Case

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Replacement of a Maxillary Right Central Incisor Using an Immediate Restoration Protocol

Christopher Evans, Adam J Rosenberg

A healthy 54-year-old male was referred to a specialist prosthodontic clinic for the management of the maxillary right central incisor, tooth 11. It had been endodontically treated approximately 20 years before and was decoronated during trauma to the mouth. Emergency treatment provided by the referring general dentist provisionally restored the tooth with a prefabricated post and full coronal resin restoration. The patient requested a fixed replacement of tooth 11. The patient displayed a moderate lip line and, on wide smiling, a display of the interproximal papilla, and 1 mm of cervical gingival margin.

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 Customized
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 crown
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 High
Complexity Moderate
Risk of Complications High

Prosthodontic SAC classification

SAC Level Complex
Defining Characteristics One missing tooth to be replaced by an implant-borne crown
Loading Protocol Immediate
Retention Screw-retained Screw-retained
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 - -
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 Sufficient
Access Adequate
Craniofacial/Skeletal Growth Completed

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