Connecting Implants and Natural Teeth: Philosophy Changing?

I think that this is just a "theory". Nobody can tell you that this has been researched and published. In the last 15 years I have seen quite a few fixed-partial dentures with implant/natural tooth combination for abutments. It is always the same: the tooth intrudes. The theory above assumes (to my understanding) that the "strong" resin cement on the tooth will "hold it" in place, without moving, therefore "behaving" like an implant (which happens to be the other abutment on the bridge). I do not believe that resin cement eliminates the PDL and its behavior. And I would like to see at least a good number of documented cases. In my humble opinion, avoid connecting implants and teeth at all costs.

I am sorry but NO.... if you connect an implant to a tooth, the restoration acts as a cantilever over the implant and i believe you allready know what that means. PDL does not exist on implants and no amount of micro movement in the framework and abutment will compensate that. Palatal screws through the crown (that is cemented)in the natural tooth has been the solution in the german technique, and even that fails sometimes in preventing the intrussion of it, in the long run... so just dont best of luck

IN THE 20 PAST YEARS I WORKED WITH IMPLANTS AND NATURAL TEETH WITHOUGT OBSERVING ANY INTRUDION OF NATURAL TOOTH CONNECTED WITH MY IMPLANTS. BUT I SPEAK ABOUT CONNECTION BETWEEN FIXED IMPLANTS AND NATURAL TEETH. so i dont know where is the problem.

I like to keep implants with implants and teeth with teeth. However there are some occasions when it is necessary to splint implants to natural teeth. When this occcurs I place gold copings on the natural teeth and cement them permanently with resin cement. Then I have the bridge cemented over this with temporary cement. The biggest problem I have seen is that the natural teeth will start to decay if I do not do this. If there happens to be intrusion and the bond of the temp cement is broken, The tooth is not at risk of decay due to the coping.

This subject has been discussed more than once on this site. There are at least 20 good studies that show you can successfully join implants to natural teeth. I have done this selectively for over 15 years and have not had any problem. There are of course parameters that need to be met and I have posted these on several earlier blogs on this subject.

In my own clinical experience,I came across a pt. with three different,fixed bridges of implant to natural tooth combination,the pt had lost count on how many years they were in function...But greater than fifteen years!!! By circumstances, of osseo integration,time,and pt desire,I was place in the situation were I had to do such procedure...And took,the lessons learn from this previous pt...And that is to incorporate a slot male female type attachment on the natural tooth, as to act as minimazer of occlusal forces on that natural tooth, also to consider sthetics, I had the lab place the slot, on a inverted position to completly hide it. At the same time, great care should be place on all the parameters of occlusion according to the Dawsonian phylosophy....Thats MHO....

Read the review "Decision making in implant dentistry: an evidence based and decision-analysis approach" by Thomas Flemmig and Thomas Beikler in Periodontology 2000 volume 50 2009. Nice synopsis of published studies looking at failure rates of implant restorations. The tooth to implant bridge had a five year survival rate of 95.5% but success dropped to 77.8% at the ten year review. Implant bridges alone had a similiar success rate at both the five and ten year period of 95%. The review article examined implant success rates in augmented and unaugmented bone: sinus lifts and bone fill success rates etc. Also discusses a decision tree for implant placement. Well worth reading and downloading at the Wiley site.

As Dr. Berg explained above the issue is all related to the presence/absence of PDL. Regardless of the rigidity we give to the natural tooth restoration it still has PDL which, based on averages,has around 15 microns of vertical movement whereas an implant barely has any movement.

Dennis Nimchuck, I too have been doing joining implants to natural teeth since 1990. Except now, I try to avoid endo treated bicuspids and mobile teeth. I prefer to evtract them and use implants.

Each case is unique and there is no only one rigid approach to the problem: to splint or not to splint implants to the natural teeth. Both solutions should be considered.

Gold coping or stress reliever (~ to pier abutment in a long span bridge, i.e. abutment-pontic-abutment-pontic-abutment). Gr8 to see that 2 responses (above) are approaching implants from a prosthetic perspective!