Rehabilitating an Edentulous Maxilla with a Conventional Removable Denture and an Edentulous Mandible with a Fixed Dental Prosthesis Using s-CAIS
This case describes a partial digital workflow in the treatment of a patient with a terminal dentition. It features virtual planning of static computer-aided implant surgery (s-CAIS) and CAD/CAM interim prostheses.
A 72-year-old male patient was referred to the prosthodontic clinic for possible implant treatment. He presented with a partially edentulous maxilla and mandible. The clinical and radiographic examination showed generalized chronic severe periodontitis with tooth mobility, dental caries, and direct composite restorations in three teeth. Pre-treatment periapical and panoramic radiographs revealed horizontal bone loss associated with all remaining teeth and vertical bone loss associated with the anterior teeth and confirmed the presence of generalized carious lesions.
Surgical SAC classification
Complex
Prosthodontic SAC classification
Complex
Learner Level
|
1
|
2
|
3
|
Source
Treatment Guide 11
CME/CPD
0.25 hours
Purchase price
10
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General information
| Case Type | |
|---|---|
| Jaw | Mandible |
| Area | Full-Arch |
| # of Teeth | - |
| # of Implants | 6 |
| Type of Implants | One-Piece |
| Attachment | One-Piece |
| Bone Augmentation | No |
|---|---|
| Augmentation Materials | - |
| Guided Surgery | Yes |
| Soft Tissue Grafting | - |
| Abutment Type | CAD/CAM |
| 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 lower jaw to be rehabilitated with two or more implants |
| Modality | 4 or more implants, immediate loading |
| Placement Protocol | - |
| Tooth Site | Tooth site |
| Socket Morphology | Socket morphology |
| Socket Integrity | Socket integrity |
| Bone Volume | Horizontally and vertically sufficient |
| Anatomic Risk | Low |
| Esthetic Risk | High |
| Complexity | High |
| Risk of Complications | Low |
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 | - |
| 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 | Ideal |
|---|
General SAC Modifiers
| Oral Hygiene and Compliance | Insufficient |
|---|---|
| Access | Adequate |
| Craniofacial/Skeletal Growth | Completed |
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