Case

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Replacement of Five Teeth with a Fixed Dental Prosthesis on Bone-Level Implants

Dejan Dragisic

A 52-year-old male patient presented at our clinic, his concern being that most of his maxillary anterior dentition (teeth 13 to 22) was missing. This extensive tooth loss was due to trauma, which had occurred several years previously, after which the patient had been wearing a removable partial denture. He stated that the residual roots were asymptomatic, did not express any other concerns, and reported not having a routine dental history with regular dental examinations. His medical history was uneventful, and he did not smoke. A clinical and radiographic examination revealed the presence of generalized periodontal disease associated with fair to poor oral hygiene, moderate plaque, subgingival fracture of teeth 13 to 22 with a poor prognosis, defective restorations on several teeth (18, 17, 14, 24, 25, 27, 37, 45, 47, 48), periapical radiolucencies around several teeth (38, 35, 33, 43, 47), and erosive/abrasive lesions on most teeth (notably in the fifth sextant).

General information

Case Type Extended Space
Jaw Maxilla
Area Anterior
# of Teeth 5
# of Implants 3
Type of Implants Two-Piece
Attachment Two-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 More than 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 Medium
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 Cemented, with prosthesis margin > 3mm submucosal Cemented, with prosthesis margin > 3mm submucosal
Maxillomandibular Relationship -
Mesio-Distal Space Adequate for the replacement of all missing teeth
Inter-Arch Distance -
Bruxism Present
Esthetic Risk Medium
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 Irregular, with no need for correction
Occlusal Scheme/Issues -

Surgical SAC Modifiers

Periodontal Status History of periodontitis or genetic predisposition

Prosthodontic SAC Modifiers

Soft Tissue Contour and Volume Slightly compromised

General SAC Modifiers

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

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