elsevier.
3 American Society of Anesthesiologists® Physical Status Classification System, [Link]
org/resources/clinical-information/asa-physical-status-classification-system.
4 Vogel R, Smith-Palmer J, Valentine W. Evaluating the Health Economic Implications and Cost-
Effectiveness of Dental Implants: A Literature Review. Int J Oral Maxillofac Implants 2013;28:343–
356. doi: 10.11607/jomi.2921.

27
Straumann® SmartMulti

Assessment and treatment planning

Step 2 | Treatment planning

DISCLAIMER

Straumann® Smart is a blended training and education program focused on the education of general
dentists who want to become surgically active in the field of dental implantology. The program is
limited to information pertaining to straightforward implant cases and focuses on a reduced portfolio
of products that are suitable for the treatment of such cases.

All clinical Straumann® Smart content – such as texts, medical record forms, pictures and videos –
was created in collaboration with Prof. Dr. Christoph Hämmerle, Prof. Dr. Ronald Jung, Dr. Francine
Brandenberg-Lustenberger and Dr. Alain Fontolliet from the University of Zürich, Clinic for Fixed and
Removable Prosthodontics and Dental Material Science, Switzerland.

Straumann does not give any guarantee that Straumann® Smart provides sufficient knowledge or
instruction for the dental professional to become surgically active in the field of implantology. It is
the dental professional’s sole responsibility to ensure that he/she has the appropriate knowledge and
instruction before placing dental implants.

Straumann® Smart does not replace a careful and thorough analysis of each individual patient by a
dental professional. Further, it does not imply any guarantee or warranty with regard to complete-
ness of the information provided to the patient. It does not replace the dental professional’s duty
to inform the patient about the treatment, the products and the risks involved and to receive the
patient’s informed consent. The dental professional is solely responsible for determining whether or
not a treatment or product is suitable for a particular patient and circumstances. Knowledge of dental
implantology and instruction in the handling of the relevant products is always necessary and the
sole responsibility of the dental professional. The dental professional must always comply with the
individual product’s Instructions For Use as well as all laws and regulations.

STRAUMANN DISCLAIMS, TO THE EXTENT POSSIBLE BY LAW, ANY LIABILITY, EXPRESS OR IMPLIED,
AND BEARS NO RESPONSIBILITY FOR ANY DIRECT, INDIRECT, PUNITIVE, CONSEQUENTIAL OR OTHER
DAMAGES, ARISING OUT OF OR IN CONNECTION WITH ANY INFORMATION PROVIDED TO PATIENTS,
ERRORS IN PROFESSIONAL JUDGMENT, IN PRODUCT CHOICES OR PRACTICE IN THE USE OR INSTALLA-
TION OF STRAUMANN PRODUCTS.

All clinical content as well as clinical and radiographic images are provided by courtesy of Prof. Dr. Chris-
toph Hämmerle, Prof. Dr. Ronald Jung, Dr. Francine Brandenberg-Lustenberger and Dr. Alain Fontolliet
from the University of Zürich, Clinic for Fixed and Removable Prosthodontics and Dental Material
Science, Switzerland.

28
International Headquarters
Institut Straumann AG
Peter Merian-Weg 12
CH-4002 Basel, Switzerland
Phone +41 (0)61 965 11 11
Fax +41 (0)61 965 11 01
490.090/en/A/00 11/16

[Link]

© Institut Straumann AG, 2016. All rights reserved.

Straumann® and/or other trademarks and logos from Straumann® mentioned herein are the trademarks or registered trademarks of
Straumann Holding AG and/or its affiliates.