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Wide Platform Implants: Should I Splint Them?

posted in Techniques and Procedures, advice

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Anon. asks:
I have a middle-aged male patient in excellent health who has lost his mandibular first and second molars due to advanced periodontal disease. He has 8mm of bone height available for implant placement which will leave me about 2mm above his inferior alveolar nerve. Buccolingual width of bone is excellent and I have adequate room to place a wide platform implant. If I use 8mm long, wide platform implants, should I splint them because they are shorter than the ideal? My preference is for free-standing implants and single crowns. Any thoughts?

6 Responses to “ Wide Platform Implants: Should I Splint Them? ”

• Mark P. Miller, DDS August 12th, 2008

  
  

  As a general rule…splint posteriors. Each time I hear Carl Misch from the podium he becomes more vocal for splinting. It distributes the load between implants rather than running the risk of overloading any one of them. I almost always splint multiple units. What’s the downside? Can’t floss? Why floss implants? They don’t get interproximal decay. Clean between them? Send a Proxibrush to your lab and instruct them to leave embrasure open enough for patient to clean. Esthetics? They get better splinted. Molar implants are nowhere as wide as the tooth that preceded them, so use custom abutments such as Atlantis to gain mesio-distal width and splint the crowns. Bruxer? Use gold occlusals. Retrievability? That’s almost a word from the history books, but if you’re concerned, use something very soft like TempoCem Soft and work you way up the food chain if the crowns loosen. Remember that when not too much time goes by, TempBond crystallizes and becomes ‘permanent’. There are no mechanical advantages to non-splinted teeth and very good mechanical advantages for splinting. And with a superb open tray impression and lab support, how many contacts do you have to adjust?

• Alejandro Berg August 12th, 2008

  
  

  As a standard yes, splinted…. in cases where you have good buccal lingual space and short bone you can use Endopore implants that are 5×7 and designed for free standing Molars and in terms of aesthetics you can use Full Zyrconia Abutments if needed.
  Best of luck
  (pretty much everything that Dr Miller Said is Right)

• Sam August 12th, 2008

  
  

  I would like to thank Dr. Miller for a very good comment. I am currently not splinting but now I think it will be my first choice. However, I don’t think that splinting is critical in the mandible as it is in the maxilla.
  Good point Dr. Miller

• JAV August 13th, 2008

  
  

  Stability is a matter of surface area. If you are using wide platform implants with a shorter length you have increased the surface area similar to a longer implant with a smaller diameter. The key here is to make sure that you have the occlusion right. Patients do not use floss threaders and have a difficult time maintaining splinted units. If he has lost first and second molars because of advanced periodontal disease, this is a big problem. This kind of problem also has to do with traumatic occlusion. You may need to adjust or crown the opposing teeth to get the occlusion right. If you do this you could avoid splinting.

• DRMA August 14th, 2008

  
  

  Crown-implant ratio is also an important question.

• Dr. Bill Woods August 27th, 2008

  
  

  Crown root ratio does not apply the same with implants as with natural teeth. Its a different animal, but you do need to load them occlusally. As with splinting, I agree and Dr. Miller’s suggestions are right on target. Great tips for hygiene. I dont agree with avoiding splinting. Think of a fence. Bill

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