Implant-retained Rehabilitation after Mandibular Rim Resection
A 77-year-old woman was referred to our department by an oral and maxillofacial surgeon for rehabilitation of her dentition. She had been diagnosed with squamous cell carcinoma 6 months earlier and was treated surgically by right mandibular rim resection and local floor-ofmouth resection extending to tooth 33. No radiotherapy or chemotherapy had been considered necessary. The patient complained that she was unable to eat and that her face was disfigured due to a lack of lip support on the resection side. She reported a history of well-controlled asthma and angina, in addition to cardiac arrhythmia and an allergy to penicillin. Her medication included acetylsalicylic acid and diltiazem.
Surgical SAC classification
Straightforward
Prosthodontic SAC classification
Advanced
Learner Level
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1
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2
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3
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Source
Treatment Guide 9
CME/CPD
0.25 hours
Purchase price
10
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General information
| Case Type | Extended Space |
|---|---|
| Jaw | Mandible |
| Area | Anterior|Posterior |
| # of Teeth | 7 |
| # of Implants | 3 |
| 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 | Straightforward |
|---|---|
| Defining Characteristics | More than 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 | Horizontally and vertically sufficient |
| Anatomic Risk | Low |
| Esthetic Risk | Low |
| Complexity | Moderate |
| Risk of Complications | Low |
Prosthodontic SAC classification
| SAC Level | Advanced |
|---|---|
| Defining Characteristics | Up to three missing teeth to be replaced with an implant-borne restoration or restorations |
| Loading Protocol | Conventional or early |
| Retention | Screw-retained, with splinted implants Screw-retained, with splinted implants |
| Maxillomandibular Relationship | - |
| Mesio-Distal Space | Adequate for the replacement of all missing teeth |
| Inter-Arch Distance | - |
| Bruxism | Absent |
| Esthetic Risk | Low |
| Provisional Implant-Supported Prosthesis | - - |
| Interim Prosthesis during Healing | - - |
| Occlusion/Articulation | Harmonious |
| Occlusal Scheme/Issues | - |
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 | Insufficient |
|---|---|
| Access | Adequate |
| Craniofacial/Skeletal Growth | Completed |
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