Free excerpt - SAC Classification in Implant Dentistry

W. MARTIN, A. DAWSON, W. D. POLIDO

5.2 Implants for Restoration of Single-Tooth Spaces: Areas of Low Esthetic Risk

Probing revealed the presence of a 9-mm pocket mesial to tooth 47 (Figure 3). The periapical radiograph confirmed the absence of periapical osteolysis and a normal level of the in- terproximal bone between teeth 47 and 48 (Figure 4). The presence of a deep pocket has been associated with increased probability of tooth loss, even in patients attend- ing supportive periodontal therapy (SPT) (Matuliene et al, 2008). Teeth with deep pockets, associated with deep in- trabony defects, have been classified as having either a questionable prognosis (ie, need complex treatment) or a hopeless prognosis, and therefore should be extracted as soon as possible (Kwok & Caton, 2007). In clinical practice, the prognostic system should be based not only on the amount of periodontal supporting appara- tus, but also on the evaluation of local and general risk fac- tors, like plaque and infection control, smoking habit, and systemic conditions. Clinicians should be cautious before declaring a tooth “hopeless,” as it has been demonstrated that even teeth with severe loss of periodontal support, like attachment loss to the apex, can be retained and kept healthy with appropriate periodontal therapy and strict SPT (Cortellini et al, 2011). Furthermore, patients with a history

5.2.1 Mandibular molar

M. ROCCUZZO

A 40-year-old-man was originally referred by his general dentist for extraction of tooth 47 and placement of two im- plants in positions 46 and 47. The patient’s medical history did not reveal any significant findings, and he was in good general health. The clinical examination of the right posterior mandible revealed the absence of tooth 46 and a mesiobuccal gingi- val recession at tooth 47 (Figure 1). A thermal test con- firmed that tooth 47 was still vital. The radiograph showed the presence of a significant bone defect, with a slope shape from the distal aspect of tooth 45 to the apex of tooth 47 (Figure 2).

Fig 1. Pretreatment lateral view. Missing tooth 46 and gingival recession on tooth 47.

Fig 2. Panoramic radiograph demonstrated the presence of a deep vertical periodontal defect mesially to tooth 47.

Fig 3. Probing revealed the presence of a 9-mm pocket mesial to tooth 47.

Fig 4. Periapical radiograph revealed an intrabony defect reaching the apex of the mesial root of tooth 47.

The SAC Classification in Implant Dentistry

57