Case

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SFE with Particulated Autografts Combined with Vertical Ridge Augmentation using Onlay Grafts and a Staged Approach

Timothy W. Head

A 61-year-old woman was referred for assessment of the possibility of bone grafts for implant placement to reconstruct her severely atrophic maxilla. She was a healthy non-smoker. Since her thirties she had worn a complete upper denture against a natural lower dentition. Ten years prior to the consultation, five implants had been placed in the maxilla for a fixed prosthesis. One implant failed immediately, and others failed over the ensuing 10 years. In the previous 2 years, she had been wearing a complete denture without retentive elements over the last two implants. Her primary concern was the instability of her denture. She had great difficulty with mastication and felt insecure when speaking. Her desire was to have a fixed prosthesis.
Surgical SAC classification
Complex
Prosthodontic SAC classification
Complex
Source
Treatment Guide 5
Purchase price
10 Academy Coins
CPD/CME
0.15 hours
Publication date: Jan 11, 2015 Last review date: Apr 10, 2018 Next review date: Apr 10, 2021

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|Sinus Floor Elevation|Staged|Vertical
Augmentation Materials Autogenous chips|Autogenous block(s)
Guided Surgery No
Soft Tissue Grafting Staged
Abutment Type Customized
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 vertically or deficient vertically AND horizontally
Anatomic Risk High
Esthetic Risk Low
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 Conventional or early
Retention Screw-retained, with 4 or more splinted implants Screw-retained, with 4 or more splinted implants
Maxillomandibular Relationship -
Mesio-Distal Space -
Inter-Arch Distance Average
Bruxism Absent
Esthetic Risk Low
Provisional Implant-Supported Prosthesis - -
Interim Prosthesis during Healing Removable Removable
Occlusion/Articulation -
Occlusal Scheme/Issues Anterior guidance

Surgical SAC Modifiers

Periodontal Status Healthy

Prosthodontic SAC Modifiers

Soft Tissue Contour and Volume Significantly deficient

General SAC Modifiers

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

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