Cologne ABC Risk Score for Implant Treatment€¦ · Cologne ABC Risk Score for Implant Treatment 7th European Consensus Conference of BDIZ EDI February 2012 European Association

Cologne ABC Risk Score for Implant Treatment

7th European Consensus Conference of BDIZ EDIFebruary 2012

European Association ofDental Implantologists (BDIZ EDI)

Lipowskystr. 12 · 81373 Munich/GermanyFON +49 (0) 89 720 69 888 · FAX +49 (0) 89 720 69 023

[email protected]

8 Seiter Score_Englisch_neu_Layout 1 23.05.12 13:39 Seite 1

Among the many dental continuing-education events, the ExpertSymposium by BDIZ EDI – European Association of Dental Implan-tologists is an event that sets standards. Professor Joachim E Zöller,BDIZ EDI Vice President and scientific director of the symposium,and his top-echelon team of speakers spent this 7th symposiumlooking for answers to the question as to what can be done tofurther minimize implant-related risks. A result of great practicalrelevance was the Cologne ABC Risk Score previously discussedby the BDIZ EDI European Consensus Conference (EuCC). This scorewas designed to assist clinicians engaging in implant dentistry,to assess potential implant patients’ pre-treatment situation,thereby contributing to minimizing risks associated with implanttherapy.

The participants of the EuCC, hosted by Dr Nickenig, had ponderedthe draft submitted by the University of Cologne, arriving at aconsensus after four hours of constructive deliberations of theCologne ABC Risk Score: Using a simple ABC system, possibly andattractively visualized in the three colors of the traffic light, clini-cians are given the opportunity to rate the planned implanttreatment.

There are four partial scores: 1. Medical history2. Local findings3. Surgical4. Restorative

Each of these partial scores is calculated by itself, with the results– like the criteria – expressed in terms of the colours green, yellowand orange, corresponding to A, B and C (“Always” – “Between” –“Complex”). If two or more criteria for a partial score are assessed

as yellow (for B, medium risk), the entire partial score is deemedto be B (yellow, medium risk). Similarly, four yellow or two orangecriteria result in an overall partial score of C (orange, increasedrisk). The ABC classification is defined as follows:

• A = “Always“lowest assessed risk green area

• B = “Between“medium risk yellow area

• C = “Complex“increased risk orange area

Red is reserved for cases where the risk assessment shows thattreatment at issue may not be recommended which is not thesame as being contraindicated.

The overall patient assessment according to the Cologne ABC RiskScore works as follows: If all partial scores are green, the patient case as a whole isassessed as low-risk (A for “Always”).

If at least two of the four partial scores are yellow, the patientcase as a whole is assessed as medium-risk (B for “Between”).

If all partial scores are yellow, the patient case is assessed asincreased-risk (C for “Complex”). The same is true if at leasttwo of the four partial scores are orange and yellow.

The Cologne ABC Risk Score is suitable as an overall score for diag-nosis and treatment planning, but partial scores may also be used.

The Cologne “ABC” Risk Score of BDIZ EDI can also be found onlineon the BDIZ EDI website (www.bdizedi.org) Professionals / CologneABC Risk Score.

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Why Cologne ABC Risk Score?

2006 - Immediate restoration and immediate loading of oral implants2007 - Ceramics in dental implantology2008 - Peri-implantitis - prevention - diagnosis - therapy2009 - Three-dimensional imaging in dental implantology2010 - Avoiding treatment errors - managing surgical complications2011 - Short and angulated implants2012 - Cologne ABC Risk Score for implant treatment

Previous guidelines of BDIZ EDI


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Medical history

Always ComplexLocal findings

Surgical

Restorative

Between Complex



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Cologne ABC Risk Score 2012

patient:name first name

Cologne ABC Risk Score for Implant Treatment | 7th European Consensus Conference of BDIZ EDI

Subsection 1: Medical history

Health status ASA classification* ASA 1, 2ASA 3ASA 4

Pre-existing conditions nonediabetes mellitus well-controlled

not well-controlled (HbA1c) irradiated jaw < 50 Gy

> 50 Gyin past 9 months

periodontal disease (PD) no PDtreated PD, PPD </= 5.5treated PD, PPD >/= 5.5untreated PD

Medications no medicationimmunosuppression “low-dose” steroid treatment

cytotoxic medicationbisphosphonates oral (for osteoporosis)

intravenous for malignacybisphosphonates + immunosuppression

Smoking non-smokermild smoking habit < 10 cigs per daysevere smoking habit > 10 cigs per day

Patient expectations adequateoverdemanding

Bruxism noyes

Subsection 2: Local findings

Aesthetic risk factors outside aesthetic zone Smile line (aesthetic zone) low

mediumhighaesthetic zone

Attached gingiva adequateinadequateperiodontal biotype thick biotype

thin biotypeprevious surgery

Ridge defect no ridge defecthorizontal deficiency local, bony walls

no bony wallsvertical deficiency local, bony walls

no bony walls

Periapical lesion (adjacent tooth) noyes

Oral hygiene favourableunfavourable


AlwaysBetweenComplex

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Cologne ABC Risk Score for Implant Treatment | 7th European Consensus Conference of BDIZ EDI

* ASA Classification

The ASA physical status classification system is a system for assessingthe fitness of patients before surgery. ASA 1: normal healthy patientASA 2: patient with mild systemic diseaseASA 3: patient with severe systemic diseaseASA 4: patient with severe systemic disease that is a constant threat to lifeASA 5: moribund patient who is not expected to survive without the operationASA 6: declared brain-dead patient whose organs are being removed for donor purposes

Subsection 3: Surgical

Anatomic risk none

proximity to neighboring structures

Healing period after tooth loss late placement

delayed

immediate

Augmentation (according to indication)

no augmentation necessary

horizontal with bony support

horizontal without bony support

sinus floor elevation, septae

sinus floor elevation, internal (>2 mm)

vertical

Subsection 4: Restorative

Biomechanics no biomechanical problems

implant-tooth connection

extension required

unfavourable load distribution (denturekinetics/crown-implant ratio/single implants and antagonistic occlusion)

implant diameter inadequate

Aesthetics adjacent tooth situation tooth (healthy condition)

pontics

implant

implant malposition

insufficient space

Fixed restoration for full arch adequate number and distribution of implants

sufficient tissue support

insufficient tissue support

inadequate number and/or distribution of implants

Removable restoration adequate number and distribution of implants

coverdenture

bridge design

inadequate number and/or distribution of implants

Complexity exceeding patient capability

favourable handling and/or cleanability

unfavourable handling and/or cleanability


Documents

Cologne ABC Risk Score for Implant Treatment€¦ · Cologne ABC Risk Score for Implant Treatment 7th European Consensus Conference of BDIZ EDI February 2012 European Association