Case

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Rehabilitating an Edentulous Maxilla with a Conventional Removable Denture and an Edentulous Mandible with a Fixed Dental Prosthesis Using s-CAIS

Wei-Shao Lin, Waldemar Daudt Polido, Jyme Rae Charette, Dean Morton

This case describes a partial digital workflow in the treatment of a patient with a terminal dentition. It features virtual planning of static computer-aided implant surgery (s-CAIS) and CAD/CAM interim prostheses. A 72-year-old male patient was referred to the prosthodontic clinic for possible implant treatment. He presented with a partially edentulous maxilla and mandible. The clinical and radiographic examination showed generalized chronic severe periodontitis with tooth mobility, dental caries, and direct composite restorations in three teeth. Pre-treatment periapical and panoramic radiographs revealed horizontal bone loss associated with all remaining teeth and vertical bone loss associated with the anterior teeth and confirmed the presence of generalized carious lesions.
Surgical SAC classification
Complex
Prosthodontic SAC classification
Complex
Source
Treatment Guide 11
Purchase price
10 Academy Coins
CPD/CME
0.15 hours
Publication date: Apr 26, 2022 Last review date: Apr 19, 2022 Next review date: Apr 19, 2025

General information

Case Type
Jaw Mandible
Area Full-Arch
# of Teeth -
# of Implants 6
Type of Implants One-Piece
Attachment One-Piece
Bone Augmentation No
Augmentation Materials -
Guided Surgery Yes
Soft Tissue Grafting -
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 lower jaw to be rehabilitated with two or more implants
Modality 4 or more implants, immediate loading
Placement Protocol -
Tooth Site Tooth site
Socket Morphology Socket morphology
Socket Integrity Socket integrity
Bone Volume Horizontally and vertically sufficient
Anatomic Risk Low
Esthetic Risk High
Complexity High
Risk of Complications Low

Prosthodontic SAC classification

SAC Level Complex
Defining Characteristics Fully edentulous lower jaw to be rehabilitated with an implant-borne fixed dental prosthesis
Loading Protocol Immediate
Retention -
Maxillomandibular Relationship -
Mesio-Distal Space -
Inter-Arch Distance -
Bruxism -
Esthetic Risk High
Provisional Implant-Supported Prosthesis -
Interim Prosthesis during Healing -
Occlusion/Articulation -
Occlusal Scheme/Issues -

Surgical SAC Modifiers

Periodontal Status History of periodontitis or genetic predisposition

Prosthodontic SAC Modifiers

Soft Tissue Contour and Volume Ideal

General SAC Modifiers

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

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