Free excerpt - SAC Classification in Implant Dentistry

5 PRACTICAL APPLICATION OF THE SAC ASSESSMENT TOOL

Fig 4. Overall treatment classification: Edentulous esthetic risk = low; Surgical classification = advanced; Prosthodontic classification = complex.

SAC RISK ASSESSMENT

The other restorative options of fixed dental prostheses supported by teeth and/or implants were discussed, but the patient was very firm that she wanted a partial denture again and preferably with a very similar design to her old denture. It would be a bonus if the new denture was more retentive and thereby less likely to dislodge at the front. The patient would also like to achieve a definite if discreet show of front teeth. Replacement of themissingmandibular molars via implant-­ supported crowns was discussed, but the patient felt she had managed well without. She did, however, express im- mediate interest at the suggestion of a strategically placed single implant in themaxillary right canine site. The implant would serve as an overdenture abutment for the long anter- ior denture saddle. Fitted with a stud attachment, this im- plant would provide both valuable support and retention and address the patient’s wish to avoid movement and dis- lodging of the front denture teeth. A schematic drawing of the proposed new design can be seen in Figure 3. Note the addition of support for the anterior saddle from the pro- posed overdenture implant as well as the adjacent maxil- lary right first premolar and the left canine.

General risk assessment

Under the general risk assessment, all patient- and site-­ related factors were low risk. It is important to note that, in spite of the significant tooth loss at a relative early age, the periodontal status of the remaining teeth as well as the patient’s oral hygiene and compliance were very good. The patient was a nonsmoker, and the proposed maxillary right canine site had no preexisting concerns as a result of pathology or previous surgery. Importantly, the patient also had realistic expectations to the extent of benefit for the maxillary partial denture that could be derived from a single implant. From the risk factors considered in arriving at the surgical classification, only one was identified as a medium diffi- culty. The residual band of keratinized tissue was border- line at around 4 mm. So, to err on the side of caution, the moderate risk option was selected for this factor. The re- maining risk factors (the planned single implant, place- ment without the need for adjunctive contour augmenta- tion, adoption of a conventional loading protocol, good soft tissue quality, and little anatomical risk), all scored low difficulty in the surgical assessment (Figure 4). Surgical classification

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The SAC Classification in Implant Dentistry