Case

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Immediate Placement of an Implant in a Mandibular First Molar Site

Roberto Cornelini

A 32-year-old male patient in good general health, a nonsmoker, presented with a very large carious lesion in the mandibular left first molar (tooth 36). The probing depth around the molar was between 1 and 2 mm. This tooth was considered hopeless for three reasons: The carious lesion at the level of the root furcation that could lead to tooth fracture, the tooth was extruded because of the loss of almost the entire crown. As a result, the crown-to-root ratio was unfavorable and maintaining the tooth by means of crown lengthening would lead to furcation exposure. Based on these considerations, tooth extraction and immediate implant placement (Type 1) was planned in agreement with the patient. Immediate placement offers an obvious advantage to the patient, as the time interval between tooth extraction and the placement of the final restoration is minimized. Additionally, patient morbidity is reduced.
Surgical SAC classification
Advanced
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 Mandible
Area Posterior
# of Teeth 1
# of Implants 1
Type of Implants One-Piece
Attachment One-Piece
Bone Augmentation No
Augmentation Materials 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 Advanced
Defining Characteristics One missing tooth to be replaced by an implant-borne prosthesis
Modality -
Placement Protocol Immediate implant placement
Tooth Site Mandibular molar
Socket Morphology Multi-root socket
Socket Integrity Sufficient, with intact bone walls
Bone Volume Sufficient, with intact walls
Anatomic Risk Low
Esthetic Risk Low
Complexity Moderate
Risk of Complications Moderate

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 Cemented, with prosthesis margin < 3mm submucosal Cemented, with prosthesis margin < 3mm submucosal
Maxillomandibular Relationship -
Mesio-Distal Space Anatomic space corresponding to the missing tooth +/- 1 mm
Inter-Arch Distance Ideal tooth height +/- 1 mm
Bruxism Absent
Esthetic Risk Low
Provisional Implant-Supported Prosthesis - -
Interim Prosthesis during Healing - -
Occlusion/Articulation -
Occlusal Scheme/Issues -

Surgical SAC Modifiers

Periodontal Status Healthy

Prosthodontic SAC Modifiers

Soft Tissue Contour and Volume -

General SAC Modifiers

Oral Hygiene and Compliance Sufficient
Access Adequate
Craniofacial/Skeletal Growth Completed

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