Case

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Placement of Narrow Diameter Two-Piece Implants with Simultaneous GBR

Daniel Buser

Surgical treatment of a 68-year-old female patient with a distal extension situation in the left mandible. As the CBCT analysis reveals, the bone crest anatomy in the area is not ideal and necessitates an augmentation procedure to achieve a good long-term prognosis for the planned implants and their prostheses. After the placement of three diameter-reduced two-piece implants the bone is augmented with autologous bone chips and DBBM particles to enlarge the crest volume. The surgery is completed with the application of two membrane layers and primary wound closure. For soft tissue management, the initial healing caps are replaced with a longer type 8 weeks after implant placement in a second intervention before prosthodontic treatment is initiated. The case concludes with the presentation of the final prostheses at the 3-year follow-up, demonstrating a stable and pleasing soft- and hard-tissue situation. Produced in cooperation with CCDE and Video-Atelier Keel.
Surgical SAC classification
Advanced
Prosthodontic SAC classification
Advanced
Duration
0 minutes
Purchase price
18 Academy Coins
CPD/CME
0.3 hours
Publication date: Jan 11, 2015 Last review date: Apr 10, 2021 Next review date: Apr 10, 2021

General information

Case Type Extended Space
Jaw Mandible
Area Posterior
# of Teeth 3
# of Implants 3
Type of Implants One-Piece|Reduced-Diameter
Attachment One-Piece|Reduced-Diameter
Bone Augmentation Horizontal|Simultaneous
Augmentation Materials Autogenous chips|Xenogenous|Membrane
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 Advanced
Defining Characteristics More than three missing teeth to be replaced with an implant-borne prosthesis or prostheses
Modality -
Placement Protocol Early or late implant placement
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 Up to three missing teeth to be replaced with an implant-borne restoration or restorations
Loading Protocol Conventional or early
Retention Screw-retained, with splinted implants Screw-retained, with splinted implants
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 - -
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 Good
Access Adequate
Craniofacial/Skeletal Growth Completed

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