Connecting crown over implant abutment via precision connector?

(Editor Note: For a fixed dental prosthesis, there are two options for connecting teeth – rigid and non-rigid connectors. Rigid connectors are cast, milled or soldered joints.  Non-rigid-connectors utilize precision and semi-precision attachments like tube-in-rod or dovetails.)

Should one consider connecting a crown over an implant abutment to a natural tooth via a precision (dovetail) connector?

Obviously, we all have the understanding that a natural tooth should not be connected with a restored implant. The question arises from a desperate need to find a solution in a case that would benefit from splinting.

If you consider to comment, please ignore the details. My main aim is to hear opinions on a general approach of the potential connection between implants and natural teeth. Is there an absolute consensus that there should never be a solid connection or is there a potential possibility for an engineered connection taking into consideration all biologic factors?

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9 thoughts on “Connecting crown over implant abutment via precision connector?

  1. I do it sometimes for various reasons and simply use zirconia telescopic crowns on the teeth and a cemented approach. The tooth abutments should always be mesial to the implants.

  2. There exists a consensus that Implants and natural teeth should not be splinted when there is tooth mobility.
    In my practice I have seen successful cases of splinted teeth and implants with a cemented ( not with temporary cement) connection, and failures with telescopic and non-cemented restorations.
    There are more details, but this is basic information.

  3. ONLY DO IF YOU CAN JUSTIFY IT MEDICO-LEGALLY IF THERE IS FAILURE ..OTHER WISE JUST REFER FOR SPECIALIST MANAGEMENT —THE $$$ ARE NOT WORTH THE STRESS OR EVEN A BOARD INVESTIGATION/COMPLAINT

  4. I have only seen a movable attachment dovetail and key connector recommended and was guarded prognosis at that. But I think Dr. Gordon Christenson has spoken on this connecting teeth to implants. Old dogmas are being pressed today to see if facts are facts or maybe some exceptions are valid if done correctly. One main one is mandible flexure and not locking implants from one posterior side to other posterior but I think locators FTX system has a ball and socket mobility full atrch connection that could be an exception to this flexure dogma. An exciting time to be a dentist!

  5. Does anyone know of any scientific reference (meaning based on a study not opinion by an authority)that specifically delineates that there should be no solid connection between a natural tooth and an implant and also any scientific proof that a movable connection should not be considered. In the category of movables one would have to distinguish directions like up and down, up and down and axial, ball attachment and perhaps some other geometry. Structural engineering has answers of connecting rigid elements to movable but dental bridges have more than structural elements to consider. In removal prosthesis we use various ways of connecting teeth to partials. Does that mean that we make a conscious decision to apply unfavorable forces to natural teeth that eventually lead to a growing partial and eventually denture? Why would we consider a compromise in one are and not in an other?

    1. The Journal of Prosthetic Dentistry
      Volume 81, Issue 6, June 1999, Pages 696-703
      Photoelastic stress analysis of load transfer to implants and natural teeth comparing rigid and semirigid connectors

      1. and

        Journal of Prosthetic Dentistry; Oct2005, Vol. 94 Issue 4, p313-320, 8p
        Retrospective evaluation of complete-arch fixed partial dentures connecting teeth and implant abutments in patients with normal and reduced periodontal support.

  6. In connecting a screw retained dental implant supported crown to a natural tooth via a dovetail, one has to consider that the occlusion is well balanced, the patient is not a bruxer or clencher, and the natural tooth must appear to be very well supported and exhibit no mobility.

    I have cases where an individual screw retained crown becomes loose from chewing after a period of time; and has to be tightened periodically……. just look at the screw and hex of the implant crown and compare this diameter to the dimensions of the crown…. a totally mismatched situation and makes no sense from an engineering point of view……..but this is what exists.

    In order to stop this from occurring, if the adjacent natural tooth will be requiring a crown, then the female portion of the dovetail will be machined into the natural crown when doing the waxup, and the male portion will be suspended from the implant crown……..this stops the problem of individual screw retained crowns from getting loose, and does no harm to the implant or the natural tooth….. it also saves the patient and the dentist from needless appointments.
    .

  7. Our study club reviewed the lit on this and the consensus was it works, don’t push the envelope in terms of spans , use of small diameter implants or the strength of the remaining tooth, but use a custom abutment and permanently cement both units as an FPD. This will not be retrievable. The only real reason to do this is due to a compromise you’re making with the patient with regard to # of surgeries or treatment cost. Use of screw retention and dovetails is unnecessarily complicated and does not lead to a longer lasting prosthesis – at least that was the consensus of the group (led by Joe Carpenteri). Hope that helps

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