Replacement of a Fractured Upper Left Central Incisor: Early Placement of a Monotype Zirconia Implant, Semi-submerged Transmucosal Healing
The present case involved the placement of a monotype ceramic implant with concurrent guided bone regeneration using transgingival semi-submerged healing. Various studies have described the successful outcome of this procedure around transmucosal titanium implants (Brägger and coworkers 1996; Hermann and coworkers 2000; Jung 2004b; Cordaro and coworkers 2012). In addition, even typical intraosseous bone defects arising around titanium implants as a result of peri-implant infections have successfully been treated using guided bone regeneration in combination with transmucosal healing (Mombelli and coworkers 2015). Advantages of monotype ceramic implants include the absence of submucosal microgaps, reduced plaque affinity compared to titanium (Scarano and coworkers 2004), and an immensely rigid overall implant body. A 31-year old woman was referred to our clinic with an inflammation of the gingiva at tooth 21. On the day of the examination, a panoramic radiograph was taken.
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 | Horizontal|Simultaneous |
---|---|
Augmentation Materials | Autogenous chips|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 | Advanced |
---|---|
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, allowing simultaneous augumentation |
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 | Cemented, with prosthesis margin < 3mm submucosal Cemented, with prosthesis margin < 3mm submucosal |
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 | 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 | Good |
---|---|
Access | Adequate |
Craniofacial/Skeletal Growth | Completed |
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