The SAC Assessment Tool

Asbjørn Jokstad, DDS, PhD

Professor and Head, Prosthodontics
Faculty of Dentistry, University of
Toronto

Holland Bloorview ITI Education Week

October 26, 2011
 The 10 steps of Implant Prosthetic
Treatment
Planning Interventions: 4 Patient centered
phases: 3 Biomaterials: 4 considerations: 3
Planning Total
Strategy 1 Diagnostic 1 Risk-factors 1

Patient
Communication

Surgery phase Site-optimizing 2

planning 2 Grafting-material 1 2
Patient Implant surgery 3 Biological
Communication response
Implant 2

Restorative 3
Hard & soft 4
phase Clinical
3 tissue restorative
planning outcomes &
Abutment 3 events Maintenance &
Patient Post-operative
Supra-construction 4
Communication interventions
 The 3 planning phases of Implant
Prosthetic Treatment
Planning Interventions: 4 Patient centered Dawson A, Chen S
phases: 3 Biomaterials: 4 considerations: 3
Planning Total
Strategy 1 Diagnostic 1 Risk-factors 1

Patient
Communication

Surgery phase Site-optimizing 2

planning 2 Grafting-material 1 2
Patient Implant surgery 3 Biological
Communication response
Implant 2
Quintessence Publishing
2009
Isbn: 978-1-85097-188-7
Restorative 3
Hard & soft 4
phase Clinical
3 tissue restorative
planning outcomes &
Abutment 3 events Maintenance &
Patient Post-operative
Supra-construction 4
Communication interventions
General Determinants of the
Normative SAC classification
Modifying Factors determining
the Final SAC classification
Modifying Factors determining
the Final SAC classification
Modifying Factors determining
the Final SAC classification
Modifying Factors determining
the Final SAC classification
General Modifying Factors

High Risk Reduced Heavy Smoker Ongoing Sub-optimal

Immune system (>10 cigs/day) preceeding
outcome
Moderate Light smoker Moderate /
Risk (<10 cigs/day) Suboptimal
outcome

Low Risk Healthy, co- Non-smoker Completed Optimal

operative with an
intact immune
system
Esthetic Modifying Factors

High High High High Triangula Acute >=7mm to >=2 Soft Vertical
Risk scalloped, r contact teeth tissue bone
thin point & defects deficienc
Restored y

Mod Mediu Medium Medium Chronic 5.5-6.5mm 1 tooth Horizontal

erate m scalloped, to contact (<= bone
Risk medium point 7mm) deficiency
thick
Low Low Low Low Rectangul None <=5mm to 1 tooth Intact soft No bone
Risk scalloped, ar contact (>= tissue deficiency
thick point & 7mm)
Virgin
Surgical Modifying Factors

High Risk Deficient, High risk of Yes /Thin Implant High / Severely
/ degree requiring prior involvement /Insufficient placement with compromised
of augmentation <1mm staged outcome
procedures
difficulty
Moderate Deficient, but Moderate risk of Implant Moderate /
Risk / allowing involvement placement with Suboptimal
degree of simultaneous simultaneous outcome
augmentation procedures
difficulty

Low Risk / Adequate Minimal risk of No /Thick Implant Minimal / No

degree of involvement /Sufficient > placement adverse effect
difficulty 1mm without
adjunctive
procedures
Restorative Modifying Factors

High Risk / a. Virgin / b. a. Adjunctive therapy a. No guidance /b. a. Fixed /b. Margin > 3mm
degree of Periodontal disease needed to gain sufficient Involved in guidance from crest /c. Immediate
difficulty or parafunction space or b. to achieve /c. Present /d. --/e. High
satisfactory result /c. Full
arch / d. Required
Moderate Risk a. Restricted / b. some a. Removable /b. Margin
/ degree of reduction required /c. <3mm from crest /c. -- /d.
difficulty Extended space PFM /e. Moderate

Low Risk / a. Restored teeth / b. a. Adequate /b. Sufficient /c. a. Anterior guidance /b. a. None /b. not required /c.
degree of Caries or Trauma Single tooth / d. Not minimal involvement /c. Conventional/Early d.
difficulty required Absent Resin-metal /e. Low
Examples, General Modifying Factors
Example, Esthetic Modifying Factors
Example, Surgical Modifying Factors

High Risk / Deficient,

degree of requiring prior
augmentation
difficulty

Moderate Deficient, but

Risk / degree allowing
simultaneous
of difficulty
augmentation

Low Risk / Adequate

degree of
difficulty
Normative
Surgical
SAC
classification
Normative
Surgical
SAC
classification
Normative
Surgical SAC
classification
Normative
Surgical SAC
classification
Normative SAC classification
+ Modifier Considerations
 SAC Classification
Application of Surgical SAC classification:
Single tooth space with
sufficient bone
Non-Esthetic Zone

Straightforward
Esthetic Zone

Advanced
Application of Surgical SAC classification:
Single tooth space with
deficient vertical bone volume
Non-Esthetic Zone

Complex
Esthetic Zone

Consistent 5 clinical parameters Complex

Application of the Restorative SAC classification
Anterior Single Teeth

Anterior edentulous spaces

Posterior Single Teeth

Posterior edentulous spaces

Clinical parameters depending on intraoral location and size

Application of the Restorative SAC classification
Edentulous – Fixed Restorations
Assumptions – SAC Tool
http://www.iti.org/var/external/
sac-tool/default-1000.htm