Transition from an “irrational to treat” Maxillary Dentition to a Full-Arch Segmented FDP by Early Loading of Eight Implants Placed Using the Staged Approach
The staged approach permits the transition from an “irrational to treat”dentition to a full arch implant supported restoration without any need to use a removable provisional prosthesis or to apply the immediate-placement and immediate-loading techniques. A failing dentition is the usual indication for a staged treatment. On the other hand, the dentition should still contain many residual teeth, but with few or none of them being suitable for use as definitive abutments for a full-arch fixed restoration.This situation is usually the result of advanced periodontal disease or of the failure of an extensive fixed prosthesis.
General information
Case Type | Edentulous Maxilla |
---|---|
Jaw | Maxilla |
Area | Full-Arch |
# of Teeth | All |
# of Implants | 8 |
Type of Implants | One-Piece |
Attachment | One-Piece |
Bone Augmentation | Horizontal|Simultaneous |
---|---|
Augmentation Materials | - |
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 | 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 horizontally, allowing simultaneous augumentation |
Anatomic Risk | Moderate |
Esthetic Risk | High |
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 | Cemented, with prosthesis margin < 3mm submucosal Cemented, with prosthesis margin < 3mm submucosal |
Maxillomandibular Relationship | - |
Mesio-Distal Space | - |
Inter-Arch Distance | Average |
Bruxism | Absent |
Esthetic Risk | High |
Provisional Implant-Supported Prosthesis | Prosthodontic margin < 3 mm apical to mucosal crest Prosthodontic margin < 3 mm apical to mucosal crest |
Interim Prosthesis during Healing | Fixed Fixed |
Occlusion/Articulation | - |
Occlusal Scheme/Issues | Anterior guidance |
Surgical SAC Modifiers
Periodontal Status | History of periodontitis or genetic predisposition |
---|
Prosthodontic SAC Modifiers
Soft Tissue Contour and Volume | Slightly compromised |
---|
General SAC Modifiers
Oral Hygiene and Compliance | Sufficient |
---|---|
Access | Adequate |
Craniofacial/Skeletal Growth | Completed |
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