Periodontal Plastic Surgery and Prosthetic Procedures to Treat Peri-Implant Soft-Tissue Dehiscences
A 30-year-old woman was referred by her general dentist for evaluation of an esthetic complication related to previous implant treatment for congenitally missing maxillary lateral incisors. The patient’s chief complaint was the inadequate esthetic appearance of her smile. The case demonstrates the use of a combined approach to achieve optimal results. Two different flap designs - a tunnel technique and a coronally advanced flap - are employed based on the surgical objectives for the affected site.
Surgical SAC classification
Advanced
Prosthodontic SAC classification
Complex
Learner Level
|
1
|
2
|
3
|
Source
Treatment Guide 12
CME/CPD
0.25 hours
Purchase price
10
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General information
| Case Type | |
|---|---|
| Jaw | Maxilla |
| Area | Anterior |
| # of Teeth | 2 |
| # of Implants | 2 |
| Type of Implants | Two-Piece |
| Attachment | Two-Piece |
| Bone Augmentation | No |
|---|---|
| Augmentation Materials | - |
| Guided Surgery | No |
| Soft Tissue Grafting | Yes |
| 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 | Advanced |
|---|---|
| Defining Characteristics | One missing tooth to be replaced by an implant-borne prosthesis |
| Modality | Modality |
| Placement Protocol | Early or late implant placement |
| Tooth Site | Tooth site |
| Socket Morphology | Socket morphology |
| Socket Integrity | Socket integrity |
| Bone Volume | Horizontally and vertically sufficient |
| Anatomic Risk | Low |
| Esthetic Risk | High |
| Complexity | Low |
| Risk of Complications | Low |
Prosthodontic SAC classification
| SAC Level | Complex |
|---|---|
| Defining Characteristics | One missing tooth to be replaced by an implant-borne crown |
| Loading Protocol | Conventional or early |
| Retention | - |
| Maxillomandibular Relationship | - |
| Mesio-Distal Space | - |
| 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 | Slightly compromised |
|---|
General SAC Modifiers
| Oral Hygiene and Compliance | Good |
|---|---|
| Access | Adequate |
| Craniofacial/Skeletal Growth | Completed |
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