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Autologous Iliac-Crest Graft for Anterior Blocks and Bilateral Sinus Floor Elevation in a Completely Edentulous Maxilla

Waldemar Daudt Polido, Paulo Eduardo Pittas do Canto

A 56-year-old woman presented for treatment with complete edentulism of the maxilla. She had been using a complete removable denture since she was relatively young (age 30). Her chief complaint at presentation was lack of retention of the upper denture and a desire for a better restoration in order to improve retention, function, and esthetics. An initial clinical examination showed that the anterior maxilla was moderately atrophic both horizontally and vertically, also revealing a vertical deficiency of the posterior alveolar process. The mandible included natural teeth from 45 to 35, with previous extrusion of the anterior teeth that was being orthodontically treated. Also, there were two external hexagon dental implants at sites 46 and 36 that had been inserted elsewhere at a previous point in time. As the conditions in the mandible were healthy, including the teeth and the two implants, the patient had no complaints there.
Surgical SAC classification
Complex
Prosthodontic SAC classification
Complex
Source
Treatment Guide 7
Purchase price
10 Academy Coins
CPD/CME
0.15 hours
Publication date: Oct 13, 2014 Last review date: Apr 10, 2021 Next review date: Apr 10, 2021

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|Sinus Floor Elevation|Staged
Augmentation Materials Autogenous chips|Autogenous block(s)
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 vertically or deficient vertically AND horizontally
Anatomic Risk High
Esthetic Risk Medium
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 Medium
Provisional Implant-Supported Prosthesis - -
Interim Prosthesis during Healing Fixed Fixed
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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