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Autologous Block Graft and Guided Bone Regeneration (GBR) for Horizontal Ridge Augmentation in the Posterior Mandible

Daniel Buser, Bruno Schmid

An 18-year-old man was referred for implant therapy in the posterior mandible to the Department of Oral Surgery and Stomatology (University of Bern, Switzerland). He was healthy and did not smoke. Tooth 35 was congenitally missing, involving a single-tooth edentulous space that offered an adequate mesiodistal dimension for implant placement but exhibited a typical pattern of buccal flattening. A panoramic radiograph was obtained, which revealed a sufficient vertical bone height above the mandibular canal and a normal bone structure in the edentulous area.
Surgical SAC classification
Complex
Prosthodontic SAC classification
Straightforward
Source
Treatment Guide 7
Purchase price
10 Academy Coins
CPD/CME
0.15 hours
Publication date: Oct 13, 2014 Last review date: Apr 10, 2018 Next review date: Apr 10, 2021

General information

Case Type Single-Tooth Space
Jaw Mandible
Area Posterior
# of Teeth 1
# of Implants 1
Type of Implants One-Piece
Attachment One-Piece
Bone Augmentation Horizontal|Staged
Augmentation Materials Autogenous chips|Autogenous block(s)|Xenogenous|Membrane
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 One missing tooth to be replaced by an implant-borne prosthesis
Modality -
Placement Protocol Early or late implant placement
Tooth Site -
Socket Morphology -
Socket Integrity -
Bone Volume Deficient horizontally, requiring prior grafting
Anatomic Risk Low
Esthetic Risk Low
Complexity High
Risk of Complications Moderate

Prosthodontic SAC classification

SAC Level Straightforward
Defining Characteristics One missing tooth to be replaced by an implant-borne crown
Loading Protocol Conventional or early
Retention Cemented, with prosthesis margin < 3mm submucosal Cemented, with prosthesis margin < 3mm submucosal
Maxillomandibular Relationship -
Mesio-Distal Space Anatomic space corresponding to the missing tooth +/- 1 mm
Inter-Arch Distance Ideal tooth height +/- 1 mm
Bruxism Absent
Esthetic Risk Low
Provisional Implant-Supported Prosthesis - -
Interim Prosthesis during Healing - -
Occlusion/Articulation -
Occlusal Scheme/Issues -

Surgical SAC Modifiers

Periodontal Status Healthy

Prosthodontic SAC Modifiers

Soft Tissue Contour and Volume -

General SAC Modifiers

Oral Hygiene and Compliance Good
Access Adequate
Craniofacial/Skeletal Growth Completed

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