Tooth-to-Implant Connection

In the treatment of partially edentulous patients, implants have often been connected to natural teeth. Numerous studies have reported significant complications and problems, while others have demonstrated favorable outcomes. The purpose of this study was to systematically review the literature regarding the splinting of implants and teeth.

Materials and Methods:

All articles between 1966 and 2006 were retrieved and studied.

Results:

A pronounced difference in the biomechanics of teeth and implants has been revealed in theoretical models. This disparity has also been supported by the majority of the experimental work published. As a result, principal complications, such as intrusion of teeth and higher risk of overload and greater marginal bone loss around the implants have been reported. Among the several types of connections utilized, the rigid connection showed fewer complications but unfortunately did not eliminate them.

Conclusion:

The consensus of the literature is for the freestanding implant prostheses over any other means of connection. The real cause of intrusion remains unknown, and only speculations have been presented. Unless the cause is determined, no etiologic solution to the problem can be given.

Combining osseointegrated implants with natural teeth should only be performed as a last resort. A risk- benefit analysis and anticipated complications should be presented to the patient and appropriate consent obtained before the treatment plan is finalized. For these limited cases, a design concept of joining implants and teeth has been presented. This proposed design rationally addresses the problems of bending forces to the implant as a result of cantilevers and intrusion of the tooth. More importantly, it allows loads to be shared between tooth and implant abutments, which is not the case in other designs. This concept takes into consideration both issues of natural tooth intrusion and implant overloading.

Reference:

Winston et al. Clinical Implant Dentistry and Related Research, Voume 12 Issue 2, Page: 122-133