Connecting Implants and Natural Teeth ?

See: Kindberg H, et al. Tooth- and implant supported prostheses: a retrospective clinical follow-up up to 8 years. International Journal of Prosthodontics. 2001;14:575-581. …The investigation confirms…that treatments with periodontally healthy teeth and implants splinted together in rigid one-piece superstructures show excellent long-term follow-up results.

i udertand that the connection implant -tooth is not recommend because the "jigglin" in the conection of the implant,,,,

The reason why dentist did not like splinting implants with natural teeth is for one major reason. Dentist believed that because the natural tooth has a PDL surrounding it the natural tooth can take impact and shift in any direction 360 degrees. Although this movement is very small, many dentist believe (which is true)because an implant is osso-integrated and there are no PDL's formed around the implant, the implant will fail because the movement of the natural tooth will cause the implant to move slightly. It is speculated that this movement will cause the implant to fail. In my experience, I have seen many implant splinted to natural teeth fail.....but I have seen quite a few survive over a decade without failure. I only splint natural teeth to implants in very rare occasions. If at all possible, I avoid splinting the two. However, I have been to many implant lectures and many dentist will splint to natural teeth with success. In your case, once a sinus is filled with bone, the dentist can place an implant to their desired length. Problem solved. Splinting #2 to an implant and then to #6 is not a good idea. Be carefull not to let expense dictate poor treatment. I certainly wouldn't do the previous splinting procedure.

I've done it with success when forced to.To compensate for the natural tooth washing out under the restoration I used a telescope coping ,that is you fabricate an undercasting for the natural tooth,cement with a hard cement and cement the bridge onto this with an intermediate cement like duralon. Works great. So far going on 5 years three cases didn't budge. This whole telescope coping is just thinking through the concept of the natural tooth moving. If it does you would still have the undercasting sealing the tooth .

As a general rule, I avoid splinting to natural teeth for the reasons listed above. The only time I would ever consider it is in an 83 year old person. (implants are likely to outlast him) However, the one place I would least consider it would be in D-4 bone of the posterior maxilla. The implants have a better chance of survival than #2 provided a sinus augmentation has been performed and an adequate implant (size) has been placed. At this stage of his life, even if he loses tooth number 2, you will have him restored to first molar occlusion. He would require no further treatment in the UR quadrant. If you join them and there is a problem, you have created a situation that you will have to resolve. As with all implants, occlusion and controllng the stress and lateral excursions is the key to longevity. Good luck with the case!

Splinting natural teeth with implants has been abandoned long time ago unless the implants are in the intermidate position and between healthy teeth on both sides , and this option should be considered as exception and not a rule . we all remember the old IMZ implant when they invented the IME intera mobile element which is a teflon ring that was used to be inserted between the fixture and the abutment that fuctions as a shock absorber which is very similar to the effect of the dental ligament , and this teflon ring has to be changed every 6 months . In spite of all that a lot of failure happened with this splinting especially screw fracture and bony resorption, and IMZ had stopped manufacturing and using the IME long long time ago , lots of papers were published in favor of not connecting implants to natural teeth.

In case of splinting natural teeth with implants, i usually perform aureo-galvan crowns.

we do not read too much more literature about this issue, since we know there will be not a good solution....natural tooth absorb the whole load and we all know what happen.... place more implants, it is more predictable!

Piezo 1, please tell me more of what a aureo-galvan crown is?

There are occasionaly exceptions to the rule, the rule being not to splint implant supported crowns or bridges to natural root supported crowns because of the PDL which can allow the natural root to move upwards of 125 microns versus negligible implant movement. This exception can work if: 1. The tooth root is large, stable and is in reasonably dense bone. 2. The joined bridge span should be short, preferably one pontic. 3. The joined units should be rigidly cemented without stress-breakers. 4. Occlusal forces should be meticulously concieved and agressive bruxers should be considered with caution. I have placed only 9 three-unit bridges where an implant abutment has been joined to a natural root abutment. These placements were made to avoid risky or undesirable surgery. So far I have seen these bridges survive with no bone loss or deleterious effects. The oldest one is about 15 years.

4 words....Just Don't Risk It!

Dr.Nimchuk,is there any practice based evidence to points 1,2 and 3 of your above comment?

I have splinted natural teeth to implant(s) with very good results. The strength of the natural tooth is the key. I have also done the non approved procedure of cementing the bridge with a permanent cement to the tooth and using impregum to cement the implant side of the bridge. It has been over 3 years and all is well. The implant has to be of the morse taper design to succeed and the fit and occlusion must be immaculate. I wouldn't be afraid to trying the routine method of combing tooth to implant. The stats are favorable. When combining tooth and implant supported bridges use implants that are of the morse taper design. The ITI symposium had their success rate as only slightly less than implant to implant.

I have splinted 2 cases to a tooth in 20 years. I saw one of mine this morning, I made in 1990. (I restored the case. My OMFS placed the implant). The case was splinted using a T-bar anterior to the implant crown, which was an IMZ with screw retention. Patient had a tough bite. (I didnt know what I was doing at the time - I just thought it was a good idea!) The T-bar distal to the tooth crown comes loose ever so often and I tighten it down just like I tighten the the implant crown. Nothing broken yet after 17 years. I think its safe to say don't splint if you can have them separate. I wouldnt do it again. Splint implants, yes, implants to crowns, no. Why risk it? Do 2 implants and forget the bridge. JMO. Bill

All the ideas and information listed above are true.....however, one has to measure the factors involved before making a decision. 1. Age of the patient, of all the elderly people who still have their own natural teeth,some seem to have molars that are literally ankylosed, and function as an implant without a PDL. The dental work just might outlast the years the patient has left. 2. Diet.... usually older people have digestive systems that like to handle food that is not too tough, and required little grinding.... so the prosthesis will not be too stressed. 3. In my own experience in dealing with splinting implants to natural teeth; the splint does not have to be a welding job....you can join teeth together by using precision attachments that allow a little verticle play.A simple key and keyway can solve the problem....decide in advance which element is going to be rigidly connected to the pontic. Use your experience and good judgement, chances are you will be successful doing it the simplest way without involving doing a sinus lift on an 83 year old patient who probably has little or no blood circulation in the sinus, so the graft might not work. Dr. Gerald Rudick, Montreal

Rigid connection of teeth to implants does not seem rational due to the adverse effects to the implants in the long term while non-rigid connection has the potential of intrusion of teeth. This connection is used to potentially gain support from the tooth, to preserve the tooth or to provide stability to rotational forces directed at the screw joint of the implant supported part of the restoration. Some clinicians claim that a non-rigid connection placed between the pontic and the tooth will alleviate the biomechanical mis-match of mobility between the implant and tooth. In practice, when this type of connection occurs, the phenomenon of intrusion of the tooth has to be expected. Those clinicians, who are in favor of connecting teeth to implants rigidly, accept the differential mobility of the implant and natural tooth. They claim that the implant components and their retaining screws exhibit some degree of flexibility, the periodontal support of the natural tooth is adequate and constant and the amplitude of movement of the prostheses will be minimal. This amplitude of movement affects the magnitude of the force to the screw joint on the implant and must be less than the preload of the retaining screw in order to prevent screw loosening. For the record, some clinicians have suggested using a non-rigid connection to allow teeth to move independently of the implant while still being connected (key and key way types of connections). When non-rigid connectors are used, one should certainly expect a tooth intrusion. Possible causes of this intrusion have been assigned to friction between the matrix and patrix of the attachment where occlusal forces depress the tooth and friction between the non-rigid components cause the eventual intrusion of teeth. Mandibular flexion may also generate forces which cause intrusion of teeth connected to implants, but, intrusion has been observed in the maxillary as well as mandibular arches. There may be two explanations for this intrusion. First, the periodontal ligament atrophies due to disuse or lack of stimulation, and the second, a transfer of shock waves to the natural tooth may happen which forces the tooth into the socket.

While I do no longer splint, I am still puzzled about strict intrusion and equating that with orthodontic forces you have to have to intrude a tooth in general. The ligament is a very forgiving instrument. My understanding of occlusal forces is that if the implant is in proper occlusion with the rest of the dentition, there is barely a mark on the table when light pressure is applied and becomes "normal", if you will, when more pressure is applied. The teeth move during this load, right? Therefore, during mastication, the teeth are hitting harder and moving. The implant doesnt. I see where the intrusion comes from, but isnt the ligament flexible enough to return the tooth to its position due to the angle of the fibers? what keeps the the tooth from returning to its static position? I just havent been able to totally visualize why since the implant is rigid. And especially if the connection is not rigid. Im telling myself that the implant crown, being rigid, would hold the tooth in place by being rigid, preventing intrusion. If it is a nonrigid connection, there is less interference with the ligament. I guess it doesnt seem to me that the friction would be enough unless there was screw loosening, but then that makes me think that the implant crown itself would be backing out and the tooh side would be extruding instead. Ive got some mental block here. Dr. jafari, straighten me out. Bill

With all due respect sir, please read the four lines at the bottom of my comment, Thank you.

My first implant reconstruction case was splinted. It was done in 1989. It utilized bilateral Stryker blade implants that secured a Morse tapered abutment in the lower second molar areas for the distal abutments. The anterior abutments were splinted first and second bicuspids. All natural teeth were covered by gold copings as well as one of the implant abutments on the rt side to improve angulation and to allow draw on the pfg bridge which was cemented using conventional cement.In this 57 yr old patient who was a strong bruxer the bridges had loosened and been recemented about 4x each over the last 18 years. Recently the rt side titanium abutment fractured just above the Morse taper connection. This was the bridge with the over angulated abutment and gold coping. In addition I had noted there was some slight rock to this bridge at the time of seating. The patient now 75 opted not to replace the bridge so it was sectioned and recemented on the bicuspids only. The left side still functions well after 18 years of service.IMHO, splint if you need to but avoid it if possible.

i want to start placing sky implants from Bredent,germeny.please leave the comment about the qualities and dis qualities of the system if some body is using or have used the system. dr ajay

Dear Ajay, I have used Sky Implants and they are wonderful and I personally know Manfred Lang since last 14 years. He is the person who has designed this Implant system with his team and they have worked nice on my demanding patients. Ambrish Maniar