Shell Technique for Horizontal and Vertical Maxillary Bone Augmentation in a Partially Edentulous Patient with Aggressive Periodontal Disease
A 46-year-old woman was referred for treatment whose main complaints were mobility of her fixed partial dentures (right maxilla and left mandible) and periodontal bleeding during function. She also reported having taken systemic antibiotics to treat recurrent swelling in the area of the upper left molars. The patient had not seen a dentist for at least 2 years. She did not smoke and had no history of major systemic disease other than two minor orthopedic procedures some years back. The first-visit examination revealed poor plaque control, tooth mobility, periodontal disease, and a residual dentition widely associated with deep periodontal pockets.
Surgical SAC classification
Complex
Prosthodontic SAC classification
Advanced
Learner Level
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1
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2
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3
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Source
Treatment Guide 7
CME/CPD
0.15 hours
Purchase price
10
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General information
| Case Type | Extended Space |
|---|---|
| Jaw | Maxilla |
| Area | Anterior|Posterior |
| # of Teeth | 5 |
| # of Implants | 3 |
| Type of Implants | One-Piece |
| Attachment | One-Piece |
| Bone Augmentation | Horizontal|Staged|Vertical |
|---|---|
| Augmentation Materials | Autogenous chips|Autogenous block(s)|Xenogenous |
| Guided Surgery | No |
| Soft Tissue Grafting | None |
| Abutment Type | Standard |
| 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 | More than 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 | Deficient vertically or deficient vertically AND horizontally |
| Anatomic Risk | High |
| Esthetic Risk | Medium |
| Complexity | High |
| Risk of Complications | High |
Prosthodontic SAC classification
| SAC Level | Advanced |
|---|---|
| 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 3 or more splinted implants Screw-retained, with 3 or more 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 | Medium |
| Provisional Implant-Supported Prosthesis | - - |
| Interim Prosthesis during Healing | - - |
| Occlusion/Articulation | Irregular with no need for correction |
| Occlusal Scheme/Issues | - |
Surgical SAC Modifiers
| Periodontal Status | History of periodontitis or genetic predisposition |
|---|
Prosthodontic SAC Modifiers
| Soft Tissue Contour and Volume | Significantly deficient |
|---|
General SAC Modifiers
| Oral Hygiene and Compliance | Insufficient |
|---|---|
| Access | Adequate |
| Craniofacial/Skeletal Growth | Completed |
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