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Clinical Case Report

Combined SFE and Horizontal Ridge Augmentation with Autologous Block Grafts, BCP, and GBR using a Staged Approach

Luca Cordaro

Various patterns of alveolar bone resorption are known to occur in the posterior maxilla. Following tooth loss, resorption may take a buccopalatal direction, resulting in a narrow ridge displaced toward the palate. Resorption may also proceed vertically in an apical direction, reducing the vertical dimension of the ridge and increasing the interocclusal space. Another common pattern of atrophy is caused by volume increases of the maxillary sinus, which will reduce the residual bone volume in an occlusal direction due to downward displacement of the sinus floor. Most cases are characterized by combined defects, leading to a variety of atrophy configurations. Whenever there is a greater need for augmentation than elevating the sinus floor with an inlay bone graft, horizontal and vertical augmentation of the residual ridge may be accomplished by intraoral harvesting of autologous onlay block grafts in the same surgical procedure. We refer to this procedure as “inlay-onlay” grafting of the posterior maxilla.

Surgical SAC classification
Complex
Prosthodontic SAC classification
Straightforward
Source
Treatment Guide 5
Purchase price
10 Academy Coins
CPD/CME
0.25 hours

Recommended content

General information

Case Type Short Space
Jaw Maxilla
Area Posterior
# of Teeth 3
# of Implants 2
Type of Implants One-Piece
Attachment One-Piece
Bone Augmentation Horizontal|Sinus Floor Elevation|Staged
Augmentation Materials Autogenous chips|Autogenous block(s)|Synthetic|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 Up to 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 Low
Complexity High
Risk of Complications High

Prosthodontic SAC classification

SAC Level Straightforward
Defining Characteristics Up to three missing teeth to be replaced with an implant-borne restoration or restorations
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 teeth +/- 1 mm
Inter-Arch Distance > 8 mm
Bruxism Absent
Esthetic Risk Low
Provisional Implant-Supported Prosthesis - -
Interim Prosthesis during Healing - -
Occlusion/Articulation Harmonious
Occlusal Scheme/Issues -

Surgical SAC Modifiers

Periodontal Status Healthy

Prosthodontic SAC Modifiers

Soft Tissue Contour and Volume -

General SAC Modifiers

Oral Hygiene and Compliance Insufficient
Access Adequate
Craniofacial/Skeletal Growth Completed
Publication date: Jan 11, 2015 Last review date: Apr 10, 2021 Next review date: Apr 10, 2024

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