Bilateral Implant Placement with Simultaneous SFE: Lateral Window Technique with a Composite Graft
A 57-year-old woman was referred for dental implant treatment. Her maxilla had been edentulous for at least 20 years. In the mandible, the residual dentition consisted of teeth 43 to 35. The left second premolar was extremely weak and had deep caries. The residual dentition was mutilated due to parafunction and the framework present. At the time of presentation, the patient was on her third complete denture in the maxilla and her fourth partial denture in the mandible. Despite several adjustments and remakes, her maxillary complete denture had been unsatisfactory over the previous 5 years, while her mandibular partial denture had never functioned adequately. She complained about poor stability as well as pain and discomfort in both jaws.
Surgical SAC classification
Complex
Prosthodontic SAC classification
Complex
Learner Level
|
1
|
2
|
3
|
Source
Treatment Guide 5
CME/CPD
0.25 hours
Purchase price
10
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General information
| Case Type | Edentulous Maxilla |
|---|---|
| Jaw | Maxilla and Mandible |
| Area | Full-Arch |
| # of Teeth | All |
| # of Implants | 6 |
| Type of Implants | One-Piece|Reduced-Diameter |
| Attachment | One-Piece|Reduced-Diameter |
| Bone Augmentation | Simultaneous|Sinus Floor Elevation |
|---|---|
| Augmentation Materials | Autogenous chips|Xenogenous|Membrane |
| Guided Surgery | No |
| Soft Tissue Grafting | None |
| Abutment Type | Customized |
| Prosthesis Type | RDP |
Esthetic Risk Assessment
| Esthetic Risk Factors | Low | Medium | High |
|---|---|---|---|
| Medical Status | Healthy | Compromised | |
| Smoking Habit | Non-smoker | Light smoker (< 10 cigarettes per day) | Heavy smoker (>= 10 cigarettes per day) |
| Patient's Esthetic Expectations | Low | Medium | High |
| Lip Line | No exposure of papillae | Exposure of papillae | Full exposure of mucosa margin |
| Periodontal Phenotype | Low-scalloped, thick | Medium-scalloped, medium-thick | High-scalloped, thin |
| Shape of Tooth Crowns | Rectangular | Triangular | |
| Infection at Implant Site | None | Chronic | Acute |
| Bone Level at Adjacent Teeth | <= 5 mm to contact point | 5.5 to 6.5 mm to contact point | > 7 mm to contact point |
| Prosthodontic Status of Neighboring Teeth | Virgin | Restored | |
| Width of Edentulous Span | 1 tooth (>= 7 mm) | 1 tooth (< 7 mm) | 2 teeth or more |
| Soft Tissue Anatomy | Intact | Defective | |
| Bone Volume | Horizontally and vertically sufficient | Horizontally deficient | Deficient vertically or deficient vertically AND horizontally |
* General SAC assessment modifiers that are also part of the ERA. To avoid redundancy they are listed in this section even if no complete ERA has been made.
** Not applicable to the ERA of immediate placement cases and replaced by "Socket Integrity" listed below under "Surgical SAC Classification". For all other placement types this value is a classification determinant and listed here even if no complete ERA has been made.
Surgical SAC classification
| SAC Level | Complex |
|---|---|
| Defining Characteristics | Fully edentulous upper jaw to be rehabilitated with four or more implants |
| Modality | Overdenture on 4 implants |
| Placement Protocol | - |
| Tooth Site | - |
| Socket Morphology | - |
| Socket Integrity | - |
| Bone Volume | Deficient vertically or deficient vertically AND horizontally |
| Anatomic Risk | High |
| Esthetic Risk | Low |
| Complexity | High |
| Risk of Complications | High |
Prosthodontic SAC classification
| SAC Level | Complex |
|---|---|
| Defining Characteristics | Fully edentulous upper jaw to be rehabilitated with an implant-borne removable overdenture |
| Loading Protocol | Conventional/early |
| Retention | - - |
| Maxillomandibular Relationship | - |
| Mesio-Distal Space | - |
| Inter-Arch Distance | - |
| Bruxism | Absent |
| Esthetic Risk | Low |
| Provisional Implant-Supported Prosthesis | - - |
| Interim Prosthesis during Healing | Removable Removable |
| Occlusion/Articulation | - |
| Occlusal Scheme/Issues | Balanced |
Surgical SAC Modifiers
| Periodontal Status | History of periodontitis or genetic predisposition |
|---|
Prosthodontic SAC Modifiers
| Soft Tissue Contour and Volume | - |
|---|
General SAC Modifiers
| Oral Hygiene and Compliance | Sufficient |
|---|---|
| Access | Adequate |
| Craniofacial/Skeletal Growth | Completed |
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