Replacement of an Ankylosed Central Incisor with a Gingival Recession: Tooth Extraction with Socket Grafting and Late Implant Placement with Simultaneous Contour Augmentation - Clinical Case Report - Home

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Clinical Case Report

Replacement of an Ankylosed Central Incisor with a Gingival Recession: Tooth Extraction with Socket Grafting and Late Implant Placement with Simultaneous Contour Augmentation

Daniel Buser, Urs C Belser

In 2008, a healthy 15-year-old female, non-smoking patient presented at our clinic with a major esthetic problem of tooth 21. Her dental history revealed that the tooth had been avulsed by trauma years before. As a result, the replanted and temporarily splinted tooth had ankylosed and was in severe apical malposition. The ankylosed tooth exhibited a significant gingival recession that disturbed the patient greatly. Due to the patient’s low age and with her skeletal growth not completed, periodic follow-up visits were scheduled to monitor the situation until the patient was old enough for implant therapy.

Surgical SAC classification: Complex
Prosthodontic SAC classification: Advanced

Source: Treatment Guide 10
Purchase price: 10 Academy Coins
CPD/CME: 0.15 hours

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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\|Simultaneous\|Staged\|Vertical
Augmentation Materials	Autogenous chips\|Xenogenous\|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 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	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	Significantly deficient

General SAC Modifiers

Oral Hygiene and Compliance	Good
Access	Adequate
Craniofacial/Skeletal Growth	In progress

Publication date: Oct 3, 2017 Last review date: Sep 26, 2023 Next review date: Sep 26, 2026

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