Free excerpt - SAC Classification in Implant Dentistry

5 PRACTICAL APPLICATION OF THE SAC ASSESSMENT TOOL

Fig 2. Overall treatment classification: Edentulous esthetic risk = medium; Surgical classification = complex; Prosthodontic classification = complex.

The patient’s general health condition was not significant in the risk assessment. In the full-arch esthetic risk assess- ment, the patient’s treatment has elevated risks due to the need for a maxillary implant-assisted prosthesis, short up- per lip, excessive maxillary ridge display at full smile, and Class III maxillomandibular interocclusal relationship. The patient presented a realistic expectation of esthetic treat- ment outcomes but also significant surgical risks. The se- verely atrophic maxillary posterior alveolar ridge elevated the surgical risk with the need for bilateral sinus augmenta- tions. The patient also required a larger number of implants to be placed. With the loss of soft tissue volume, prosthetic replacement of soft tissues was needed for both maxillary and mandibular prostheses. Full-arch maxillary and man- dibular prostheses required special attention to the design of the occlusal scheme and anterior guidance. The need to splint multiple implants for the definitive prostheses also further increased the prosthetic treatment risk. Although the patient was highly motivated and compliant, a strict home care regimen and postoperative maintenance were critical factors to be with the patient during the treatment planning phase. Overall, this patient’s treatment presented with high level of risk and degree of difficulty based on the full-arch esthetic risk, surgical risk, and prosthetic risk assessment. Upon reviewing the patient’s medical history, no contribut- ing factors would contraindicate the patient for dental treat- ment, including routine surgical and restorative procedures. The patient reported no allergies and no prescription med- ication usage. Various implant-assisted treatment options were discussed with the patient, and she showed great in- PLANNING AND CLINICAL TREATMENT

terest in the fixed dental prostheses. The patient was in- formed that due to the high lip mobility and the need for denture extension for sufficient facial support, removable dental prostheses would be more suitable. An implant-­ supported milled bar overdenture assisted by six dental implants was proposed and accepted by the patient to achieve her desire for increased maxillary prosthesis stabil- ity. The patient also accepted a treatment plan of amandib- ular implant-supported fixed complete denture supported by five dental implants. Antibiotics were prescribed to the patient to manage the acute sinusitis, and bilateral sinus augmentations were per- formed. Six dental implants (Straumann Tissue Level Im- plants) were placed in the posterior maxilla, and five dental implants were placed in the anterior mandible (Straumann Tissue Level Implants). After the 3-month healing period, the patient returned to the prosthodontics clinic for defini- tive prostheses. Scan bodies were attached to the implants under 15 Ncm torque (Figures 3a-d). Intraoral scans were made for bothmaxillary andmandibular arches (Figure 3e). CAD/CAM dental casts were articulated with facebow trans- fer and the maxillomandibular relationship recorded on a semiadjustable articulator. Maxillary and mandibular trial teeth arrangements were made in a dental laboratory. At trial insertion, the tooth arrangements were evaluated for esthetics, phonetics, occlusal vertical dimension, and cen- tric relation. The denture extension was inadequate and distorted the facial appearance while smiling (Figures 4a, b). A wrinkle was noted below the patient’s nose. Additional wax was added to the trial teeth arrangement to provide proper facial support (Figures 4c, d).

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The SAC Classification in Implant Dentistry