The all-on-6 treatment concept is available for cases with no teeth on the upper or lower jaw. The foremost condition for implant application is that the implant candidate area must have sufficient bone capacity. Together with that, the patient's general health condition is required to be suitable. The foremost health conditions to be taken into consideration in case of systemic diseases:
Blood thinners are anticoagulant and antiplatelet medicines used for cardiovascular diseases and to prevent the formation of blood clots. Although the usage of such medications is recommended to be discontinued before the dental implant applications involving oral surgery, the right approach is to monitor the patient's blood picture and general health condition by a cardiologist before the oral surgical procedures. During minor surgical dentistry procedures (dental implant, tooth extraction, endodontic surgery, gum surgery, etc.), intense bleeding is not expected. In addition, to ensure doctor and patient comfort during surgical procedures, we recommend that blood thinners be discontinued by checking the International Normalized Ratio (INR) values in the blood. For moderate oral surgical procedures, an INR value between 2-3 is a safe value during the surgical procedure. The 2016 Clinical Practice Statement of the American Academy of Oral Medicine organization stated that moderate invasive oral surgery (defined as "uncomplicated tooth extraction") is safe with an INR value of 3,5. If the surgical procedure planned is advanced invasive surgery, an INR value must be ≤2 for advanced surgical procedures. All-on-6 procedures can be considered advanced oral surgical procedures, including multiple tooth extractions alongside implant applications. As a result, in all-on-6 treatment approaches, an INR value must be ≤2 for the safety of the procedure.
How many cardiovascular, general surgery, and medical-surgical procedures can be performed on diabetic patients, and dental/oral surgical procedures can also be performed? Here, the most critical issue is keeping Diabetes under control. Therefore, before All-on-6 dental implant applications, conducting a Hemoglobin A1C (HbA1C) test is important, as it shows the average blood sugar (glucose) level in the last two or three months. To perform oral surgical procedures safely, the HbA1C blood value is expected to be 64 mmol/mol (8%) ≤ n. Patients with HbA1C values higher than the reference range may experience delayed recovery and an increased risk of infection. The usage of biphosphonate and similar medicine. Physiologically, two mechanisms in the bone function at the same time. Bone construction (osteoblastic activity) and bone destruction (osteoclastic activity).
Bisphosphonate and a drug group with similar effects inhibit the bone destruction mechanism; in other words, prevent it, and bone construction continues. In this situation, the balance of the bone mechanism turns in favor of bone construction, and during drug use, continuous bone construction continues. As a result of intense osteoblastic activity, recovery of a surgical wound will turn into a risky situation. This disorder in bone recovery causes necrotic tissues to form in the bone, and these necrotic areas that cause intraosseous infection must be cleaned.
These intraosseous lesions are generally known as MRONJ (Medication-related Osteonecrosis of the Jaw). β-CTx values are measured in the blood of patients using this group of drugs to evaluate the risk of developing MRONJ. If the β-CTx value is <100 pg/ml, risk/safety values are stated for oral surgery procedures.
Smoking is one of the most important elements that negatively affect oral hygiene. Like how it causes gingivitis followed by bone destruction around the natural teeth, bad oral hygiene causes bone destruction caused by plaque buildup in soft and hard tissues around the dental implants. Together with this, scientific research has shown that implant loss rates in patients who smoke are 2.14 times higher than in patients who do not smoke. Smoking is an important element that threatens the long-term success and usage of dental implants. However, Smoking is an important bad habit that impairs healing and prevents tissue formation not only in implant surgical procedures but also in bone graft applications.
Alcohol is known to cause tissue-specific changes in healthy tissue protein metabolism. Alcohol consumption affects the immune system and changes the structure of proteins that help the tissue recover. As a result, the recovery period is disrupted. As all-on-6 treatment approaches are included in oral surgery procedures, alcohol consumption has a significant negative impact on tissue healing after such surgery.