**Headline: Treatment Plan Request for Image-Guided Implantology for Replacement of Fractured Maxillary Premolar (Tooth 15) with Implant-Supported Crown**
Sure, I’d be happy to help. Could you please provide me with the patient’s question?
Certainly! Here is a comprehensive treatment plan utilizing image-guided implantology for the replacement of a fractured, nonrestorable maxillary premolar (tooth 15) with an implant-supported crown. We will be integrating AI-based prediction of implant osteointegration success, based on analysis of radiography planning data, to augment the SAC **Straightforward, Advanced, Complex** Classification.
### Patient Profile Overview:
– **Expectations:** Moderate for aesthetics and function
– **Medical History:** No immunological disorders, diabetes, or active periodontitis; non-smoker
– **Dental Situation:** Fractured, nonrestorable maxillary premolar (tooth 15), thick gingival biotype, and adequate bone volume
– **Desired Outcome:** Immediate implant placement and loading
### Treatment Plan:
#### 1. **Initial Assessment and Planning:**
– **Clinical Examination:**
– Confirm the non-restorability of tooth 15.
– Evaluate surrounding teeth and gingival health.
– **Radiographic Assessment:**
– Acquire CBCT (Cone Beam Computed Tomography) scans to evaluate the bone structure and volume.
– Use AI-based prediction tools to assess insertion torque and predict osteointegration success, based on these radiographic findings.
#### 2. **Pre-Surgical Preparation:**
– **Treatment Planning:**
– Use specialized software to plan the exact position, angle, and depth of the implant placement.
– Review AI-based predictions and ensure they align with clinical judgment.
– **Patient Counseling:**
– Discuss the treatment plan, including the use of image-guided implantology and AI-based predictions, to manage patient expectations.
#### 3. **Surgical Phase:**
– **Tooth Extraction:**
– Atraumatically extract the fractured tooth 15 ensuring minimal damage to the surrounding bone.
– **Implant Placement:**
– Place the immediate implant in the extraction socket using computer-guided surgical guides derived from the CBCT data.
– Ensure correct primary stability by confirming the predicted insertion torque values.
– **Soft Tissue Management:**
– Ensure adequate soft tissue coverage over the implant to promote healing.
#### 4. **Post-Surgical Phase:**
– **Immediate Loading:**
– Attach a temporary crown or prosthesis to the implant for immediate functional and aesthetic restoration.
– Ensure that the occlusion is adjusted to avoid excessive forces on the implant.
#### 5. **Follow-Up and Maintenance:**
– **Regular Monitoring:**
– Schedule follow-up visits to monitor the healing process and stability of the implant.
– Use periodic radiographs to assess ongoing osteointegration, guided by AI-based analytics for early detection of any potential issues.
– **Final Prosthetic Placement:**
– Once adequate osteointegration is confirmed, replace the temporary crown with a permanent implant-supported crown.
– **Hygiene and Maintenance:**
– Provide instructions for optimal oral hygiene to maintain the health of the peri-implant tissues.
– Regular dental check-ups to ensure the longevity of the implant and prosthesis.
#### 6. **Outcome Evaluation:**
– Assess aesthetic and functional outcomes in line with the patient’s expectations.
– Use patient feedback and clinical data to refine future treatment plans and improve AI-based prediction models.
### Advantages of This Approach:
1. **Minimally Invasive:**
– Reduced surgical trauma due to precise planning and placement.
2. **High Predictability:**
– AI-based prediction of osteointegration success enhances the reliability of the treatment.
3. **Immediate Function:**
– Immediate loading allows for rapid restoration of function and aesthetics.
4. **Patient Comfort:**
– Minimally invasive techniques and immediate loading improve patient comfort and satisfaction.
5. **Improved Outcomes:**
– Integration of AI and image-guided technology ensures optimal implant positioning and stability, leading to better long-term outcomes.
This treatment plan focuses on leveraging advanced technology to provide a precise, efficient, and patient-centered approach to implant placement, ensuring the best possible outcome for the replacement of the fractured maxillary premolar.
### **Introduction**
The Medlibre AI-SAC classification system is a valuable tool in the field of image-guided implantology, offering a structured method to categorize dental implant cases based on their complexity. This system aids clinicians in evaluating various factors such as aesthetic importance, surgical and prosthetic complexity, patient health, and expected risks. By doing so, it helps in formulating a tailored treatment plan that leads to predictable and successful outcomes.
### **Patient Analysis**
#### **Medical History:**
1. **General Health:** The patient is healthy with no immunological diseases or diabetes mellitus.
2. **Periodontal Status:** The patient does not have active periodontitis.
3. **Smoking Status:** The patient is a non-smoker.
#### **Dental History and Presenting Condition:**
1. **Tooth to be Replaced:** Maxillary premolar (tooth 15).
2. **Aesthetic Considerations:** The tooth is not visible when the patient smiles, and the papilla is not visible due to the lip line.
3. **Gingival Biotype:** The patient has a thick gingival biotype.
4. **Tooth Shape:** The adjacent teeth have a triangular shape.
5. **Condition of Adjacent Teeth:** Neighboring teeth are restored with fillings or crowns.
6. **Bone and Soft Tissue Status:** Adequate horizontal and vertical bone volume with an intact volume of soft tissue to cover the implant.
7. **Immediate Implant:** The patient desires an immediate implant placement.
8. **Loading Protocol:** Immediate loading of the implant is preferred.
### **Classification**
Based on the analysis, the case is categorized under the **Advanced (A)** classification according to the Medlibre AI-SAC system. The key factors influencing this classification include:
1. **Aesthetic Importance:** Although the site is not highly aesthetic, the triangular tooth shape and presence of restorations on adjacent teeth introduce moderate complexity.
2. **Bone Availability:** Adequate bone volume is available, avoiding the need for complex grafting procedures.
3. **Soft Tissue Condition:** Healthy and sufficient soft tissue allows for full coverage of the implant.
4. **Surgical Complexity:** The procedure involves immediate implantation with immediate loading, introducing a moderate level of surgical complexity.
5. **Patient Health:** Healthy, non-smoking status reduces overall risk.
### **Treatment Plan**
#### **Step 1: Preoperative Planning**
1. **Digital Imaging and 3D Planning:**
– Conduct a CBCT scan to evaluate the bone volume and quality, and to identify anatomical structures.
– Utilize digital planning software to plan the implant position and angulation accurately.
2. **Study Models and Wax-Up:**
– Create diagnostic models and a wax-up of the proposed restoration to guide surgical and prosthetic procedures.
3. **Surgical Guide:**
– Fabricate a custom surgical guide based on the digital plan to ensure precise implant placement.
#### **Step 2: Surgical Procedure**
1. **Tooth Extraction:**
– Atraumatically extract the fractured tooth 15, preserving as much alveolar bone as possible.
2. **Implant Site Preparation:**
– Ensure adequate bone height and width around the apex of the planned implant site.
– Utilize the surgical guide to prepare the osteotomy site.
3. **Implant Placement:**
– Place a suitable implant (e.g., titanium or zirconia) in the prepared site immediately post-extraction, ensuring primary stability.
– Verify implant position and alignment with intraoperative radiographs or CBCT.
4. **Bone Grafting (if necessary):**
– Evaluate the necessity for minor bone grafting to fill any residual defects around the implant.
5. **Soft Tissue Management:**
– Ensure the soft tissue is adequately adapted around the implant collar.
– Consider placing a healing abutment to shape the gingival tissues.
#### **Step 3: Immediate Loading**
1. **Provisional Restoration:**
– Fabricate a provisional crown to be placed immediately after implant placement.
– Ensure that the provisional restoration is out of occlusion to avoid undue stress on the implant during the healing period.
#### **Step 4: Postoperative Care and Follow-Up**
1. **Postoperative Instructions:**
– Provide the patient with detailed postoperative care instructions, including oral hygiene measures and dietary recommendations.
– Prescribe appropriate medications such as antibiotics and analgesics.
2. **Follow-Up Visits:**
– Schedule follow-up visits at 1 week, 1 month, and 3 months post-surgery to monitor healing and implant integration.
– Assess soft tissue health and ensure proper adaptation around the provisional crown.
#### **Step 5: Final Restoration**
1. **Final Impression:**
– Once the implant is fully integrated (typically 3-6 months), take a final impression using a custom impression tray.
– Ensure precise recording of the implant position and surrounding soft tissue.
2. **Fabrication of Final Crown:**
– Collaborate with the dental laboratory to fabricate a final ceramic or zirconia crown.
– Ensure proper shade matching and anatomical contours for optimal aesthetics and function.
3. **Crown Placement:**
– Place the final crown, ensuring proper occlusal contacts and alignment.
– Verify the fit and finish of the restoration and make necessary adjustments.
4. **Occlusal Adjustment:**
– Perform occlusal adjustments to ensure even distribution of forces and prevent overloading of the implant.
### **Conclusion**
This treatment plan outlines a comprehensive approach to replacing a fractured, nonrestorable maxillary premolar (tooth 15) with an implant-supported crown using image-guided implantology. The classification of the case as „Advanced“ ensures that the moderate complexity and expected challenges are adequately addressed. By following this structured plan, we aim to achieve a predictable and successful outcome, restoring both function and aesthetics for the patient.
**Classification Justification:**
– **Surgical Complexity:** Immediate implant placement and loading introduce moderate surgical challenges.
– **Prosthetic Complexity:** The need for provisional and final restorations requires additional planning and precision.
– **Patient Factors:** The patient’s healthy status and non-smoking habit reduce risk, but their aesthetic expectations and complex tooth morphology elevate the case to an advanced level.
Emphasizing continuous follow-up and detailed postoperative care will ensure the longevity and success of the implant-supported restoration.
—
TMJ
(AI generated)
### [Termin vereinbaren](https://calendly.com/smile-wien/implantat-beratung-ai)
Ordination Dr. Michael Truppe
Albertgasse 3/6 1080 Wien
Telefon 01 408 95 00 66
Email ordination@smile.wien
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