Combined SFE and Horizontal Ridge Augmentation with Autologous Block Grafts, BCP, and GBR using a Staged Approach
Various patterns of alveolar bone resorption are known to occur in the posterior maxilla. Following tooth loss, resorption may take a buccopalatal direction, resulting in a narrow ridge displaced toward the palate. Resorption may also proceed vertically in an apical direction, reducing the vertical dimension of the ridge and increasing the interocclusal space. Another common pattern of atrophy is caused by volume increases of the maxillary sinus, which will reduce the residual bone volume in an occlusal direction due to downward displacement of the sinus floor. Most cases are characterized by combined defects, leading to a variety of atrophy configurations. Whenever there is a greater need for augmentation than elevating the sinus floor with an inlay bone graft, horizontal and vertical augmentation of the residual ridge may be accomplished by intraoral harvesting of autologous onlay block grafts in the same surgical procedure. We refer to this procedure as “inlay-onlay” grafting of the posterior maxilla.
General information
Case Type | Short Space |
---|---|
Jaw | Maxilla |
Area | Posterior |
# of Teeth | 3 |
# of Implants | 2 |
Type of Implants | One-Piece |
Attachment | One-Piece |
Bone Augmentation | Horizontal|Sinus Floor Elevation|Staged |
---|---|
Augmentation Materials | Autogenous chips|Autogenous block(s)|Synthetic|Membrane |
Guided Surgery | No |
Soft Tissue Grafting | None |
Abutment Type | Standard |
Prosthesis Type | FDP |
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 | Up to three missing teeth to be replaced with an implant-borne prosthesis or prostheses |
Modality | - |
Placement Protocol | Early or late implant placement |
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 | Straightforward |
---|---|
Defining Characteristics | Up to three missing teeth to be replaced with an implant-borne restoration or restorations |
Loading Protocol | Conventional or early |
Retention | Cemented, with prosthesis margin < 3mm submucosal Cemented, with prosthesis margin < 3mm submucosal |
Maxillomandibular Relationship | - |
Mesio-Distal Space | Anatomic space corresponding to the missing teeth +/- 1 mm |
Inter-Arch Distance | > 8 mm |
Bruxism | Absent |
Esthetic Risk | Low |
Provisional Implant-Supported Prosthesis | - - |
Interim Prosthesis during Healing | - - |
Occlusion/Articulation | Harmonious |
Occlusal Scheme/Issues | - |
Surgical SAC Modifiers
Periodontal Status | Healthy |
---|
Prosthodontic SAC Modifiers
Soft Tissue Contour and Volume | - |
---|
General SAC Modifiers
Oral Hygiene and Compliance | Insufficient |
---|---|
Access | Adequate |
Craniofacial/Skeletal Growth | Completed |
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