Case

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Treatment of Peri-Implant Infection at Adjacent Implant-Supported Single Crowns

Lisa J A Heitz-Mayfield

A 45-year-old woman was referred for management of an infection associated with two implant-supported crowns replacing the maxillary central incisors. Two tissue-level implants had been placed and restored with cemented single metal-ceramic crowns in those sites 4 years previously. The patient presented with a draining sinus (i.e. a pathological duct from an abscess cavity to a surface) 3 mm from the midfacial peri-implant mucosal margin of the maxillary right implant crown. She was in good general health, did not smoke, showed a good oral hygiene status, and had no history of periodontal disease. The implants were well positioned. While the patient was very satisfied with the appearance of her crowns, she had noted that the peri-implant soft tissue had receded since their insertion and was concerned about the possibility of further recession.

General information

Case Type Short Space
Jaw Maxilla
Area Anterior
# of Teeth 2
# 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 Advanced
Defining Characteristics Up to 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 Horizontally and vertically sufficient
Anatomic Risk Low
Esthetic Risk Medium
Complexity Moderate
Risk of Complications Moderate

Prosthodontic SAC classification

SAC Level Straightforward
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 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 Removable Removable
Occlusion/Articulation Harmonious
Occlusal Scheme/Issues -

Surgical SAC Modifiers

Periodontal Status Healthy

Prosthodontic SAC Modifiers

Soft Tissue Contour and Volume Ideal

General SAC Modifiers

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

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