Case

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Bilateral SFE in the Edentulous Maxilla with DBBM using a Staged Approach

Sanja Umanjec-Korac

A healthy 56-year-old woman was referred to our Department of Oral Implantology for complete rehabilitation of both jaws. She was a non-smoker and requested being treated with fixed restorations. The patient was dissatisfied with her appearance, particularly with the excessive length of her mandibular dentition. Her dental history was extensive. Over the previous 20 years, she had undergone periodontal and orthodontic treatment but also orthognathic surgery to advance the mandible. Clinical examination revealed good oral hygiene. The patient wore a maxillary denture, and the roots of teeth 13 and 23 were endodontically treated. Panoramic radiographs were obtained, indicating pneumatization of the sinuses and an inadequate vertical dimension of the alveolar process distal to both maxillary canines.
Surgical SAC classification
Complex
Prosthodontic SAC classification
Complex
Source
Treatment Guide 5
Purchase price
10 Academy Coins
CPD/CME
0.15 hours
Publication date: Jan 11, 2015 Last review date: Apr 10, 2021 Next review date: Apr 10, 2021

General information

Case Type Edentulous Maxilla
Jaw Maxilla and Mandible
Area Full-Arch
# of Teeth All
# of Implants 12
Type of Implants One-Piece
Attachment One-Piece
Bone Augmentation Sinus Floor Elevation|Staged
Augmentation Materials Autogenous chips|Xenogenous|Membrane
Guided Surgery No
Soft Tissue Grafting None
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 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 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 High
Provisional Implant-Supported Prosthesis - -
Interim Prosthesis during Healing Removable Removable
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 Good
Access Adequate
Craniofacial/Skeletal Growth Completed

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