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Clinical Case Report

Replacement of Four Incisors with a Fixed Dental Prosthesis on Two Bone-Level Implants

Hideaki Katsuyama, Masaaki Hojo, 雅子 小川

In November 2007, a 52-year-old woman presented with a failing restoration of the anterior maxilla in the form of a four-unit metal-ceramic fixed partial denture. As secondary caries had led to fracture of the abutment teeth bilaterally, the existing restoration could not be preserved. The patient was in good systemic health, and her medical history was without significant findings. Nor did the ensuing intra- and extraoral examination yield any significant findings. The patient had both a high lip line and high esthetic expectations. The preextraction findings suggested that no hard-tissue augmentation would be required before implant placement. After discussing the higher risk of immediate placement with the patient, she agreed to undergo “early implant placement after soft-tissue healing” simultaneously with guided bone regeneration (GBR) for hard-tissue augmentation.

Surgical SAC classification
Advanced
Prosthodontic SAC classification
Advanced
Source
Treatment Guide 6
Purchase price
10 Academy Coins
CPD/CME
0.15 hours

Recommended content

General information

Case Type Extended Space
Jaw Maxilla
Area Anterior
# of Teeth 4
# of Implants 2
Type of Implants Two-Piece
Attachment Two-Piece
Bone Augmentation Horizontal|Simultaneous
Augmentation Materials Autogenous chips|Synthetic|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 More than three missing teeth to be replaced with an implant-borne prosthesis or prostheses
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 Up to three missing teeth to be replaced with an implant-borne restoration or restorations
Loading Protocol Conventional or early
Retention Cemented, with meso-structure Cemented, with meso-structure
Maxillomandibular Relationship -
Mesio-Distal Space Adequate for the replacement of all missing teeth
Inter-Arch Distance -
Bruxism Absent
Esthetic Risk High
Provisional Implant-Supported Prosthesis Prosthodontic margin >3 mm apical to mucosal crest Prosthodontic margin >3 mm apical to mucosal crest
Interim Prosthesis during Healing Fixed Fixed
Occlusion/Articulation Harmonious
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: Oct 13, 2014 Last review date: Apr 10, 2022 Next review date: Apr 10, 2025

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