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Peri-implantitis Resulting in Bisphosphonate-related Osteonecrosis of the Jaw

Michael M. Bornstein

A 82-year-old female patient was referred to the Department of Oral Surgery and Stomatology at the University of Bern, Switzerland, for further diagnosis and treatment of growing discomfort in the right mandible (implant 45) and left maxilla (implant 23). The patient had had implants of various types inserted in the mandible and maxilla over the course of the previous three decades (in the 1980s and 1990s). The patient had received removable partial dentures on implants in the maxilla and on natural teeth in the mandible. The implants in the posterior right mandible had been restored with two splinted single crowns. The lower partial denture was not well tolerated by the patient and therefore had not been worn for over ten years. After insertion of the implants, there had been no complications for many years, but implants 45 and 46 as well as 23 had begun to exhibit signs of peri-implantitis with limited bone loss several years previously. The infection had been treated by the private practitioner, and bone loss around the three implants had not progressed until about half a year previously.
Surgical SAC classification
Straightforward
Prosthodontic SAC classification
Straightforward
Source
Treatment Guide 8
Purchase price
10 Academy Coins
CPD/CME
0.15 hours
Publication date: Mar 31, 2016 Last review date: Mar 24, 2018 Next review date: Mar 24, 2021

General information

Case Type Short Space
Jaw Maxilla and Mandible
Area Anterior|Posterior
# of Teeth 8
# of Implants 6
Type of Implants One-Piece
Attachment One-Piece
Bone Augmentation No
Augmentation Materials -
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 Straightforward
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 Horizontally and vertically sufficient
Anatomic Risk Low
Esthetic Risk Low
Complexity Low
Risk of Complications Low

Prosthodontic SAC classification

SAC Level Straightforward
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 Absent
Esthetic Risk Low
Provisional Implant-Supported Prosthesis Prosthodontic margin < 3 mm apical to mucosal crest Prosthodontic margin < 3 mm apical to mucosal crest
Interim Prosthesis during Healing - -
Occlusion/Articulation Harmonious
Occlusal Scheme/Issues -

Surgical SAC Modifiers

Periodontal Status History of periodontitis or genetic predisposition

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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