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Clinical Case Report

Iatrogenic Complications Managed by Replacing Prosthetic Components: Non-surgical Approach

Bruno Schmid

A male patient had lost teeth 11 and 22 as a result of a bicycle accident at age 14. In his adolescent years, a removable prosthesis had replaced the missing teeth. At age 21, the patient was referred by his dentist to the university clinic for treatment of the missing teeth 11 and 22 with implants. He was in good health and a nonsmoker. The absence of teeth 11 and 22 over many years had led to significant atrophy of the alveolar ridge, particularly at site 11. As a first step, the alveolar ridge was augmented using a block graft to replace the lost bone. A Straumann SP implant (diameter 4.1 mm, length 12 mm; Institut Straumann AG, Basel, Switzerland) and a Straumann Narrow Neck implant (length 10 mm) were inserted in the correct location and axial position at sites 11 and 22, respectively, six months later. After three months of healing and subsequent reentry, the patient returned to the referring dentist to receive the prosthetic restoration. The patient was seen again six months after the restoration had been placed. The frontal view showed a high smile line, an irregular gingival profile, and a bluish-gray tinge to implant crowns 11 and 22 compared to the natural dentition.
Surgical SAC classification
Complex
Prosthodontic SAC classification
Advanced
Source
Treatment Guide 8
Purchase price
10 Academy Coins
CPD/CME
0.15 hours

Recommended content

General information

Case Type Single-Tooth Space
Jaw Maxilla
Area Anterior
# of Teeth 2
# of Implants 2
Type of Implants One-Piece|Reduced-Diameter
Attachment One-Piece|Reduced-Diameter
Bone Augmentation Staged
Augmentation Materials Autogenous block(s)
Guided Surgery No
Soft Tissue Grafting None
Abutment Type Customized
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 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 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 Ideal

General SAC Modifiers

Oral Hygiene and Compliance Sufficient
Access Adequate
Craniofacial/Skeletal Growth Completed
Publication date: Jan 30, 2016 Last review date: Jan 25, 2021 Next review date: Jan 25, 2024

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