Free excerpt - SAC Classification in Implant Dentistry

W. MARTIN, A. DAWSON, W. D. POLIDO

5.9 Implants for Restoration of Long Edentulous Spaces: Removable Prostheses

tions as well as helping out in her local community.

Themissing teeth had been lost many years before, and she had not lost any during the life of the maxillary partial den- ture. It was also many years since she last had a new filling. She had, however, had the maxillary right first premolar root treated and fitted with a crown. She occasionally expe- rienced discomfort from the gingiva between her maxillary molars on both sides, which would be a prompt to see the dental hygienist. The clinical examination demonstrated good oral hygiene and gingival health except for some minor inflammation in the interproximal spaces between themaxillarymolars. The latter was likely related to the open contact points seen on the panoramic radiograph and occasional trauma from food impaction. The radiographic examination confirmed the clinical findings of good, stable marginal bone levels for the patient’s age as well as absence of dental caries and periapi- cal pathology (Figure 2). The panoramic radiograph also showed bilateral pneumatization of themaxillary sinuses in the edentate second premolar sites. The vertical dimension of static occlusion was determined by the opposing natural first premolar teeth, and the only natural tooth anterior guidance was between the opposing left canines. The partial denture had a cast metal framework with limited support from a few remaining occlusal rests on the posterior teeth but no support anteriorly to provide ef- fective anterior guidance (Figure 3).

5.9.1 Maxilla

C. STILWELL

A 63-year-old woman was seen in private practice with an interest in replacing her maxillary partial denture. The exist- ing partial denture was 20 years old, and it was replacing a premolar on each side as well as the four incisors and the right canine. In the mandible, she had a shortened dental arch with five teeth either side of the midline (Figure 1). The patient had been very happy with the partial denture from both an esthetic and functional perspective. She did, however, recognize that it was getting older and lookingworn, and that she was gradually showing less of the front denture teeth inher smile. The denture had alsodeveloped an increas- ing tendency to move anteriorly, and this could lead to mo- ments of loss of denture privacy and embarrassment. The patient had a history of successfully treated breast can- cer, and after 15 years of no recurrence, she was no longer on any medication. She described herself as fit, able, and active and enjoying a happy family life with three genera-

Fig 2. Periapical radiograph of the root-filled maxillary right first premolar showing satisfactory obturation and absence of periapical pathology.

Fig 1. Baseline panoramic radiograph.

Fig 3 a-c. Schematic drawing of the proposed partial denture design and the actual prosthesis, improved by addition of rests for tooth support as well as planned use of single implant as an overdenture abutment with a stud attachment in the maxillary right canine site. a b c

The SAC Classification in Implant Dentistry

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