Le Fort I Interpositional Graft and Mandibular Sandwich Osteotomy for Maxillofacial Rehabilitation after Severe Periodontitis
A 47-year-old woman who had suffered from aggressive periodontitis requiring a number of periodontal interventions over more than 10 years was referred by her general dental practitioner and periodontologist for bone augmentation and implant therapy. Her failing dentition had already been scheduled for extraction. The patient expressed a desire for implant-supported fixed restorations and esthetic improvement of her lower face. She had agreed to consult with a maxillofacial surgeon after the referring dentist had suggested bone augmentation. An initial examination by the maxillofacial surgeon revealed mobility of all residual teeth in a patient who was very unhappy with the function of her removable partial dentures. Due to periodontally migrated flaring teeth and loss of occlusal support, the vertical dimension of occlusion was dramatically reduced. The patient was displeased with her lower face because of deepened nasolabial, commissural, and supramental folds.
Surgical SAC classification
Complex
Prosthodontic SAC classification
-
Learner Level
|
1
|
2
|
3
|
Source
Treatment Guide 7
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 | 14 |
| Type of Implants | Two-Piece |
| Attachment | Two-Piece |
| Bone Augmentation | Horizontal|Sinus Floor Elevation|Staged|Vertical |
|---|---|
| Augmentation Materials | Autogenous chips|Autogenous block(s)|Xenogenous|Membrane |
| Guided Surgery | No |
| Soft Tissue Grafting | Staged |
| Abutment Type | - |
| 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 | Fully edentulous upper jaw to be rehabilitated with four or more implants |
| Modality | Fixed hybrid bridge on 5+ implants |
| Placement Protocol | - |
| Tooth Site | - |
| Socket Morphology | - |
| Socket Integrity | - |
| Bone Volume | Deficient vertically or deficient vertically AND horizontally |
| Anatomic Risk | High |
| Esthetic Risk | High |
| Complexity | High |
| Risk of Complications | High |
Prosthodontic SAC classification
| SAC Level | - |
|---|---|
| Defining Characteristics | - |
| Loading Protocol | - |
| Retention | - |
| Maxillomandibular Relationship | - |
| Mesio-Distal Space | - |
| Inter-Arch Distance | - |
| Bruxism | - |
| Esthetic Risk | High |
| Provisional Implant-Supported Prosthesis | - |
| Interim Prosthesis during Healing | - |
| Occlusion/Articulation | - |
| 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 | Sufficient |
|---|---|
| Access | Adequate |
| Craniofacial/Skeletal Growth | Completed |
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