Case

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Four Immediately Loaded Mini-Implants Supporting a Mandibular Overdenture

Shahrokh Esfandiari

A 74-year-old male patient, a non-smoker, who had been wearing complete dentures for more than 30 years, presented to our clinic complaining about discomfort in connection with his lower denture. The patient suffered from asthma and had a history of cardiac disease and blood pressure disorders. All conditions were medically controlled and stable. The clinical inspection of the oral cavity revealed an ill-fitting complete mandibular denture. The patient expressed the wish for his lower denture to “stop moving when chewing, swallowing, and speaking.” He reported having heard about dental implants and asked whether these could help in “fixing” his lower denture, but also requested non-invasive treatment. The mucosa presented healthy and was free of defects such as pressure sores. An band of keratinized mucosa approximately 2 mm wide was visible. The patient’s mucosal biotype was medium thick to thin.
Surgical SAC classification
Advanced
Prosthodontic SAC classification
Advanced
Source
Treatment Guide 9
Purchase price
10 Academy Coins
CPD/CME
0.15 hours
Publication date: Jan 8, 2017 Last review date: Jan 2, 2020 Next review date: Jan 2, 2020

General information

Case Type Edentulous Mandible
Jaw Mandible
Area Full-Arch
# of Teeth All
# of Implants 4
Type of Implants One-Piece|Reduced-Diameter
Attachment One-Piece|Reduced-Diameter
Bone Augmentation No
Augmentation Materials -
Guided Surgery No
Soft Tissue Grafting None
Abutment Type Standard
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 Advanced
Defining Characteristics Fully edentulous lower jaw to be rehabilitated with two or more implants
Modality 3 or 4 interforaminal implants
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 Advanced
Defining Characteristics Fully edentulous lower 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 Low
Provisional Implant-Supported Prosthesis - -
Interim Prosthesis during Healing Removable Removable
Occlusion/Articulation -
Occlusal Scheme/Issues Balanced

Surgical SAC Modifiers

Periodontal Status History of periodontitis or genetic predisposition

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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