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Early Implant Placement with GBR using DBBM

Early (Type 2) placement in a healthy, non-smoking male patient aged 28 years who required removal and replacement of the maxillary right central incisor due to external root resorption. A horizontal bone deficit requires a simultaneous augmentation procedure. The overall esthetic risk is high due to the horizontal bone deficit, medium to high lip line with exposure of the soft tissue margin when smiling, and the patient’s high esthetic expectations.

After flapless tooth extraction and a healing period of 6 weeks, a standard-diameter one-piece implant is placed. A gap between the implant and the facial bone wall is filled with autogenous bone chips harvested from the anterior nasal spine and covered with DBBM particles. Contour augmentation on the facial aspect is achieved using DBBM particles and a collagen membrane, according to the principles of guided bone regeneration (GBR). The flap is coronally repositioned for semisubmerged healing.

Surgical SAC classification: Advanced
Prosthodontic SAC classification: -

Duration: 32 minutes
Purchase price: 32 Academy Coins
CPD/CME: 0.53 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	Autogenous chips\|Xenogenous
Guided Surgery	No
Soft Tissue Grafting	-
Abutment Type	-
Prosthesis Type	-

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	-
Defining Characteristics	-
Loading Protocol	-
Retention	-
Maxillomandibular Relationship	-
Mesio-Distal Space	-
Inter-Arch Distance	-
Bruxism	-
Esthetic Risk	High
Provisional Implant-Supported Prosthesis	-
Interim Prosthesis during Healing	-
Occlusion/Articulation	-
Occlusal Scheme/Issues	-

Surgical SAC Modifiers

Periodontal Status	Healthy

Prosthodontic SAC Modifiers

Soft Tissue Contour and Volume	-

General SAC Modifiers

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

Publication date: Jun 28, 2015 Last review date: Jun 23, 2022 Next review date: Jun 23, 2025

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