Case

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Peri-implantitis Treated by an Antimicrobial and Regenerative Approach

Andrea Mombelli, Philipp Wick

A 73-year-old woman was referred to the Division of Periodontology (University of Geneva School of Dental Medicine) after repeated unsuccessful treatment of a peri-implant infection. She was systemically healthy and did not smoke. The patient’s history revealed that, three years earlier, an immediate implant (Straumann Tapered Effect RN 4.8/4.1; Institut Straumann AG, Basel, Switzerland) had been inserted to replace the upper right central incisor. A metal-ceramic crown had been delivered using an adhesive resin cement. One year later, the patient had consulted another dentist due to discomfort in the soft tissues in the implant region. There was a suppurating peri-implant pocket, 10 mm deep. Peri-implant bone loss and excess luting cement were seen on the radiograph. The situation was treated with non-surgical debridement, amoxicillin, and repeated submucosal irrigation with a chlorhexidine digluconate solution. The patient was referred after the suppuration had persisted for several months.

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 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 One missing tooth to be replaced by an implant-borne prosthesis
Modality -
Placement Protocol Immediate implant placement
Tooth Site Maxillary incisor or canine
Socket Morphology Single-root socket
Socket Integrity Sufficient, with intact bone walls
Bone Volume Sufficient, with intact walls
Anatomic Risk Low
Esthetic Risk Medium
Complexity Moderate
Risk of Complications High

Prosthodontic SAC classification

SAC Level Advanced
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 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 - -
Occlusion/Articulation -
Occlusal Scheme/Issues -

Surgical SAC Modifiers

Periodontal Status Healthy

Prosthodontic SAC Modifiers

Soft Tissue Contour and Volume Ideal

General SAC Modifiers

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

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