Implant Treatment Planning and Referral for Implant Surgery

Subject: III. Clinical – I. Patient Care

Policy/Procedure: Implant Treatment Planning and Surgery - Referral in the Predoctoral Clinic

Effective Date: July 2016

Reviewed and/or Revised: 09/01/2017, 02/07/2024, 07/29/2025

Implant planning and referral to radiology and surgeons must occur under the supervision of a Prosthodontics attending.

Case selection: single tooth implants in the non-esthetic zone, two consecutive implants in the posterior and mandibular implant overdentures are considered mainstream treatments in most treatments. Other treatment types such as single implants in the esthetic zone, implant supported FPDs in the posterior area, partial edentulous implant overdentures, maxillary overdentures, etc. are considered advanced treatment and may need to be referred to the implant clerkship, advanced prosthodontics clerkship or Advanced Dental Education Programs (ADE) for treatment.
Fixed Case Presentation Appointment: once the patient has completed Phase I (disease control and periodontal clearance). The patient should be scheduled in an IMP/TP chair in the undergraduate clinic for clinical evaluation. Appropriate treatment plan codes must be entered, and treatment consent must be obtained. If the patient is a patient of record periodontal maintenance should be up to date and/or an approval from the GP director must be obtained to move on with the implant planning.
Required codes: the following codes must be present in all implant plannings: D9450.9 (Pre-Implant Prosth Review), D9450.3 (Fixed Case Presentation), and D6190 (Radiographic Template/surgical guide). Additionally, all fixed implants treatments must have D6085 (Implant Provisionals) code. All these codes should be approved by Prosthodontic attending signifying case acceptance for restoration in the undergraduate clinic. At this time treatment consent should be obtained. Additional fees for radiographs and other surgical fees will be planned by the requesting provider and additional consent obtained at the time of the surgical consultation.
Financial Arrangements: During this appointment the patient makes the financial arrangements with the business office and makes a payment for the fabrication of the surgical guide.
Referral to the Specialty Clinic: Patient should be referred to ADE Periodontics, OMS department or ADE Prosthodontics for implant placement based on input from supervising prosthodontic faculty. A consultation with ADE program/OMS will be requested to determine if any site preparation is required (e.g., sinus elevation, GBR procedures, etc.). After this consultation, a referral for CBCT scan will be submitted in Axium using the RADCON form, specifying a full volume to capture both arches. CBCT codes are planned by the Radiology Division, not by the student. Additionally, a referral to specialty clinic Axium form is submitted to the appropriate specialty.
Digital planning and surgical guide fabrication: all implant treatments will be planned using a digital workflow and a surgical guide is fabricated. Once the plan is completed and approved by the prosthodontic attending, the students will contact the surgeon to stop by the clinic floor and in presence of a prosthodontic attending to approve the digital plan. After approval, the student will proceed to finalize the surgical guide design.
Surgical guide: The student must prepare and submit a laboratory prescription using PR DIGITAL laboratory in Axium and obtain prosthodontic attending approval. This prescription is then printed and dropped off at the in-house lab for printing of the guide. Students must allow 7 business days for the guide to be completed. Finally, the student must pick up the guide and verify seating on the diagnostic cast and attach the metal sleeves to the surgical guide under the supervision of a prosthodontic faculty.

Note: In certain cases, a CBCT may not be required (e.g. immediate implant in a posterior site), and a vacuum form guide can be requested by the surgeon with the prosthodontic attending agreement.

Changes to the treatment plan (placement of additional implants e.g.) should not be made without consulting the referring student and their attending faculty. In some cases, the new treatment plan may exceed the capability of the undergraduate students and therefore the case may need to be reassigned to a more advanced student with commensurately higher fees. In any case the new treatment must also be consented to by the patient.

Predoctoral clinic Directors will ensure that the restorative treatment plan has been discussed with the patient by confirming that there is a restorative treatment plan for the implants that is signed by the patient in the Axium record prior to sending the patient for an implant consult. Documentation that is signed by the patient and a related treatment note are the only record that this discussion was had with the patient. The student should additionally advise the patient of the restorative procedures and fees and the need for a surgical phase of treatment, including the surgical procedures (implant placement, grafts, etc.) and the associated fees for those treatments.

Although Directors and restorative faculty have the primary responsibility for ensuring the completeness and accuracy of the restorative treatment plan (for implants), ADE residents are encouraged to monitor the presence of a restorative treatment plan in Axium when formulating the surgical treatment plan (as a means of check and balance). This effort will help ensure that a restorative plan has been formulated and documented and that the patient is aware of that phase of treatment, including the fees associated with restoring the implants.

Predoctoral prosthodontic faculty have been asked to identify instances when treatment is modified by residents in the ADE programs without appropriate consultation with the pre-doctoral student, and faculty, and to report these cases to the Assistant Dean for Clinical Affairs. Treatment that is planned and approved by faculty in the predoctoral clinic should never be changed by residents of any specialty clinic without consultation and approval by the predoctoral student and faculty who referred the patient to them.