Replacement of the Four Maxillary Incisors with a Fixed Dental Prosthesis Using an Immediate Loading Protocol
In November 2001, a 53-year-old female presented seeking advice and options for treatment of her maxillary incisor teeth. She was dissatisfied with both the functional and esthetic qualities of her existing restorations. Her medical health was excellent, and she reported no contraindications to dental care. On presentation, the patient’s dental health was less than ideal. Although she had no probing depths greater than 3 mm, she suffered from generalized chronic adult periodontitis and displayed multiple sites of bleeding on probing. Her remaining dentition was heavily restored, and many teeth had been endodontically treated. Areas of recurrent dental caries were noted on many teeth. Radiographically and clinically, the maxillary incisor teeth exhibited large areas of active caries, and after the splinted crowns had been removed, the teeth were determined to be non-restorable.
General information
Case Type | Extended Space |
---|---|
Jaw | Maxilla |
Area | Anterior |
# of Teeth | 4 |
# 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 | Complex |
---|---|
Defining Characteristics | Up to three missing teeth to be replaced with an implant-borne restoration or restorations |
Modality | - |
Placement Protocol | Immediate implant placement |
Tooth Site | Maxillary incisor or canine |
Socket Morphology | Single-root socket |
Socket Integrity | Sufficient, with intact bone walls |
Bone Volume | Sufficient, with intact walls |
Anatomic Risk | Low |
Esthetic Risk | Medium |
Complexity | Moderate |
Risk of Complications | High |
Prosthodontic SAC classification
SAC Level | Complex |
---|---|
Defining Characteristics | Up to three missing teeth to be replaced with an implant-borne restoration or restorations |
Loading Protocol | Immediate |
Retention | Screw-retained, with 3 or more splinted implants Screw-retained, with 3 or more splinted implants |
Maxillomandibular Relationship | - |
Mesio-Distal Space | Adequate for the replacement of all missing teeth |
Inter-Arch Distance | - |
Bruxism | Absent |
Esthetic Risk | Medium |
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 | Irregular, with no need for correction |
Occlusal Scheme/Issues | - |
Surgical SAC Modifiers
Periodontal Status | History of periodontitis or genetic predisposition |
---|
Prosthodontic SAC Modifiers
Soft Tissue Contour and Volume | Ideal |
---|
General SAC Modifiers
Oral Hygiene and Compliance | Insufficient |
---|---|
Access | Adequate |
Craniofacial/Skeletal Growth | Completed |
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