Case

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Immediate Flapless Placement of an Implant in a Maxillary Left Central Incisor Site

Stephen T Chen

A 29-year-old female patient presented for treatment to replace the upper left central incisor tooth with an implant- supported restoration. The tooth had been intermittently symptomatic for the previous 12 months. The tooth had originally suffered trauma about 15 years previously. Several endodontic treatments had been performed, including an apicectomy procedure to retain the tooth. The patient was healthy and a non-smoker. She had reasonable expectations in regard to esthetic outcomes and the risk of marginal tissue recession following treatment. At medium smile, the gingival margins of the upper teeth were visible, with a display of 3 to 4 mm of the gingival margins. Gingival recession of tooth 21 and a discrepancy in the gingival levels between teeth 11 and 21 was observable during normal speech and smile.
Surgical SAC classification
Complex
Prosthodontic SAC classification
Straightforward
Source
Treatment Guide 3
Purchase price
10 Academy Coins
CPD/CME
0.15 hours
Publication date: Jan 11, 2015 Last review date: Apr 10, 2021 Next review date: Apr 10, 2021

General information

Case Type Single-Tooth Space
Jaw Maxilla
Area Anterior
# of Teeth 1
# of Implants 1
Type of Implants One-Piece
Attachment One-Piece
Bone Augmentation No
Augmentation Materials -
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 crown
Modality -
Placement Protocol Immediate implant placement
Tooth Site Maxillary incisor or canine
Socket Morphology Single-root socket
Socket Integrity Damage to one or more bone walls
Bone Volume Damage to one or more socket walls
Anatomic Risk Low
Esthetic Risk Medium
Complexity Moderate
Risk of Complications High

Prosthodontic SAC classification

SAC Level Straightforward
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 Medium
Provisional Implant-Supported Prosthesis - -
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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