Replacement of a Failing Upper Left Central Incisor: Immediate Placement of an RC Bone Level Implant and Provisionalization - Clinical Case Report - Home

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Clinical Case Report

Replacement of a Failing Upper Left Central Incisor: Immediate Placement of an RC Bone Level Implant and Provisionalization

Eduardo R Lorenzana, Jason R Gillespie

A healthy 23-year-old female patient was referred for a consultation on replacing tooth 21 with an implant-supported restoration. The patient had recently moved to the area and reported a history of endodontic and periodontal treatment for tooth 21. The tooth had been deemed non-restorable by her previous periodontist but since she was going to be moving, he recommended consulting to a dentist in her new city to continue her treatment. A review of her medical history yielded no significant findings and no known drug allergies. The analysis of her smile revealed a medium to high symmetrical smile line and a slightly discolored tooth 21.

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
Augmentation Materials	Xenogenous
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	Complex
Defining Characteristics	One missing tooth to be replaced by an implant-borne prosthesis
Modality	-
Placement Protocol	Immediate implant placement
Tooth Site	Maxillary incisor or canine
Socket Morphology	Single-root socket
Socket Integrity	Damage to one or more bone walls
Bone Volume	Damage to one or more socket walls
Anatomic Risk	Low
Esthetic Risk	Medium
Complexity	Moderate
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	Immediate
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	Medium
Provisional Implant-Supported Prosthesis	Prosthodontic margin < 3 mm apical to mucosal margin Prosthodontic margin < 3 mm apical to mucosal margin
Interim Prosthesis during Healing	- -
Occlusion/Articulation	-
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

Publication date: Jan 8, 2018 Last review date: Jan 1, 2023 Next review date: Jan 1, 2026

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