Minimally Invasive Treatment of a Patient in Her Nineties After Removing Implants Affected by Severe Peri-implantitis
A 93-year-old female patient presented in September 2010 with an enlarged swelling on the lingual side of her lower incisors. At the time, she was essentially healthy, except for reduced vision due to bilateral age-related macular degeneration. She had been a heavy smoker (about 30 cigarettes a day) for the past 20 years after becoming a widow. The patient lived at home by herself, with full-time domestic support. An extraoral examination revealed nothing adverse. Intraoral plaque control was anything but ideal, and a soft-tissue tumescence was visible around the lingual aspect of 41–42. Because the nature of the lesion was not clear, a biopsy was carried out that revealed the inflammatory nature of the lesion. The panoramic radiograph showed six irregularly distributed mandibular implants supporting a full-arch prosthesis, with various degrees of interproximal peri-implant resorption. The periapical radiograph revealed interproximal bone resorption mesially and distally to implant 41.
Surgical SAC classification
Straightforward
Prosthodontic SAC classification
Advanced
Learner Level
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1
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2
|
3
|
Source
Treatment Guide 9
CME/CPD
0.25 hours
Purchase price
10
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General information
| Case Type | Extended Space |
|---|---|
| Jaw | Mandible |
| Area | Posterior |
| # of Teeth | 6 |
| # of Implants | 2 |
| Type of Implants | One-Piece |
| Attachment | One-Piece |
| Bone Augmentation | No |
|---|---|
| Augmentation Materials | - |
| 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 | Straightforward |
|---|---|
| Defining Characteristics | More than three missing teeth to be replaced with an implant-borne prosthesis or prostheses |
| Modality | - |
| Placement Protocol | Early or late implant placement |
| Tooth Site | - |
| Socket Morphology | - |
| Socket Integrity | - |
| Bone Volume | Horizontally and vertically sufficient |
| Anatomic Risk | Low |
| Esthetic Risk | Low |
| Complexity | Moderate |
| Risk of Complications | Low |
Prosthodontic SAC classification
| SAC Level | Advanced |
|---|---|
| Defining Characteristics | Up to three missing teeth to be replaced with an implant-borne restoration or restorations |
| Loading Protocol | Conventional or early |
| Retention | Screw-retained, with splinted implants Screw-retained, with splinted implants |
| Maxillomandibular Relationship | - |
| Mesio-Distal Space | Anatomic space corresponding to the missing teeth +/- 1 mm |
| Inter-Arch Distance | > 8 mm |
| Bruxism | Absent |
| Esthetic Risk | Low |
| Provisional Implant-Supported Prosthesis | Prosthodontic margin < 3 mm apical to mucosal crest Prosthodontic margin < 3 mm apical to mucosal crest |
| Interim Prosthesis during Healing | - - |
| Occlusion/Articulation | Harmonious |
| Occlusal Scheme/Issues | - |
Surgical SAC Modifiers
| Periodontal Status | History of periodontitis or genetic predisposition |
|---|
Prosthodontic SAC Modifiers
| Soft Tissue Contour and Volume | - |
|---|
General SAC Modifiers
| Oral Hygiene and Compliance | Insufficient |
|---|---|
| Access | Adequate |
| Craniofacial/Skeletal Growth | Completed |
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