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Clinical Case Report

Soft Tissue Augmentation before Implant Placement in an Area of High Surgical and Esthetic Risk

Xian Jun Edwin Goh, Sheralyn Quek

The Straightforward, Advanced and Complex (SAC) classification in implant dentistry was introduced following an International Team for Implantology (ITI) Consensus conference held in 2007 (Dawson 2009). The classification aimed to assist clinicians in evaluating the difficulty of cases, and serve as a tool for case selection and treatment planning. Individual cases can be classified into straightforward, advanced, or complex in both surgical and restorative aspects depending on their associated risk factors and complexity. The aim of this article is to illustrate how the SAC classification was used to identify a case of high surgical and esthetic risk, the steps undertaken to minimize potential complications, and its successful long-term follow-up.


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

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General information

Case Type
Jaw Maxilla
Area Anterior
# of Teeth 1
# of Implants 1
Type of Implants One-Piece
Attachment One-Piece
Bone Augmentation Simultaneous
Augmentation Materials Xenogenous
Guided Surgery -
Soft Tissue Grafting Yes
Abutment Type -
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 One missing tooth to be replaced by an implant-borne prosthesis
Modality Modality
Placement Protocol Early or late implant placement
Tooth Site Tooth site
Socket Morphology Socket morphology
Socket Integrity Socket integrity
Bone Volume Deficient horizontally, allowing simultaneous augumentation
Anatomic Risk Low
Esthetic Risk High
Complexity Low
Risk of Complications Low

Prosthodontic SAC classification

SAC Level Complex
Defining Characteristics One missing tooth to be replaced by an implant-borne crown
Loading Protocol Conventional or early
Retention -
Maxillomandibular Relationship -
Mesio-Distal Space -
Inter-Arch Distance -
Bruxism -
Esthetic Risk High
Provisional Implant-Supported Prosthesis -
Interim Prosthesis during Healing -
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 Completed
Publication date: Sep 26, 2022 Last review date: Sep 19, 2022 Next review date: Sep 19, 2025

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