Free excerpt - SAC Classification in Implant Dentistry

5 PRACTICAL APPLICATION OF THE SAC ASSESSMENT TOOL

Fig 3. Overall treatment classification: Surgical classification = advanced to complex; Prosthodontic classification = straightforward to advanced.

TREATMENT RISK PROFILE

SURGICAL TREATMENT

The treatment risk profile was assessedwith the SAC Assess- ment Tool in order to define specific esthetic, surgical, and prosthetic risk factors (Figure3). Esthetic risk was judged reduced in this case, since the area of treatment is partially visible when the patient smiles. The patient in any case de- clared realistic expectations. Main surgical risk factors are represented by the proximity of the sinus floor, the presence of amultirooted tooth that has to be extractedwithminimal trauma, the need to achieve primary stability, and a pros- thetically driven implant position in a complex anatomical situation. Finally, the need for simultaneous grafting pro- cedures should be considered to manage the residual gap. Prosthetic risk factors for this case are not significant, since restorative space is adequate, occlusion is normal, and im- mediate loading or temporization are not required. Based on the clinical and radiological situation, the follow- ing treatment plan was proposed: • Extraction of the fractured maxillary molar • I mmediate implant placement in the area of the interra- dicular bone septum, combined with a grafting procedure in order to fill the gap between the implant and the socket walls. • Placement of a custom-made healing abutment to seal the extraction socket and provide immediate soft tissue support. • Realization anddelivery of the definitive implant-supported crown after osseointegration of the implant and healing of the soft tissues. The patient agreed to the proposed treatment, providing his written informed consent. TREATMENT PLANNING

The extraction and implant placement procedure were per- formed under local anesthesia. A preliminary separation, per- formedwith a carbide bur, allowed the surgeon to remove the crown and achieve accessibility to the roots that were subse- quently separated and extracted. Extraction was minimally traumatic, and it was performed bymeans of thin periotomes and elevators to avoid any damage to the socket walls and to the interradicular bone. After complete extractionof the tooth, integrity of the interradicular septumwas confirmedandprep- aration of the implant bed was performed with a sequence of drills. An implant with an aggressive external design (5 x 10 BLXWide Base [WB]) was selected to achieve an adequate pri- mary stability, and an hydrophilic implant surface (SLActive) was chosen to shorten the time of osseointegration in a com- plex anatomical situation. A prosthetically driven implant placement at the center of the socket was achieved (Figure 4). After implant placement, the gap between the implant and the surrounding socket walls was filled with trimmed frag- ments of an osteoconductive xenograft represented by DBBM in a collagen matrix (Bio-Oss Collagen). Gentle pres- sure was applied to the biomaterial in order to obtain per- fect adaptation to the defect (Figure 5). The benefit of this material, compared to simple granules of DBBM, is repre- sented by its stability and the tendency to remain in place despite bleeding from the recipient site. After placement of the graft, a customized healing abutment was used to seal the socket and protect the underlying graft (Figure 6). The custom-made healing screw was obtained, relining a temporary titaniumabutment with flowable com- posite resin. Teflon tape was used to isolate the surgical field from the composite resin. Teflon tape and flowable composite resin were also used to seal the screw access. No sutures were utilized.

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The SAC Classification in Implant Dentistry