Clinical Case Report
Immediate Flapless Placement of an Implant in a Maxillary Left Central Incisor Site
A 29-year-old female patient presented for treatment to replace the upper left central incisor tooth with an implant- supported restoration. The tooth had been intermittently symptomatic for the previous 12 months. The tooth had originally suffered trauma about 15 years previously. Several endodontic treatments had been performed, including an apicectomy procedure to retain the tooth. The patient was healthy and a non-smoker. She had reasonable expectations in regard to esthetic outcomes and the risk of marginal tissue recession following treatment. At medium smile, the gingival margins of the upper teeth were visible, with a display of 3 to 4 mm of the gingival margins. Gingival recession of tooth 21 and a discrepancy in the gingival levels between teeth 11 and 21 was observable during normal speech and smile.
Surgical SAC classification
Complex
Prosthodontic SAC classification
Straightforward
Learner Level
|
1
|
2
|
3
|
Source
Treatment Guide 3
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 | No |
|---|---|
| Augmentation Materials | - |
| Guided Surgery | No |
| Soft Tissue Grafting | None |
| Abutment Type | Customized |
| 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 crown |
| Modality | - |
| Placement Protocol | Immediate implant placement |
| Tooth Site | Maxillary incisor or canine |
| Socket Morphology | Single-root socket |
| Socket Integrity | Damage to one or more bone walls |
| Bone Volume | Damage to one or more socket walls |
| Anatomic Risk | Low |
| Esthetic Risk | Medium |
| Complexity | Moderate |
| Risk of Complications | High |
Prosthodontic SAC classification
| SAC Level | Straightforward |
|---|---|
| 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 | Medium |
| Provisional Implant-Supported Prosthesis | - - |
| Interim Prosthesis during Healing | Removable Removable |
| Occlusion/Articulation | - |
| Occlusal Scheme/Issues | - |
Surgical SAC Modifiers
| Periodontal Status | Healthy |
|---|
Prosthodontic SAC Modifiers
| Soft Tissue Contour and Volume | Slightly compromised |
|---|
General SAC Modifiers
| Oral Hygiene and Compliance | Good |
|---|---|
| Access | Adequate |
| Craniofacial/Skeletal Growth | Completed |
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