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Immediate Loading of Four Implants in the Mandible and Six Implants in the Maxilla and Final Restoration with a Full-Arch Metal Framework FDP and a Full-Arch CAD/CAM Zirconia Framework FDP

Paolo Casentini

A 65-year-old female patient with a failing residual maxillary dentition and a complete mandibular removable denture was referred for consultation and treatment. The patient’s chief complaint was that her upper residual teeth were mobile and she was unable to chew. The patient also asked us to improve the esthetic appearance of her smile. The patient’s desire was a stable and comfortable dentition in both jaws, and she specifically asked for a fixed rehabilitation. The patient reported a history of recurrent caries, endodontic complications, and periodontal disease as main reasons for previous teeth extractions. The anamnesis was negative for bruxism and TMJ disorders. The patient had no systemic diseases, was not on any medication,and did not smoke. The extraoral examination revealed a medium lip line, a wide diastema between the two central incisors (which, according to the patient, had appeared recently), and a partial collapse of the perioral soft tissues, probably due to loss of the correct vertical dimensions.
Surgical SAC classification
Complex
Prosthodontic SAC classification
Complex
Source
Treatment Guide 4
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 10
Type of Implants Two-Piece
Attachment Two-Piece
Bone Augmentation Horizontal|Simultaneous
Augmentation Materials Xenogenous
Guided Surgery No
Soft Tissue Grafting None
Abutment Type CAD/CAM
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 horizontally, allowing simultaneous augumentation
Anatomic Risk Moderate
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 Immediate
Retention Cemented, with prosthesis margin < 3mm submucosal Cemented, with prosthesis margin < 3mm submucosal
Maxillomandibular Relationship -
Mesio-Distal Space -
Inter-Arch Distance Average
Bruxism Absent
Esthetic Risk High
Provisional Implant-Supported Prosthesis Prosthodontic margin < 3 mm apical to mucosal crest Prosthodontic margin < 3 mm apical to mucosal crest
Interim Prosthesis during Healing - -
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 Sufficient
Access Adequate
Craniofacial/Skeletal Growth Completed

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