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Clinical Case Report

Replacement of an Ankylosed Central Incisor with a Gingival Recession: Tooth Extraction with Socket Grafting and Late Implant Placement with Simultaneous Contour Augmentation

Daniel Buser, Urs C Belser

In 2008, a healthy 15-year-old female, non-smoking patient presented at our clinic with a major esthetic problem of tooth 21. Her dental history revealed that the tooth had been avulsed by trauma years before. As a result, the replanted and temporarily splinted tooth had ankylosed and was in severe apical malposition. The ankylosed tooth exhibited a significant gingival recession that disturbed the patient greatly. Due to the patient’s low age and with her skeletal growth not completed, periodic follow-up visits were scheduled to monitor the situation until the patient was old enough for implant therapy.

Surgical SAC classification
Complex
Prosthodontic SAC classification
Advanced
Source
Treatment Guide 10
Purchase price
10 Academy Coins
CPD/CME
0.15 hours

Recommended content

General information

Case Type Single-Tooth Space
Jaw Maxilla
Area Anterior
# of Teeth 1
# of Implants 1
Type of Implants Two-Piece
Attachment Two-Piece
Bone Augmentation Horizontal|Simultaneous|Staged|Vertical
Augmentation Materials Autogenous chips|Xenogenous|Membrane
Guided Surgery No
Soft Tissue Grafting None
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 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 One missing tooth to be replaced by an implant-borne crown
Loading Protocol Conventional or early
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 Removable Removable
Occlusion/Articulation -
Occlusal Scheme/Issues -

Surgical SAC Modifiers

Periodontal Status Healthy

Prosthodontic SAC Modifiers

Soft Tissue Contour and Volume Significantly deficient

General SAC Modifiers

Oral Hygiene and Compliance Good
Access Adequate
Craniofacial/Skeletal Growth In progress
Publication date: Oct 3, 2017 Last review date: Sep 26, 2021 Next review date: Sep 26, 2024

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