Autologous Block Graft and Guided Bone Regeneration (GBR) for Horizontal Ridge Augmentation in the Anterior Maxilla
A 27-year-old man was referred to the Department of Oral Surgery and Stomatology (University of Bern, Switzerland for implant therapy in the anterior maxilla. The patient was healthy and did not smoke. His tooth 21 was apically malpositioned and ankylosed due to a dental trauma during adolescence. The preoperative examination included an esthetic risk assessment (Martin and coworkers 2006), which revealed a number of high-risk elements, most important among them the patient’s high smile line and the non-harmonious gingival margins of the maxillary anterior dentition. Tooth 21 was associated with significant gingival recession. Tooth 11 required treatment to eliminate or mask severe discoloration from previous root canal treatment. A periapical radiograph confirmed the ankylosed condition of root 21 and disclosed characteristic signs of advanced external root resorption, also showing that both central incisors had been exposed to root canal treatment. Neither tooth showed indications of apical pathology.
Surgical SAC classification
Complex
Prosthodontic SAC classification
Advanced
Learner Level
|
1
|
2
|
3
|
Source
Treatment Guide 2
CME/CPD
0.25 hours
Purchase price
10
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General information
| Case Type | Single-Tooth Space |
|---|---|
| Jaw | Maxilla |
| Area | Anterior |
| # of Teeth | 1 |
| # of Implants | 1 |
| Type of Implants | One-Piece |
| Attachment | One-Piece |
| Bone Augmentation | Staged |
|---|---|
| Augmentation Materials | Autogenous chips|Autogenous block(s)|Xenogenous|Membrane |
| Guided Surgery | No |
| Soft Tissue Grafting | None |
| Abutment Type | Standard |
| Prosthesis Type | FDP |
Esthetic Risk Assessment
| Esthetic Risk Factors | Low | Medium | High |
|---|---|---|---|
| Medical Status | Healthy | Compromised | |
| Smoking Habit | Non-smoker | Light smoker (< 10 cigarettes per day) | Heavy smoker (>= 10 cigarettes per day) |
| Patient's Esthetic Expectations | Low | Medium | High |
| Lip Line | No exposure of papillae | Exposure of papillae | Full exposure of mucosa margin |
| Periodontal Phenotype | Low-scalloped, thick | Medium-scalloped, medium-thick | High-scalloped, thin |
| Shape of Tooth Crowns | Rectangular | Triangular | |
| Infection at Implant Site | None | Chronic | Acute |
| Bone Level at Adjacent Teeth | <= 5 mm to contact point | 5.5 to 6.5 mm to contact point | > 7 mm to contact point |
| Prosthodontic Status of Neighboring Teeth | Virgin | Restored | |
| Width of Edentulous Span | 1 tooth (>= 7 mm) | 1 tooth (< 7 mm) | 2 teeth or more |
| Soft Tissue Anatomy | Intact | Defective | |
| Bone Volume | Horizontally and vertically sufficient | Horizontally deficient | Deficient vertically or deficient vertically AND horizontally |
* General SAC assessment modifiers that are also part of the ERA. To avoid redundancy they are listed in this section even if no complete ERA has been made.
** Not applicable to the ERA of immediate placement cases and replaced by "Socket Integrity" listed below under "Surgical SAC Classification". For all other placement types this value is a classification determinant and listed here even if no complete ERA has been made.
Surgical SAC classification
| SAC Level | Complex |
|---|---|
| Defining Characteristics | One missing tooth to be replaced by an implant-borne prosthesis |
| Modality | - |
| Placement Protocol | Early or late implant placement |
| Tooth Site | - |
| Socket Morphology | - |
| Socket Integrity | - |
| Bone Volume | Deficient horizontally, requiring prior grafting |
| Anatomic Risk | Low |
| Esthetic Risk | High |
| Complexity | Moderate |
| Risk of Complications | Moderate |
Prosthodontic SAC classification
| SAC Level | Advanced |
|---|---|
| Defining Characteristics | One missing tooth to be replaced by an implant-borne crown |
| Loading Protocol | Conventional or early |
| Retention | Screw-retained Screw-retained |
| Maxillomandibular Relationship | Angle Class I and III |
| Mesio-Distal Space | Symmetry +/- 1 mm of contra-lateral tooth |
| Inter-Arch Distance | - |
| Bruxism | - |
| Esthetic Risk | High |
| Provisional Implant-Supported Prosthesis | - - |
| Interim Prosthesis during Healing | - - |
| Occlusion/Articulation | - |
| Occlusal Scheme/Issues | - |
Surgical SAC Modifiers
| Periodontal Status | Healthy |
|---|
Prosthodontic SAC Modifiers
| Soft Tissue Contour and Volume | Significantly deficient |
|---|
General SAC Modifiers
| Oral Hygiene and Compliance | Good |
|---|---|
| Access | Adequate |
| Craniofacial/Skeletal Growth | Completed |
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