Case

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Clinical Case Report

Replacement of Multiple Teeth in a Partially Dentate Posterior Maxilla with Crowns Using a Conventional Loading Protocol

Gary S. Solnit

In 2004, an 84-year-old female patient presented at our practice with a hopeless prognosis for her maxillary right first and second premolars. These teeth were supporting a three-unit fixed dental prosthesis and had a cantilevered pontic replacing the first molar. Both teeth had combined endodontic and periodontal lesions, with significant bone loss in the area. The patient also had a large maxillary sinus apical to the first molar site. The patient presented with normal facial form and upon normal smiling, she displayed the affected area. She reported mobility and pain with mastication. The fixed dental prosthesis displayed severe mobility and could be depressed into the alveolar sockets. Exudate was evident around both abutments. There were no significant medical problems reported and the patient reported taking no medications.

Surgical SAC classification
Complex
Prosthodontic SAC classification
Straightforward
Source
Treatment Guide 2
Purchase price
10 Academy Coins
CPD/CME
0.15 hours

Recommended content

General information

Case Type Short Space
Jaw Maxilla
Area Posterior
# of Teeth 3
# of Implants 3
Type of Implants One-Piece
Attachment One-Piece
Bone Augmentation Horizontal|Sinus Floor Elevation|Staged
Augmentation Materials Autogenous chips|Xenogenous
Guided Surgery No
Soft Tissue Grafting None
Abutment Type Standard
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 Up to three missing teeth to be replaced with an implant-borne restoration or restorations
Modality -
Placement Protocol Early or late implant placement
Tooth Site -
Socket Morphology -
Socket Integrity -
Bone Volume Deficient vertically or deficient vertically AND horizontally
Anatomic Risk High
Esthetic Risk Low
Complexity High
Risk of Complications High

Prosthodontic SAC classification

SAC Level Straightforward
Defining Characteristics Up to three missing teeth to be replaced with an implant-borne restoration or restorations
Loading Protocol Conventional or early
Retention Cemented, with prosthesis margin < 3mm submucosal Cemented, with prosthesis margin < 3mm submucosal
Maxillomandibular Relationship -
Mesio-Distal Space Anatomic space corresponding to the missing teeth +/- 1 mm
Inter-Arch Distance > 8 mm
Bruxism Absent
Esthetic Risk Low
Provisional Implant-Supported Prosthesis - -
Interim Prosthesis during Healing Removable Removable
Occlusion/Articulation Harmonious
Occlusal Scheme/Issues -

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
Publication date: Jan 11, 2015 Last review date: Apr 10, 2023 Next review date: Apr 10, 2026

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