Replacement of a Compromised Upper Right Central Incisor: Hard- and Soft-tissue Augmentation, Late Placement of an RC Bone Level Implant
A 36-year-old male patient with a compromised maxillary central incisor was referred by his general dentist for consultation. The patient’s chief complaints were the gradual debonding of a temporary crown on the right central incisor and unsatisfactory esthetics due to an increasing diastema between the right central and lateral incisors. The patient reported a traumatic event some years previously, when a crown had been placed after root-canal treatment. The referring dentist wanted to provide a new crown restoration, but was concerned about the condition of the residual root. Anamnesis was negative for any other dental or periodontal pathology in the remaining dentition. The patient reported taking no medications: He was a smoker (10 to 15 cigs/day) and had realistic esthetic expectations.
Surgical SAC classification
Complex
Prosthodontic SAC classification
Advanced
Learner Level
|
1
|
2
|
3
|
Source
Treatment Guide 10
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 | Two-Piece |
| Attachment | Two-Piece |
| Bone Augmentation | Horizontal|Simultaneous|Staged |
|---|---|
| Augmentation Materials | Xenogenous|Membrane |
| Guided Surgery | No |
| Soft Tissue Grafting | Simultaneous |
| Abutment Type | CAD/CAM |
| 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 | Medium |
| 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 | Medium |
| Provisional Implant-Supported Prosthesis | Prosthodontic margin > 3 mm apical to mucosal margin Prosthodontic margin > 3 mm apical to mucosal margin |
| 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 | Sufficient |
|---|---|
| Access | Adequate |
| Craniofacial/Skeletal Growth | Completed |
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