SFE with Particulated Autografts Combined with Vertical Ridge Augmentation using Onlay Grafts and a Staged Approach
A 61-year-old woman was referred for assessment of the possibility of bone grafts for implant placement to reconstruct her severely atrophic maxilla. She was a healthy non-smoker. Since her thirties she had worn a complete upper denture against a natural lower dentition. Ten years prior to the consultation, five implants had been placed in the maxilla for a fixed prosthesis. One implant failed immediately, and others failed over the ensuing 10 years. In the previous 2 years, she had been wearing a complete denture without retentive elements over the last two implants. Her primary concern was the instability of her denture. She had great difficulty with mastication and felt insecure when speaking. Her desire was to have a fixed prosthesis.
General information
Case Type | Edentulous Maxilla |
---|---|
Jaw | Maxilla |
Area | Full-Arch |
# of Teeth | All |
# of Implants | 8 |
Type of Implants | Two-Piece |
Attachment | Two-Piece |
Bone Augmentation | Horizontal|Sinus Floor Elevation|Staged|Vertical |
---|---|
Augmentation Materials | Autogenous chips|Autogenous block(s) |
Guided Surgery | No |
Soft Tissue Grafting | Staged |
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 | 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 | Low |
Complexity | High |
Risk of Complications | High |
Prosthodontic SAC classification
SAC Level | Complex |
---|---|
Defining Characteristics | Fully edentulous upper jaw to be rehabilitated with an implant-borne fixed dental prosthesis |
Loading Protocol | Conventional or early |
Retention | Screw-retained, with 4 or more splinted implants Screw-retained, with 4 or more splinted implants |
Maxillomandibular Relationship | - |
Mesio-Distal Space | - |
Inter-Arch Distance | Average |
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 | Healthy |
---|
Prosthodontic SAC Modifiers
Soft Tissue Contour and Volume | Significantly deficient |
---|
General SAC Modifiers
Oral Hygiene and Compliance | Good |
---|---|
Access | Adequate |
Craniofacial/Skeletal Growth | Completed |
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