Oral Rehabilitation of an Elderly Edentulous Patient with Osteoarthritis Using an Implant-supported Mandibular Prosthesis with Locator Abutments
A 78-year-old man was referred to the dental hospital by his general dental practitioner. He was a non-smoker but was taking a number of medications as prescribed by his general medical practitioner, including atorvastatin-calcium for high cholesterol, lisinopril and hydrochlorothiazide for hypertension, warfarin as an anticoagulant, and metformin for the management of type 2 diabetes. The patient also suffered from osteoarthritis in both hands. The patient was edentulous in the maxilla and partially dentate in the mandible. A mandibular acrylic partial lower denture had been recently delivered but was poorly tolerated.
Surgical SAC classification
Advanced
Prosthodontic SAC classification
Advanced
Learner Level
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1
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2
|
3
|
Source
Treatment Guide 9
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 | 2 |
| Type of Implants | One-Piece |
| Attachment | One-Piece |
| Bone Augmentation | Horizontal|Simultaneous |
|---|---|
| Augmentation Materials | Autogenous chips|Xenogenous|Membrane |
| 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 | Advanced |
|---|---|
| Defining Characteristics | Fully edentulous lower jaw to be rehabilitated with two or more implants |
| Modality | 2 interforaminal implants |
| Placement Protocol | - |
| Tooth Site | - |
| Socket Morphology | - |
| Socket Integrity | - |
| Bone Volume | Deficient horizontally, allowing simultaneous augumentation |
| Anatomic Risk | Moderate |
| Esthetic Risk | Low |
| Complexity | Moderate |
| Risk of Complications | Moderate |
Prosthodontic SAC classification
| SAC Level | Advanced |
|---|---|
| Defining Characteristics | Fully edentulous lower 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 | Balanced |
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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