Staged GBR with Allogeneic Particulate Grafting Material for Single-Tooth Replacement
Staged bone augmentation of the alveolar ridge is indicated whenever a proposed implant site is deficient and will not support implant placement with simultaneous grafting. This is particularly true of healed sites presenting with facial flattening of the ridge. Since primary stability cannot possibly be achieved in this situation, it is recommended to use a staged approach with guided bone regeneration (GBR) for correct three-dimensional placement of the implant. In the anterior maxilla, staged GBR procedures are conducted not only to provide adequate bone volume for implant placement but also to restore a proper and stable contour of the orofacial ridge for improved long-term esthetics. A case is presented that demonstrates the technique for single-tooth replacement utilizing a staged approach with a particulate grafting material. A 50-year-old man whose tooth 11 was missing presented for consultation to the Center for Implant Dentistry in January 2010.
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|Staged |
---|---|
Augmentation Materials | Allogenous|Membrane |
Guided Surgery | No |
Soft Tissue Grafting | None |
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 | 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 | 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 | 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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