Free excerpt - SAC Classification in Implant Dentistry

3 RISKS IN IMPLANT DENTISTRY

Table 8 Surgical modifying factors: Surgical complexity.

Surgical modifying factors

Risk or degree of difficulty

Low

Medium

High

Site factors

Surgical complexity Timing of placement

Healed (late implant placement)

Partially healed (early implant placement)

Immediate implant placement

Grafting procedures

Without adjunct procedures

Simultaneous small hard and/ or soft tissue augmentation

Need for large simultaneous horizontal and vertical augmentation; need for staged hard and/or soft tissue procedures

Number of implants

One

Two to three

More than three

Congress lecture Implant Number in the Edentulous Jaw: Practical Considerations for the Fixed Rehabilita- tion by Waldemar Daudt Polido.

Review article from the 6th ITI Consensus Conference on Number of Implants Placed for Complete-Arch Fixed Prostheses by Waldemar Daudt Polido and coworkers (2017).

3.7.1 Restorative site factors Assessment of the restorative site and its characteristics is aimed at determining whether there are any prosthodontic issues with the dimensions and contours of the restorative space. Both can impact treatment complexity and risk for complications. These restorative site factors are highlighted in Table 9 and also addressed by the ITI in its Academy Learning Module “Site-Specific Clinical Examinations” (Shahdad, 2015).

In completely edentulous situations, inclination (tilting) of implants may be indicated to avoid more invasive grafting procedures and reduce the cantilever, thus improving im- plant distribution (Lin & Eckert, 2018). The direct influence of the relationship between multiple implants that need to be splinted adds more complexity to the treatment (Table 8). 3.7 Prosthetic Risks The SAC classification includes several modifying factors that have an impact on the level of difficulty and risk of the restorative aspects of implant treatment. They are divided into four groups related to consideration of restorative site factors, occlusal factors, complexity of process, and compli- cating factors. Identification of potential restorative risks often requires additional investigations in addition to a comprehensive extraoral, intraoral, and site-specific clinical examination. These additional investigations can be in the form of an an- alog or digital diagnostic work-up as well as photographic and/or videographic evaluation. These investigations are addressed by the ITI in its Academy Learning Module “Addi- tional Diagnostic Investigations” (Vorster, 2015). C. STILWELL, W. MARTIN

ITI Learning Module Site-Specific Clinical Examination by Shakeel Shahdad.

ITI Treatment Guide Vol. 4 Loading Protocols in Implant Dentistry – Edentulous Patients by Daniel Wismeijer, Paolo Casentini, German Gallucci and Matteo Chiapasco.

ITI Treatment Guide Vol. 10 Implant Therapy in the Esthetic Zone: Current Treatment Modalities and Materials for Single-tooth Replacements by Vivianne Chappuis and William Christopher Martin.

ITI Learning Module Additional Diagnostic Investigations by Christiaan Vorster.

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The SAC Classification in Implant Dentistry