【正文】 controlled diabetes should be stablised before contemplating implant placement.Facial Pain Particular care must be taken with patients suffering from “atypical facial pain”, as an implant may bee a focus for this pain, leading to an intractable problemThe origin of any facial pain needs to be carefully diagnosed, with specialist help as appropriate Psychological ProblemsThe suitability of patients with psychological disorders needs to be assessed most carefully before agreeing to proceed with treatment. A full dental history is essential. includes detailed extra and intraoral examinationSpecial attention needs to be paid to progressive periodontal disease, active caries and destructive parafunctional activities.For Example If split roots, typically relating to post crown, are present these tend to be associated with rapid bone loss and should be removed as a matter of urgency to preserve a possible implant site Clinical ExaminationExtraoralA full extraoral examination should be carried out , with particular attention being paid to the following:? temporomandibular jionts(TMJ) and muscles of mastication? facial profile and lip support? smile line The TMJ and muscles of mastication are examined for anatomical abnormalities, signs of dysfunction and pathology. The facial profile and lip support, with and without any existing denture, need to be carefully evaluated and any atypical features noted.The smile line relates to the level of the upper and lower lips in relation to the corresponding gingival margins.The smile line is of particular importance in cases in which gingival defects and long teeth are included in the smile A high lip line may be demanding aestheticallyIntraoralA prehensive intraoral examination must be pleted, with special attention to a number of general and site specific features as follows:General features as follows: primary disease, parafunction, prognosis of remaining teeth, occlusal support and control Clinical Examination? Specific to site: spaceinterdental and interocclusal ridge thickness and shape Clinical Examination? Specific to site: nature, thickness and condition of the soft tissues availability of bone, taking account of features such as concavities Clinical ExaminationStudy CastsIt is invariably necessary to obtain articulated study casts to allow a wellconsidered treatment plan to be formulated. Radiographic ExaminationIt is required to evaluate the quantity and, as best as possible, the quality of bone available for implant placement. Radiographic ExaminationIt is also essential to identify and locate anatomical structures.The radiographs need to be accurate to allow for precise measurements to be made before implant placement.The structures of particular interest include: Maxilla maxillary sinus nasal floor incisive canal labial concavities.The structures of particular interest include:Mandible inferior dental canal mental foramen lingual concavities.It is advisable to use a bination of radiographic views to reduce the chance of error.The bination of an axial tomogram and periapical radiographs is normally sufficient for the majority of implant proceduresFollowing the detailed examination and discussion of the patient’s wishes and expectations, decisions can be made and a treatment plan formulated. All options must be considered and presented to the patient, together with details of the advantages, disadvantages, risks, costs and anticipated success. It is felt by some that implants should be the last resort and teeth should be maintained at all costs. The high success rate of implant therapy questions this opinion.Once the decision to provide an implantsupported prosthesis has been taken, the case must be planned in detail to span all the necessary stages and the various procedures. Any other approach invariably leads to unnecessary difficulties. An essential part of the planning stage is to ensure that the environment in which the prosthesis is to be placed is as favourable