Screening and medical evaluation of adults: contraindications for invasive dental procedures

Implant and preprosthetic surgeries aim to restore normal anatomical contours, function, comfort, esthetics, and oral health. Systemic screening of a patient prior to implant and/or biomaterial insertion is critical to patient well being and success of the surgical procedure(s). It is no longer appropriate to limit the general contraindications to the malfunction of major organs and systems and not consider the devastating long-term effects of an unhealthy lifestyle (smoking, inadequate diet, etc.). Modern standards of care should not systematically exclude patients with relative or marginal health conditions without exploring the possibilities of improving and stabilizing those conditions. Based on the classification of the American Society of Anesthesiology, a number of absolute and relative contraindications are presented. Treatments are proposed for optimizing some marginal health conditions and stabilizing unbalanced physiological function prior to surgery. A knowledge of the fundamentals of internal medicine is an important prerequisite for predictable implant and preprosthetic surgery. This paper reflects the opinion of a physician and dentist who has been actively involved in implant and preprosthetic surgery for the past quarter of a century in both private and university hospital practice.