Case

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Implant Placement with Simultaneous SFE: Lateral Window Technique with a Composite Graft

Vivianne Chappuis

A 68-year-old woman presented for treatment to replace her maxillary right second premolar and first molar. Three years previously, her general dental practitioner had extracted tooth 16 because of a perforated root canal with a developing interradicular lesion. The patient was satisfied with the chewing function of her premolar occlusion until tooth 15 became symptomatic 2 months before presentation. Since a root fracture had developed, this tooth had to be extracted as well. The patient was a non-smoker. She had continuously received dental care by her private practitioner. Her plaque control and gingival health was, for the most part, excellent. Periodontal probing depths never exceeded 3 mm. She displayed a medium smile line; her esthetic demands were moderate to high. Her gingival biotype was classified as medium, and the dentition revealed signs of bruxism.

General information

Case Type Short Space
Jaw Maxilla
Area Posterior
# of Teeth 2
# of Implants 2
Type of Implants One-Piece
Attachment One-Piece
Bone Augmentation Horizontal|Simultaneous|Sinus Floor Elevation
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 with an implant-borne prosthesis or prostheses
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 Cemented, with prosthesis margin < 3mm submucosal Cemented, with prosthesis margin < 3mm submucosal
Maxillomandibular Relationship -
Mesio-Distal Space Anatomic space corresponding to the missing teeth +/- 1 mm
Inter-Arch Distance > 8 mm
Bruxism Present
Esthetic Risk High
Provisional Implant-Supported Prosthesis - -
Interim Prosthesis during Healing - -
Occlusion/Articulation Harmonious
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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