Connecting Natural Teeth and Implants: Best Plan?

I will never ever connect a natural tooth to an implant. No comments and I respect and wish good luck to whoever does it.

You have to remember that the implant has NO periodontal ligament and zero mobility . The tooth however will have slight mobility so therefore when you connect the two using a fixed bridge , you are essentially cantilievering both the pontic AND the abutment of the natural tooth off the implant ! This is going to cause either constant loosening of the implant abutment at best or a comlplete failure of the implant eventually. It is therefore totally inadvisable to connect the two. A better but still nonideal situation would be to do a seperate crown on the tooth and cantiliever the pontic off the implant if it is of wide enough diameter ( At least 4.3 mm ) and keep the pontic with flat anatomy and totally out of occlusion. This would work if the pontic is of bicuspid size only . If it is a molar that is being replaced, again this would be inadvisable and another implant would need to be placed. Hope this helps and good luck !

Mr. BC The literature recommends not splinting natural teeth to implants because of the differences in mobility, one being slightly cushioned by the periodontal ligament, and the other rigidly fused to the bone. Before it was shown that it was not a good idea, it was done often, and the cases with the worst results were those that included either a coping, or a semi-rigid attachment. Make sure that the dentist is aware that this is not the norm by today's standards and if you have to do it, a one-piece metal framework is the way to go. Be aware that if the dentist mis-diagnoses and mis-designs the case, it will most likely fail. Good luck.

Dear friend BC dental Lab. Your last idea is recommended.However, placing INTER-CORONAL attachment(male on the natural tooth and femal attach to the bridge)is the best in this case.Remember, inter-coronal attachment has a plastic seal for some hybrid for natural tooth.. Hopefully help. Dr. Vaziri-Tehran Iran

The implant resists forces best when they are applied along the long axis of the implant. To subject the implant to the forces created with a long cantilever (pontic plus the crowned natural tooth abutment) is asking for problems. Attaching the pontic to the natural tooth using male on the implant abutment and female of the attachment in the pontic would reduce unfavorable forces on the implant. Best just place another implant in the pontic space. If you do it as a rigid bridge you must not use temporary cement, use a composit or something like C&B metabond, or else the cement is likely to fail on the natural tooth.

The connection of Implants to teeth has been debated for quite sometime . Logic and clinical outcomes seem to contradict each other however Clearly teeth move to the compressibility of the PDL and implants move very little (depending on bone density) It can, and does work in select cases..you cant argue with 15 yrs of function in multiple cases...the question is when to do it . Here are some guidlines.... a) If a tooth is even remotely periodontally involved and exhibiting mobility ..then no splinting The longer the span the longer the cantilever and the greater the forces...so keep spans very short (one or one and a half premolar units) Distal position of teeth will incur greater forces so avoid distal teeth abutments If you have a bridge with the pier abutments being implants and a tooth in the middle ,say a 5 unit bridge ..this is actually quite predictable. Avoid teeth as peir abutments Anterior cases with properly designed occlusion or ant open bite are very limited risk Wide implants have a greater resistance to lateral load ,so logic dictates to use wide implants where possible. Personally I have tried to avoid splinting and tend towards more ideal dentistry infact one implant per tooth would be nice but that just is not always realistic or feasible In the real world of Dental practice you are faced with numerous constraints and realities, you need to know what can and cant work . In 15 years of implant dentistry i have not seen a failure that I would blame due to a tooth/implant splint I have also always followed these guidelines. Check out Misch multiple texts on the subject ...he really is the authority on this kind of biomechanics stuff Unless you have a practice with totally motivated patients who have unlimited funds ....I wish!

It is too risky. Just convience the Dentist to place one more implant at the pontic site,to be safe, if the pt is having financial problem ,discount can help a lot . but a wrong tx plan can be a dissaster to a pt. who has a limited budjet.

If the standard guidelines for the Biomechanics are followed as I had begun to outline above then there is no greater risk factor than doing non splinted implants. i have seen no difference in success rates either way due to the splinting (when design protocol is followed) Its not about "just add another implant"..most of us would ,I often over engineer all my cases..its little difference to me to add an "extra" implant if Im in already..but the splinting is done when the pontic area is very thin or across a sinus lobe etc ..now its a little different as a block graft or a sinus graft is required...philosophically ..i woud rather avoid splinting...the reality of clinical practice is that when you are faced with this, and other factors are favorable ..it definitely works ...the texts and literature is replete with long term success over decades

screw-retained restoration on implant and telescopic crown on natural tooth - total retrievability. There are even screws for telescopics, i heard.

Check out the literature review on this subject by Greenstein and Tarnow in which they concluded: 1. The potential for intrusion of an abutment tooth cannot be ignored; however, it should not be a deterrent from connecting teeth to inmplants.... The literature supports the idea that a rigid connection between a tooth and an implant usually precludes intrusion of teeth. 2. The literature indicates use of rigid connections between teeth and implants in a tooth-implant supported prosthesis usually reduces mechanical complications to a level that appears to be comparable with problems associated with implant supported prostheses. 3. Numerous studies (over 25 given) indicate implants can be splinted to teeth and function sucdfessfully. 4. Use permanent cementation, not screw retention or temporary cementation. 5. The bridge span should be short. 6. In general, do not use tooth-imnplant supported prostheses in patients with parafunctional habits. This is the SCIENCE on the subject...

This subject comes up every 6 months or so on this blog. SG perio is correct. While the general principle of isolation implants from natural teeth is a good baseline to follow, there are some circumstances where is is not only viable but good treatment practice to do so. Many other posters have splinted natural teeth to implants with success and there is lots of literature evidence supporting the principle of joining a tooth to an implant. The protocol which I use are the following: • The implant abutment should be of substantial size and should be placed in type II bone to best withstand the increase in shear forces that can arise from this type of hybrid bridge system. • The pontic should have a short span, preferably only a single tooth, to minimize torque forces on the abutments. • The natural root abutment should have good stability, preferably with no mobility and the tooth should preferably be multi-rooted to minimize tooth displacement. • Both abutment connectors should have a rigid connector design. Nonrigid attachments should be avoided as they are associated with a greater incidence of root intrusion. • If telescopes or copings are used, avoid temporary cements; in particular, avoid the no-cement coping technique, as loss or absence of a rigid connection will induce the highest incidence of intrusion. • Use highly retentive cements with superior design features for retentive preparation at the abutment to resist cementation failure. • Eliminate or minimize unbalanced tooth contacts in excursive movements as well as in centric. • Consider bruxism as a risk factor; if present, manage bruxism with an anti-bruxism splint, preferably placed on the arch that contains the bridge.

Dr. NIMCHUCK, WELL STATED.

All of the comments above are valid and scientific. They can be distilled down to the following paradigm: If the prosthesis is primarily implant-borne, it is safe to attach a natural abutment. If the prosthsis is primarily tooth-borne, consider separating the components. Virtually 100% of the hybrid failures I have seen in the past 25 years is where an implant has been attached to a tooth-borne prosthesis with mobility. RJM