Replacement of Failing Hydroxyapatite-Coated Cylinder-Type Implants with Bone-Level Implants and a Screw-Retained Fixed Partial Denture in the Anterior Maxilla
This 49-year-old woman was referred for treatment by her general dentist with the request that she be evaluated for her “failing implants.” This very cooperative patient presented for care with no significant medical conditions, no known drug allergies, and was not taking any prescription medications. She did report a history of mild insomnia in the previous 7 years and was taking a multi-vitamin supplement in addition to over-the-counter vitamin D and calcium supplements. She complained of mild discomfort and swelling around her dental implants and occasional foul taste and unpleasant aroma in her mouth. A thorough history and examination revealed no evidence of parafunctional habits or temporomandibular joint disorder.
General information
Case Type | Extended Space |
---|---|
Jaw | Maxilla |
Area | Anterior |
# of Teeth | 6 |
# of Implants | 2 |
Type of Implants | Two-Piece |
Attachment | Two-Piece |
Bone Augmentation | Horizontal|Staged |
---|---|
Augmentation Materials | Allogenous|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 | Complex |
---|---|
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 | Deficient horizontally, requiring prior grafting |
Anatomic Risk | Moderate |
Esthetic Risk | High |
Complexity | Moderate |
Risk of Complications | Moderate |
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 | Adequate for the replacement of all missing teeth |
Inter-Arch Distance | - |
Bruxism | Absent |
Esthetic Risk | High |
Provisional Implant-Supported Prosthesis | Prosthodontic margin < 3 mm apical to mucosal crest Prosthodontic margin < 3 mm apical to mucosal crest |
Interim Prosthesis during Healing | Removable Removable |
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 | Significantly deficient |
---|
General SAC Modifiers
Oral Hygiene and Compliance | Good |
---|---|
Access | Adequate |
Craniofacial/Skeletal Growth | Completed |
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