Replacement of a Missing Upper Left Central Incisor, Late Placement of an RC Bone Level Implant and Adjacent Tooth Restoration - Clinical Case Report - Home

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Clinical Case Report

Replacement of a Missing Upper Left Central Incisor, Late Placement of an RC Bone Level Implant and Adjacent Tooth Restoration

Adam Hamilton

A healthy 38-year-old male patient was referred for replacement of a failing tooth-supported cantilever fixed dental prosthesis on teeth 11 and 21. The patient reported a history of trauma at 13 years of age that had resulted in the subsequent loss of tooth 11, as well as endodontic treatment of the adjacent abutment tooth 21. A metal-ceramic cantilever fixed dental prosthesis replacing tooth 11 had been provided by his general dentist several years after the loss of the tooth, with tooth 21 as the sole abutment. At the time of initial presentation, this restoration had been in service for over 20 years.

Surgical SAC classification: Advanced
Prosthodontic SAC classification: Advanced

Source: Treatment Guide 10
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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
Augmentation Materials	Xenogenous\|Membrane
Guided Surgery	No
Soft Tissue Grafting	None
Abutment Type	Customized
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	-
Placement Protocol	Early or late implant placement
Tooth Site	-
Socket Morphology	-
Socket Integrity	-
Bone Volume	Deficient horizontally, allowing simultaneous augumentation
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	Cemented, with prosthesis margin < 3mm submucosal Cemented, with prosthesis margin < 3mm submucosal
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	Fixed Fixed
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

Publication date: Aug 7, 2018 Last review date: Jul 31, 2022 Next review date: Jul 31, 2025

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