Case

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Replacement of the Four Maxillary Incisors with a Fixed Dental Prosthesis Using an Immediate Loading Protocol

Dean Morton, James Ruskin

In November 2001, a 53-year-old female presented seeking advice and options for treatment of her maxillary incisor teeth. She was dissatisfied with both the functional and esthetic qualities of her existing restorations. Her medical health was excellent, and she reported no contraindications to dental care. On presentation, the patient’s dental health was less than ideal. Although she had no probing depths greater than 3 mm, she suffered from generalized chronic adult periodontitis and displayed multiple sites of bleeding on probing. Her remaining dentition was heavily restored, and many teeth had been endodontically treated. Areas of recurrent dental caries were noted on many teeth. Radiographically and clinically, the maxillary incisor teeth exhibited large areas of active caries, and after the splinted crowns had been removed, the teeth were determined to be non-restorable.

General information

Case Type Extended Space
Jaw Maxilla
Area Anterior
# of Teeth 4
# of Implants 2
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 Up to three missing teeth to be replaced with an implant-borne restoration or restorations
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 Complex
Defining Characteristics Up to three missing teeth to be replaced with an implant-borne restoration or restorations
Loading Protocol Immediate
Retention Screw-retained, with 3 or more splinted implants Screw-retained, with 3 or more splinted implants
Maxillomandibular Relationship -
Mesio-Distal Space Adequate for the replacement of all missing teeth
Inter-Arch Distance -
Bruxism Absent
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 - -
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 Ideal

General SAC Modifiers

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

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