Case

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Mandibular Overdenture Supported by a CAD/CAM-milled Bar with Long Distal Extensions on Two Conventionally Loaded Implants

Murali Srinivasan

An 87-year-old man was referred to our Division of Gerodontology and Removable Prosthodontics at the University Clinics of Dental Medicine, Geneva, Switzerland for dental implant therapy. He was retired and led a very active social life, keeping himself busy in the company of his many grandchildren and with frequent travels to Italy. The patient’s past medical and drug histories revealed that he suffered from angina, asthma, and arthritis of the knee. He was allergic to penicillin. His regular prescription medications included anti-anginal and antiasthmatic drugs, along with occasional non-steroidal anti- inflammatory drugs for joint pain. Otherwise, he was a healthy patient who occasionally consumed alcohol on social occasions and did not smoke. A detailed dental history revealed that he had lost his teeth to chronic adult periodontal disease and had had an edentulous maxilla for over 20 years.
Surgical SAC classification
Advanced
Prosthodontic SAC classification
Advanced
Source
Treatment Guide 9
Purchase price
10 Academy Coins
CPD/CME
0.15 hours
Publication date: Dec 20, 2016 Last review date: Dec 14, 2019 Next review date: Dec 14, 2019

General information

Case Type Edentulous Mandible
Jaw Mandible
Area Full-Arch
# of Teeth All
# of Implants 2
Type of Implants One-Piece
Attachment One-Piece
Bone Augmentation No
Augmentation Materials -
Guided Surgery No
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 Advanced
Defining Characteristics Fully edentulous lower jaw to be rehabilitated with two or more implants
Modality 2 interforaminal implants
Placement Protocol -
Tooth Site -
Socket Morphology -
Socket Integrity -
Bone Volume Deficient horizontally, allowing simultaneous augumentation
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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