Replacement of a Missing Upper Left Central Incisor: Late Placement of an RC Bone Level Implant, CAD/CAM Zirconia Abutment - 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, CAD/CAM Zirconia Abutment

Eduardo R Lorenzana, Jason R Gillespie

A healthy 37-year-old female patient was referred for a consultation on the replacement of missing tooth 21 with an implant-supported restoration. She stated that several years previously the tooth had been traumatically avulsed following a motor vehicle accident. The tooth was replaced with a three-unit fixed partial denture (FPD) immediately afterwards. Over time, she became disillusioned with the FPD and looked for a different option, including orthodontic therapy. She presented still in her orthodontic appliances, with the pontic sectioned free from the FPD but attached to the archwire. Her orthodontist felt that orthodontic treatment had been successfully completed, but nevertheless referred her before removing the appliances in case adjustments were necessary.

Surgical SAC classification: Advanced
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
Augmentation Materials	Xenogenous\|Membrane
Guided Surgery	No
Soft Tissue Grafting	Simultaneous
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	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: Dec 5, 2017 Last review date: Nov 28, 2022 Next review date: Nov 28, 2025

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