Replacement of Two Central Incisors and One Lateral Incisor with a Fixed Dental Prosthesis on Two Tissue-Level Implants
A 29-year-old woman was referred to our department for implant therapy. At the day of examination, a detailed Esthetic Risk Assessment (ERA) was performed (Martin and coworkers 2006). The patient was in good general health, but a heavy smoker (more than 20 cigarettes per day). When her midface had been injured in a severe car accident 10 years earlier, the dentition in the anterior maxilla was also affected. The injured anterior teeth (11, 21, 22) required endodontic treatment and were restored with crowns. Within a few years of the accident, the patient developed a considerable esthetic problem due to progressive recession of the gingiva in the area of the restored teeth. The local status demonstrated severe exposure of the root surfaces, especially of root 21, and black triangles between the three teeth. Thanks to her medium smile line, the patient was able to conceal the exposed root surfaces, but not the black triangles.
Surgical SAC classification
Complex
Prosthodontic SAC classification
Advanced
Learner Level
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1
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2
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3
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Source
Treatment Guide 6
CME/CPD
0.15 hours
Purchase price
10
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General information
| Case Type | Short Space |
|---|---|
| Jaw | Maxilla |
| Area | Anterior |
| # of Teeth | 3 |
| # of Implants | 2 |
| Type of Implants | One-Piece |
| Attachment | One-Piece |
| Bone Augmentation | Horizontal|Simultaneous |
|---|---|
| Augmentation Materials | Autogenous chips|Xenogenous|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 | Up to three missing teeth to be replaced by two implants |
| Modality | - |
| Placement Protocol | Early or late implant placement |
| Tooth Site | - |
| Socket Morphology | - |
| Socket Integrity | - |
| Bone Volume | Deficient vertically or deficient vertically AND horizontally |
| Anatomic Risk | High |
| Esthetic Risk | High |
| Complexity | High |
| Risk of Complications | High |
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 2 splinted implants Screw-retained, with 2 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 | Healthy |
|---|
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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