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Ridge Preservation and Implant Placement for a Fixed Dental Prosthesis After a Car Accident

Mario Roccuzzo

It is well known to clinicians that any removal of teeth will, over time, cause the dimensions of the alveolar ridge to be reduced by resorption of the bundle bone and by changes related to external modeling. This development is particularly evident in the crestal region with its thin buccal bone that consists of bundle bone almost entirely. The facial bone will rapidly resorb as blood supply from the periodontal ligament gets disrupted (Araújo and Lindhe 2005). There is no reason why traumatic tooth loss should not have the same consequences. It takes more than achieving implant osseointegration for a treatment outcome to be considered successful. No deficiency of bone or soft tissue is acceptable when an ideal esthetic outcome is the goal. Several articles (Sanz and coworkers 2011; Vignoletti and coworkers 2011) have reported on techniques of improving the alveolar ridge for implant treatment, notably focusing on protecting tissues from resorption.

General information

Case Type Extended Space
Jaw Maxilla
Area Anterior|Posterior
# of Teeth 6
# of Implants 4
Type of Implants One-Piece|Reduced-Diameter
Attachment One-Piece|Reduced-Diameter
Bone Augmentation Horizontal|Simultaneous|Sinus Floor Elevation|Staged
Augmentation Materials Xenogenous|Membrane
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 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 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 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 Anatomic space corresponding to the missing teeth +/- 1 mm
Inter-Arch Distance > 8 mm
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 - -
Occlusion/Articulation Harmonious
Occlusal Scheme/Issues -

Surgical SAC Modifiers

Periodontal Status Healthy

Prosthodontic SAC Modifiers

Soft Tissue Contour and Volume Slightly compromised

General SAC Modifiers

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

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