4-Unit Implant Supported Bridge with natural tooth and implant: prognosis?

I have a patient (limited finances) with a failed 4-unit bridge from his maxillary second molar to his first premolar.  The second molar is intact and stable and a suitable abutment but the first premolar must be extracted due to non-restorable caries.  I have treatment planned this for a new 4-unit bridge from the second molar (natural tooth) to an implant in the first premolar site.  For those of you who have experience with cases like this, what would you recommend?  What is the long-term prognosis?

11 thoughts on “4-Unit Implant Supported Bridge with natural tooth and implant: prognosis?

  1. Leal says:

    That would not be a valid/decent/acceptable option.
    Minimum two implants at 1st molar and 1st premolar and an implant supported bridge after integration.
    Plenty of bone to do that. 1st molar with internal sinus lift even without bone graft and 1st bicuspid exo+implant 2 surgeries (bicuspid has periapical pathology): wait 2,5/3 months after exo or check Peter Fairbairn’s protocol.


    if real limited finances then RPD.

    No place for screwing around in implant dentistry.

    • Leal says:

      Forgot to add that the bridge would be sectioned at the mesial aspect of 2nd molar and the metal polished in the sectioned area.

        • Joe Nolan says:

          Hi Peter, sorry you couldn’t make Dublin, I was devastated, not even Howard Koch could cheer me up. Poorly supported evening though. I have just bought ethoss , have a 26 year old female in ortho , missing UL1, with UL2 in place of the UL1, I have managed to get 8-9 mm of space but there is a labial deficiency, so I am going to flap down to bone with papilla protection, add the etoss and see how it goes. What is your best assessment of ready for implant time, and are you ok with a 2.8 mm implant?

  2. rsdds says:

    this case in my office would most likely be an immidiate loading case but first i would take a cbct and possibly place 2 or 3 implants ..

    • VD says:

      Agree with getting a CBCT scan. Please do NOT do a 4-unit bridge connecting a natural tooth with an implant as you will have problems. 3 implants would be ideal, otherwise 2 implants for a 3-unit bridge is also acceptable.

  3. Lakota311 says:

    The research does not support utilizing a fixed bridge supported by a natural tooth and a dental implant. Primarily due to the natural tooth retainer possessing a PDL, while the implant retainer does not possess a PDL. Two to three implants would be recommended in your case. If finances are the limiting factor, fabricate a RPD until the patient can restore the area properly.

  4. mwjohnson dds. ms says:

    well, I’ll go against the current. I have been connecting teeth to implants since 1994. Bo Rangert, an engineer with the branemark group discussed attaching teeth to implants back in the early 90’s. All of the above comments are valid as my first choice is always implant supported restorations independent of teeth. However, if absolutely needed and the patient understands this is less than ideal, and if the natural tooth is periodontally sound, no pockets, no mobility, then your four unit FPD idea is sound. Implant #5, then use a semiprecision attachment on the mesial of #2 (arrowhead type of attachment, placed with arrow pointing up so pontic will sit over it). I also use a little temporary cement on the attachment to stabilize the joint but make it removable if needed. Then make sure patient has a nightguard. Most practitioners that bad mouth implants to natural teeth have never done them. I want to know what “problems” these practitioners are talking about. The “problem” that hits the literature is intrusion of the natural tooth/teeth. That’s why I don’t recommend copings on natural teeth with a bridge temporarily cemented over the coping. Otherwise, there’s absolutely no literature that says connecting implants to natural teeth causes a higher implant or tooth failure rate. I’ve had one implant failure when connected to natural teeth (your exact situation actually) in 22 years and it wasn’t a result of the connected FPD.

  5. Kathleen Neilson says:

    I am a patient who had surgery 3 days ago to remove two natural teeth which supported a 4 tooth bridge and broke off at the gum line. The surgery also included starting a bone graft, and cleaning a pocket of infection next an existing adjacent tooth. This am a recurring temple pain has awakened me. It started next to the upper corner of my left (the surgery side) eye, and a little upward and further from my eye. The pain is not bad. It makes me wince, but only lasts a second or two. It occurs about every couple of minutes. Should I be concerned about a blood clot? The numbness is just beginning to wear off from the surgery.


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