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Staged GBR with Allogeneic Particulate Grafting Material for Single-Tooth Replacement

Emma L Lewis, Eduardo R Lorenzana

Staged bone augmentation of the alveolar ridge is indicated whenever a proposed implant site is deficient and will not support implant placement with simultaneous grafting. This is particularly true of healed sites presenting with facial flattening of the ridge. Since primary stability cannot possibly be achieved in this situation, it is recommended to use a staged approach with guided bone regeneration (GBR) for correct three-dimensional placement of the implant. In the anterior maxilla, staged GBR procedures are conducted not only to provide adequate bone volume for implant placement but also to restore a proper and stable contour of the orofacial ridge for improved long-term esthetics. A case is presented that demonstrates the technique for single-tooth replacement utilizing a staged approach with a particulate grafting material. A 50-year-old man whose tooth 11 was missing presented for consultation to the Center for Implant Dentistry in January 2010.
Surgical SAC classification
Complex
Prosthodontic SAC classification
Advanced
Source
Treatment Guide 7
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 Single-Tooth Space
Jaw Maxilla
Area Anterior
# of Teeth 1
# of Implants 1
Type of Implants Two-Piece
Attachment Two-Piece
Bone Augmentation Horizontal|Staged
Augmentation Materials Allogenous|Membrane
Guided Surgery No
Soft Tissue Grafting None
Abutment Type CAD/CAM
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 One missing tooth to be replaced by an implant-borne prosthesis
Modality -
Placement Protocol Early or late implant placement
Tooth Site -
Socket Morphology -
Socket Integrity -
Bone Volume Deficient horizontally, requiring prior grafting
Anatomic Risk Low
Esthetic Risk High
Complexity Moderate
Risk of Complications Moderate

Prosthodontic SAC classification

SAC Level Advanced
Defining Characteristics One missing tooth to be replaced by an implant-borne crown
Loading Protocol Conventional or early
Retention Screw-retained Screw-retained
Maxillomandibular Relationship Angle Class I and III
Mesio-Distal Space Symmetry +/- 1 mm of contra-lateral tooth
Inter-Arch Distance -
Bruxism -
Esthetic Risk High
Provisional Implant-Supported Prosthesis Prosthodontic margin > 3 mm apical to mucosal margin Prosthodontic margin > 3 mm apical to mucosal margin
Interim Prosthesis during Healing Removable Removable
Occlusion/Articulation -
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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