Case

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Metal Allergy

Daniel Wismeijer, Daan Kruger, Joris Muris

In 2004, the patient, a smoker, began dental treatment at the ACTA graduate clinic. She was a TV producer exposed to a lot of stress in her job and had a sick husband. Her maxillary teeth had been extracted, as had the mandibular canines, premolars, and molars, with the exception of tooth 34. She received a complete maxillary denture and a mandibular skeleton denture. In October 2007, her maxilla was augmented by an oral and maxillofacial surgeon; in March 2008, implants (Biomet 3i, Palm Beach, Florida, USA) were inserted at that same clinic. In 2008, the patient was presented at the Department of Oral Implantology and Prosthetic Dentistry to request restorations for her implants. An implant-supported overdenture was planned. She also asked if we could restore her occlusion with fixed prosthetics.
Surgical SAC classification
Complex
Prosthodontic SAC classification
Complex
Source
Treatment Guide 8
Purchase price
10 Academy Coins
CPD/CME
0.15 hours
Publication date: Dec 21, 2015 Last review date: Dec 14, 2020 Next review date: Dec 14, 2020

General information

Case Type Edentulous Maxilla
Jaw Maxilla
Area Full-Arch
# of Teeth All
# of Implants 8
Type of Implants Two-Piece
Attachment Two-Piece
Bone Augmentation Horizontal|Staged
Augmentation Materials Xenogenous
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 Complex
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 Deficient horizontally, requiring prior grafting
Anatomic Risk Low
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 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 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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