Case

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Replacement of an Upper Right Central and Lateral Incisor with an Implant-Supported Crown and a Distal Cantilever

Bruno Schmid, Daniel Buser

This 20-year-old woman was referred to our department in July 2006. Four months earlier, she had experienced dental trauma to the anterior maxilla when traveling in South America. The emergency treatment included emergency root canal treatment of teeth 12 and 11. Tooth 21 was also subjected to endodontic treatment later. At the initial examination, the patient was not in pain but reported increased mobility of tooth 12. The clinical examination revealed a high smile line, medium thickness of the soft tissue, and rectangular tooth forms. Discoloration of tooth 12 was evident. The periapical radiograph provided by the referring dentist indicated a fracture line at both teeth 12 and 11. A cone-beam computed tomography (CBCT) scan confirmed these fractures. No pathology was found to be associated with tooth 21.
Surgical SAC classification
Advanced
Prosthodontic SAC classification
Advanced
Source
Treatment Guide 6
Purchase price
10 Academy Coins
CPD/CME
0.15 hours
Publication date: Oct 13, 2014 Last review date: Apr 10, 2021 Next review date: Apr 10, 2021

General information

Case Type Short Space
Jaw Maxilla
Area Anterior
# of Teeth 2
# of Implants 1
Type of Implants One-Piece
Attachment One-Piece
Bone Augmentation Horizontal|Simultaneous
Augmentation Materials Autogenous chips|Xenogenous|Membrane
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 Advanced
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 Deficient horizontally, allowing simultaneous augumentation
Anatomic Risk Low
Esthetic Risk High
Complexity Moderate
Risk of Complications Moderate

Prosthodontic SAC classification

SAC Level Advanced
Defining Characteristics Up to three missing teeth to be replaced with an implant-borne restoration or restorations
Loading Protocol Conventional or early
Retention Screw-retained, with 2 unsplinted implants Screw-retained, with 2 unsplinted implants
Maxillomandibular Relationship -
Mesio-Distal Space Adequate for the replacement of all missing teeth
Inter-Arch Distance -
Bruxism Absent
Esthetic Risk High
Provisional Implant-Supported Prosthesis Prosthodontic margin >3 mm apical to mucosal crest Prosthodontic margin >3 mm apical to mucosal crest
Interim Prosthesis during Healing Removable Removable
Occlusion/Articulation Harmonious
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 In progress

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