Case

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Conventional Loading of Six Implants in the Mandible and Final Restoration with a Full-Arch Metal-Ceramic FDP

Arne F Boeckler, Dean Morton

A 68-year-old, completely edentulous male patient presented for evaluation and treatment options. He reported excellent general health and was taking no regular medication. He had been edentulous for approximately 12 years, having lost his teeth to periodontal disease and dental caries. The patient’s chief complaint was incompetent function. His secondary concerns included his appearance and the desire for a predictable outcome. He attributed his reduced functional capacity to his lower complete denture, which he described as poor. He was particularly concerned with the denture’s instability and poor fit. In general terms, he was satisfied with the maxillary complete prosthesis. The maxillary prosthesis was characterized by adequate retention, stability, and support, although the fit was considered less than ideal.

General information

Case Type Edentulous Mandible
Jaw Mandible
Area Full-Arch
# of Teeth All
# of Implants 6
Type of Implants One-Piece
Attachment One-Piece
Bone Augmentation No
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 Advanced
Defining Characteristics Fully edentulous lower jaw to be rehabilitated with two or more implants
Modality > 4 implants, extending to mental nerve region
Placement Protocol -
Tooth Site -
Socket Morphology -
Socket Integrity -
Bone Volume Horizontally and vertically sufficient
Anatomic Risk Moderate
Esthetic Risk Low
Complexity Moderate
Risk of Complications Moderate

Prosthodontic SAC classification

SAC Level Complex
Defining Characteristics Fully edentulous lower jaw to be rehabilitated with an implant-borne fixed dental prosthesis
Loading Protocol Conventional/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 Adequate
Bruxism Absent
Esthetic Risk Low
Provisional Implant-Supported Prosthesis - -
Interim Prosthesis during Healing Removable Removable
Occlusion/Articulation -
Occlusal Scheme/Issues No anterior guidance

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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