Maxillary Implant-supported Full-arch Removable Dental Prostheses for a Geriatric Patient: Sequencing the Treatment for an Optimal Outcome
A 90-year-old, essentially healthy woman requested assistance following what she determined was the loss of a dental restoration from a maxillary anterior tooth. She also complained of pain associated with tooth 11. The patient was assessed as relatively fit and healthy. She took medications for mild hypertension and to prevent angina attacks (atenolol and diltiazem). She had a form of arthritic joint degeneration affecting several joints; especially in her hands and fingers. When required she used an NSAID (meloxicam) for pain management. She reported living alone in a care facility that allows for independent living, with domestic support when and if necessary and primary medical triage when required.
Surgical SAC classification
Straightforward
Prosthodontic SAC classification
Complex
Learner Level
|
1
|
2
|
3
|
Source
Treatment Guide 9
CME/CPD
0.25 hours
Purchase price
10
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General information
| Case Type | Edentulous Maxilla |
|---|---|
| Jaw | Maxilla |
| Area | Full-Arch |
| # of Teeth | All |
| # of Implants | 4 |
| Type of Implants | - |
| Attachment | - |
| Bone Augmentation | No |
|---|---|
| Augmentation Materials | - |
| Guided Surgery | No |
| Soft Tissue Grafting | None |
| Abutment Type | Standard |
| 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 | Straightforward |
|---|---|
| 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 | Horizontally and vertically sufficient |
| Anatomic Risk | Low |
| Esthetic Risk | Low |
| Complexity | Low |
| Risk of Complications | Low |
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 | Anterior guidance |
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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