Replacement of Multiple Teeth in a Partially Dentate Posterior Mandible with a Fixed Dental Prosthesis Using a Flapless Approach
An 80-year-old female patient was referred to clinic for rehabilitation of her dentition. The patient’s medical history revealed no significant findings that would preclude routine dental and oral surgical procedures. She reported no drug allergies and was currently taking no prescription medications.
Her chief complaint was her inability to masticate efficiently due to the recent loss of her mandibular second premolars and first molars bilaterally. She expressed a desire for fixed prostheses in the shortest possible time due to her advanced age, requesting that replacement teeth should look as natural as possible. She was otherwise comfortable and not experiencing any symptoms from her teeth.
Surgical SAC classification
Advanced
Prosthodontic SAC classification
Straightforward
Learner Level
|
1
|
2
|
3
|
Source
User Case
CME/CPD
0.15 hours
Purchase price
10
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General information
| Case Type | Short Space |
|---|---|
| Jaw | Mandible |
| Area | Posterior |
| # of Teeth | 4 |
| # of Implants | 4 |
| Type of Implants | One-Piece|Two-Piece |
| Attachment | One-Piece|Two-Piece |
| Bone Augmentation | No |
|---|---|
| Augmentation Materials | - |
| Guided Surgery | Yes |
| Soft Tissue Grafting | None |
| Abutment Type | Customized |
| 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 | Advanced |
|---|---|
| Defining Characteristics | Up to 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 | Moderate |
Prosthodontic SAC classification
| SAC Level | Straightforward |
|---|---|
| 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 2 splinted implants Screw-retained, with 2 splinted implants |
| Maxillomandibular Relationship | - |
| Mesio-Distal Space | Anatomic space corresponding to the missing teeth +/- 1 mm |
| Inter-Arch Distance | > 8 mm |
| Bruxism | Absent |
| Esthetic Risk | Low |
| Provisional Implant-Supported Prosthesis | Prosthodontic margin < 3 mm apical to mucosal crest Prosthodontic margin < 3 mm apical to mucosal crest |
| Interim Prosthesis during Healing | - - |
| Occlusion/Articulation | Harmonious |
| Occlusal Scheme/Issues | - |
Surgical SAC Modifiers
| Periodontal Status | Healthy |
|---|
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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