Case

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Late Placement of an Implant in a Maxillary Left Central Incisor Site

Yasushi Nakajima

A 30-year-old female patient had lost tooth 21 and was referred to our clinic for consultation and treatment. Due to advanced apical infection, tooth 21 had been extracted two months earlier at another clinic and an acrylic-resin tooth had been bonded to the adjacent teeth. The patient desired implant treatment to avoid any damage to the adjacent natural teeth. While the patient had no history of any systemic disorder, she was a heavy smoker and exhibited medium to advanced periodontitis in the entire jaw. After the initial treatment to achieve a pocket probing depth of less than 4 mm and no bleeding on probing, a decrease in the height of the papillae mesial and distal to the extraction site and overall gingival recession were observed.

General information

Case Type Single-Tooth Space
Jaw Maxilla
Area Anterior
# of Teeth 1
# of Implants 1
Type of Implants One-Piece|Reduced-Diameter
Attachment One-Piece|Reduced-Diameter
Bone Augmentation Horizontal|Staged
Augmentation Materials Autogenous chips|Membrane
Guided Surgery No
Soft Tissue Grafting Simultaneous
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 Complex
Defining Characteristics One missing tooth to be replaced by an implant-borne crown
Loading Protocol Conventional or early
Retention Cemented, with meso-structure Cemented, with meso-structure
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 Fixed Fixed
Occlusion/Articulation -
Occlusal Scheme/Issues -

Surgical SAC Modifiers

Periodontal Status History of periodontitis or genetic predisposition

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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