Immediate Loading of Four Implants in the Mandible and Final Restoration with a Full-Arch Metal Framework FDP
A fully edentulous 65-year-old woman was referred to our clinic for esthetic and functional dental rehabilitation. The patient presented with inadequate complete maxillary and mandibular prostheses, insufficient vertical dimension, and extensive tooth wear. The clinical examination and anamnesis showed no local or systemic contraindications, no signs or symptoms of bruxism, and an absence of smoking habits. The treatment proposed was implant placement in the mandibular interforaminal area and immediate loading with a fixed definitive prosthesis. A removable mucosa-supported complete prosthesis was indicated for the upper jaw, since its bone structure offered satisfactory retention and the financial condition of the patient disfavored a full-mouth implant-supported rehabilitation.
Surgical SAC classification
Advanced
Prosthodontic SAC classification
Complex
Learner Level
|
1
|
2
|
3
|
Source
Treatment Guide 4
CME/CPD
0.25 hours
Purchase price
10
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General information
| Case Type | Edentulous Mandible |
|---|---|
| Jaw | Mandible |
| Area | Full-Arch |
| # of Teeth | All |
| # of Implants | 4 |
| Type of Implants | One-Piece |
| Attachment | One-Piece |
| Bone Augmentation | No |
|---|---|
| Augmentation Materials | - |
| 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 | Advanced |
|---|---|
| Defining Characteristics | Fully edentulous lower jaw to be rehabilitated with two or more implants |
| Modality | 3 or 4 interforaminal implants |
| Placement Protocol | - |
| Tooth Site | - |
| Socket Morphology | - |
| Socket Integrity | - |
| Bone Volume | Horizontally and vertically sufficient |
| Anatomic Risk | Moderate |
| Esthetic Risk | Low |
| Complexity | Moderate |
| Risk of Complications | Moderate |
Prosthodontic SAC classification
| SAC Level | Complex |
|---|---|
| Defining Characteristics | Fully edentulous lower jaw to be rehabilitated with an implant-borne fixed dental prosthesis |
| Loading Protocol | Immediate |
| Retention | Screw-retained, with 4 or more splinted implants Screw-retained, with 4 or more splinted implants |
| Maxillomandibular Relationship | - |
| Mesio-Distal Space | - |
| Inter-Arch Distance | Adequate |
| Bruxism | Absent |
| Esthetic Risk | Low |
| Provisional Implant-Supported Prosthesis | - - |
| Interim Prosthesis during Healing | - - |
| Occlusion/Articulation | - |
| Occlusal Scheme/Issues | Anterior guidance |
Surgical SAC Modifiers
| Periodontal Status | Healthy |
|---|
Prosthodontic SAC Modifiers
| Soft Tissue Contour and Volume | - |
|---|
General SAC Modifiers
| Oral Hygiene and Compliance | Good |
|---|---|
| Access | Adequate |
| Craniofacial/Skeletal Growth | Completed |
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