Free excerpt - SAC Classification in Implant Dentistry

5 PRACTICAL APPLICATION OF THE SAC ASSESSMENT TOOL

5.3 Implants for Restoration of Single-Tooth Spaces: Areas of High Esthetic Risk

the use of tobacco in any form. Clinical examination of tooth 11 highlighted a porcelain-fused-to-metal (PFM) crown with minimal mobility. A periodontal probing exam was per- formed showing normal (1 to 3 mm) depths other than a 6-mm probing at midfacial. The tooth was asymptomatic with no evidence of an acute infection. A localized CBCT scan was taken which allowed the central incisor’s root to be viewed in relation to the axial thickness of the maxilla, highlighting missing bone in the facial aspect and a chronic periapical lesion (Figure 2). The treatment risk was assessed utilizing the SAC Assess- ment Tool highlighting key esthetic, surgical, and prosthetic risk factors resulting in an overall treatment risk (Figure 3). When evaluating the esthetic risk, the patient presentedwith high gingival display at full smile, adequate prosthetic space for restoration. The tissue phenotype was high scalloped thin, and the soft tissues were intact. A review of the CBCT highlighted a facial plate < 1 mm, with adjacent tooth inter- proximal bone heights of 5.5 mm to the interproximal con- tact points. This patient presented with realistic treatment expectations. Surgical risk factors of consideration were the need for bone augmentation (socket or horizontal) after ex- traction of tooth 11. The area of treatment being located in a region of esthetic importance and the potential for poor pri- mary stability of the implant at the time of tooth extraction were additional considerations. The prosthetic risk factors in this rehabilitation are favorable due to the available pros- thetic volume and absence of parafunctional habits. The

5.3.1 Maxillary central incisor

L. GONZAGA, W. MARTIN

A 60-year-old woman presented to our clinic to address a nonrestorable central incisor (tooth 11) and explore avail- able treatment options (Figure 1). She was seen previously by an endodontist who diagnosed the tooth as having a ver- tical root fracture. This tooth had a long history of dental procedures to address function and esthetics involving two root canal treatments in addition to an apical surgery. Ac- cording to the patient, a fistula was once present facial to the tooth, but is no longer present. At this visit, she ex- pressed an interest to explore options to replace the tooth with an implant-supported crown in an effort to prevent involvement of the adjacent teeth or the need for a remov- able prosthesis. A review of her past medical history revealed no contribut- ing factors that would prevent routine surgical and restora- tive treatment. She reported no allergies nor medications other thanmultivitamins and supplements. She also denied

Fig 2. Localized CBCT of maxilla with isolation of tooth 11.

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b

Fig 1 a-b. Full smile and an open-retracted view of the right central incisor (tooth 11).

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The SAC Classification in Implant Dentistry