Case

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Flapless Guided Surgery: Bar-supported Overdenture on Four Implants

Robbert Jan Renting

A female patient, born in 1934, medically compromised (Renton and coworkers 2013) (ASA III: history of CVAs, arrhythmia, high blood pressure, type 2 diabetes mellitus, hypothyroid, arthroses, and hyperventilation) presented at our clinic. Her remaining maxillary dentition had had to be extracted some years ago due to multiple periapical infections; since then, the patient had been functioning with a conventional maxillary denture. This denture had been giving her problems in terms of function, eating, and digesting food. She lived at a considerable distance from the clinic. Despite the pain while wearing and using the denture, she kept her spirits and hoped for a different solution. She wished for more comfort and better chewing ability; at the time, she could not visit friends or have dinner in a restaurant with her conventional denture.
Surgical SAC classification
Straightforward
Prosthodontic SAC classification
Complex
Source
Treatment Guide 9
Purchase price
10 Academy Coins
CPD/CME
0.15 hours
Publication date: Dec 20, 2016 Last review date: Dec 14, 2016 Next review date: Dec 14, 2019

General information

Case Type Edentulous Maxilla
Jaw Maxilla
Area Full-Arch
# of Teeth All
# of Implants 4
Type of Implants One-Piece
Attachment One-Piece
Bone Augmentation No
Augmentation Materials -
Guided Surgery Yes
Soft Tissue Grafting None
Abutment Type CAD/CAM
Prosthesis Type RDP

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 Straightforward
Defining Characteristics Fully edentulous upper jaw to be rehabilitated with four or more implants
Modality Overdenture on 4 implants
Placement Protocol -
Tooth Site -
Socket Morphology -
Socket Integrity -
Bone Volume Horizontally and vertically sufficient
Anatomic Risk Low
Esthetic Risk High
Complexity Low
Risk of Complications Low

Prosthodontic SAC classification

SAC Level Complex
Defining Characteristics Fully edentulous upper jaw to be rehabilitated with an implant-borne removable overdenture
Loading Protocol Conventional/early
Retention - -
Maxillomandibular Relationship -
Mesio-Distal Space -
Inter-Arch Distance -
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 Healthy

Prosthodontic SAC Modifiers

Soft Tissue Contour and Volume -

General SAC Modifiers

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

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