Page 53 - CEREC Q3|2013

quarter 3 | 2013 | cerecdoctors.com | 51
treatment. Conventionally, the identi-
fication and classification of a potential
implant patient is a subjective process
that is dependent on the clinician, their
training and experience.
The ITI’s SAC method provides
a concise, objective guideline that
can be used by all clinicians for all
patient types. We expect patients to
present with different degrees of risk
for esthetic, restorative and surgical
complications. To date, there is no other
widely accepted classification system
in implant dentistry aimed at defining
the level of treatment complexity and
the potential for complications. These
guidelines will provide clinicians with
a reference for selecting appropriate
cases and planning implant therapy.
case study
The following case presented tomy prac-
tice about fivemonths ago. At first glance,
I was perplexed with the complexity of
the defect of a young male who was
involved in a motor vehicle accident two
years ago. This case study highlights a
young, mid-30s male with a non-contrib-
utory medical history who sustained
trauma to the lower face and subse-
quent avulsion of teeth #24-27. Upon
initial consultation, our clinical teamwas
informed that the patient had a narrow
time frame within which treatment
was to be completed due to insurance
coverage. The following case is consid-
ered to be Complex using the ITI’s online
SAC tool. In addition to the classification
of being complex, the patient has some
additional requirements regarding time-
frame and expectation of final results
(Figs. 2-3).
Our first appointment included a diag-
nostic CBCT and thorough comprehen-
sive oral evaluation. His radiographic
findings included the large mandibular
vertical defect with a retained root tip
of #26, otherwise within normal limits.
It was noted that the patient intends to
have orthodontic treatment in the future
to correct anterior open bite and reduce
overall maxillary crowding. His clinical
findings include a significant vertical defi-
ciency with slight horizontal deficiency
from the MVA. In addition, he presented
with irregular gingival form from the
trauma that is not visible during function
or in the esthetic zone when smiling.
Fig. 2: Assessment of restorative cases:
Multi-use restoration in the anterior zone
Defining characteristics: Up to three missing teeth to be replaced
with an implant-borne restoration or restorations
Intermaxillary relationship: Angle Class I and III
Mesio-Distal Space: Adequate for replacement of missing teeth
Occlusionan/Articulation: Irregular, no need for correction
Interim restoration during healing: Fixed
Provisional implant-supported resoration:
Restorative margin >3 mm apical to mucosal crest
Bruxism: Absent
Loading Protocal: Immediate
Retention: Cemented, with meso-structure
Modifiers
Patient's expectations: High
Oral Hygiene and Compliance: Sufficient
Craniofacial/Skeletal Growth: Completed
Access: Adequate
Lip Line: Exposure of papilae
Gingival Biotype: Medium-scalloped, medium-thick
Shape of tooth crowns: Triangular
Restorative status of neighboring teeth: Virgin
Soft tissue contour and Volume: Significantly deficient
risk assessment
esthetic risk: High
normative classification: COMPLEX
additional complexity/risk
based on modifiers: none moderate high
Fig. 3: Assessment of SURGICAL cases:
EXTENDED GAP (> 3 TEETH)
Defining characteristics: More than three missing teeth to be replaced by
more than two implants.
placement protocol: Early or late implant placement
bone volume: Deficient vertically or vertically AND horizontally
Modifiers
width of edentulous span: 2 teeth or more
Lip Line: No exposure of papilae
Gingival Biotype: Medium-scalloped, medium-thick
Shape of tooth crowns: Triangular
infection at implant site: None
bone level at adjacent teeth: ≥ 7 mm to contact point
Restorative status of neighboring teeth: Virgin
Soft tissue anatomy: Defective
loading protocol: Immediate
risk assessment
anatomic risk: High esthetic risk: High
complexity: High risk of complication: High
additional procedures that may be required
→ Staged vertical and/or horizontal bone augmentation
→ Adjunctive soft tissue graft
→ Sinus floor graft in posterior maxillary sites
additional risks
→ Esthetic complications and increased complexity of treatment
with adjacent implants
→ Complications with adjacent teeth with some vertical
augmentation procedures
→ Involvement of the nasopalatine canal in anterior maxillary sites,
which may adversely influence implant position
normative classification: COMPLEX
additional complexity/risk
based on modifiers: none moderate high