Implant tooth connection
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Transcript of Implant tooth connection
05/02/2023
Tooth and implant
connection
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Contents • Introduction • Indications• Contraindications• Advantages • Disadvantages • Types of connections
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• Guidelines • Risk factors• Conclusion• References
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Introduction
tooth-supported bridge
tooth-suppor
ted bridge with
cantilevers
resin-bonded bridge
implant-
supported
bridge
tooth-implant
supported bridge.
Serhat Ramoglu, Simge Tasar, Selim Gunsoy, Oguz Ozan, and Gokce Meric .Tooth-Implant Connection: A Review ISRN Biomaterials
September 2012
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Indications • Indicated in kennedy classI and class
II situation• Sometimes in kennedy classIII
situation• When patient can’t afford for implant
supported bridge• Esthetics as major concern• Proprioception
Serhat Ramoglu, Simge Tasar, Selim Gunsoy, Oguz Ozan, and Gokce Meric .Tooth-Implant Connection: A Review ISRN Biomaterials September 2012
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Contraindications• Peridontally weakened teeth • Long span edentulous arch• Insufficient bone posterior to the
teeth.• Systemic health related problems
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Advantages • Increasing the treatment options for
splinting teeth for implants. Cases with anatomical restrictions
(maxillarysinus, mental foramen). When insufficient bone exists and
placement of implant is not possible. When patient does not agree to
have augmentation.Gary Greenstein, John Cavallaro, Richard Smith, and Dennis Tarnow. Connecting Teeth to Implants: A Critical Review of the Literature and Presentation of Practical
Guidelines, Compendium ,September 2009—Volume 30, Number 7.
Splinting mobile teeth with an implant.
Eliciting teeth proprioception.
Reducing cost.
Additional support against load which affects teeth.
Reducing the numbers of implants for restoration.
Avoiding cantilever bridge.
Protection of papilla for functional or esthetical concern.
05/02/2023Gary Greenstein, John Cavallaro, Richard Smith, and Dennis Tarnow. Connecting Teeth to Implants: A Critical Review of the Literature and Presentation of Practical Guidelines,
Compendium ,September 2009—Volume 30, Number 7.
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Technical Problems1. Implant fracture
2. Tooth intrusion
3. Intrusion of teeth with telescopic crowns
4. Cement bond breakdown
5. Abutment tooth fracture
6. Abutment screw loosening
7. Fracturing of veneers
8. Prosthesis fractureGary Greenstein, John Cavallaro, Richard Smith, and Dennis Tarnow. Connecting Teeth to Implants: A Critical Review of the Literature and Presentation of Practical
Guidelines, Compendium ,September 2009—Volume 30, Number 7.
05/02/2023
Biologic Problems1. Peri-implantitis
2. Endodontic problems
3. Loss of an abutment tooth
4. Loss of an implant
5. Caries
6. Root fracture
Gary Greenstein, John Cavallaro, Richard Smith, and Dennis Tarnow. Connecting Teeth to Implants: A Critical Review of the Literature and Presentation of Practical
Guidelines, Compendium ,September 2009—Volume 30, Number 7.
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Biomechanics of Natural Teeth
• Natural teeth are attached to the bone indirectly via the periodontal ligament.
• This ligament provides a physiological horizontal mobility in the range of 150 to 200 micro meters.
• In the presence of periodontal disease, this tooth movement can increase by 10-fold.
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Biomechanics of Implants• Implants are rigidly anchored to the bone. • Their mobility ranges from17 to 66 micro m
in horizontal direction. • Any movement is the result of the inherent
resiliency of the bone and the flexibility of the prosthetic joints and components.
• Teeth display a two-stage movement. The first stage is rapid, within the confines of the periodontal ligament, while the second is more linear
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Types of connection
• Rigid connection: The tooth is rigidly connected to the implant with a fixed dental prosthesis.
Tooth implant supported Prosthesis: A Literature review,Journal of Interdisciplinary Dentistry / Sep-Dec 2013 /
Vol-3 / Issue-3
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Non rigid connection• The tooth is non‑rigidly connected to
the implant by means of precision attachments, non‑precision attachments and telescopic restorations
Tooth implant supported Prosthesis: A Literature review,Journal of Interdisciplinary
Dentistry / Sep-Dec 2013 / Vol-3 / Issue-3
05/02/2023Nonrigid semiprecision key and keyway type attachment.
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Resilient connection
• It incorporates a flexible component that simulates the periodontal ligament
Tooth implant supported Prosthesis: A Literature review,Journal of Interdisciplinary Dentistry / Sep-Dec 2013 / Vol-3 / Issue-3
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Principles of Implant andNatural Teeth Connection
Natural teeth must have low mobility clinically
If two or more implants are supports, there is pressing stress on the implant that is nearest to pontic, while flexion stress will be formed on the furthest implant to pontic
When molar teeth are used as a support, they have more resistance to horizontal rotational movements which can occur on implant abutment with lateral forces so as to number of root and root surface area
Gary Greenstein, John Cavallaro, Richard Smith, and Dennis Tarnow. Connecting Teeth to Implants: A Critical Review of the Literature and Presentation of Practical
Guidelines, Compendium ,September 2009—Volume 30, Number 7.
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When precision connections are localized to natural teeth area, they may cause intrusion of teeth with axial forces
Eliminating occlusal forces in lateral direction or application of posterior disclussion will decrease the effect of lateral forces
Short pontic, short wing designations in mandible can be applied while general principle in maxilla is placing maximum number of implants as much as anatomy allows
Gary Greenstein, John Cavallaro, Richard Smith, and Dennis Tarnow. Connecting Teeth to Implants: A Critical Review of the Literature and Presentation of Practical
Guidelines, Compendium ,September 2009—Volume 30, Number 7.
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GuidelinesSplint implants to natural teeth only when the teeth need support: Teeth do not stabilize implants.
Do not end the fixed prosthesis on the weakest splinted abutment.
Regardless of the connection teeth must be cemented using definitive cement
Vidya Kamalaksh Shenoy, Shobha J. Rodrigue, Prashanti E,Sharon J. R. Saldanha.Tooth implant supported Prosthesis: A Literature review,Journal of
Interdisciplinary Dentistry / Sep-Dec 2013 / Vol-3 / Issue-3
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For a natural pier abutment between two implants a stress breaker is not indicated.
Avoid telescopic attachments whenever possible
Design of the prosthesis should allow minimal movement in a buccolingual direction.
Vidya Kamalaksh Shenoy, Shobha J. Rodrigue, Prashanti E,Sharon J. R. Saldanha.Tooth implant supported Prosthesis:
A Literature review,Journal of Interdisciplinary Dentistry / Sep-Dec 2013 / Vol-3 / Issue-3
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The risks associated with connecting teeth
to implants• Overloading.
Frank Spear. Connecting teeth to implants.The truth about a debated technique JADA, Vol. 140 may 2009.
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• Loss of retrievability
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Risk to the tooth intrusion.• The cause may be multifactorial
depending on the clinical situation and includes
• Disuse atrophy• Debris impaction• Impaired rebound memory• Mechanical bending and
Cherilyn G. Sheets, and James C. Earthman.Tooth intrusion in implant-assisted prostheses J Prosthet Dent 1997;77:39-45.
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Change in implant abutment complex allowed increased energy absorption by implants, which lessened mechanical stress transmitted to natural tooth. Resultant equilibrium change stimulates osteoblasts and/or cellular components to start extrusion processCherilyn G. Sheets, and James C. Earthman.Tooth intrusion in implant-
assisted prostheses J Prosthet Dent 1997;77:39-45.
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Mechanical stress acts as orthodontic force to stimulate cellular response in osteoclasts and osteoblasts and resuits in tooth intrusion Cherilyn G. Sheets, and James C. Earthman.Tooth intrusion in implant-
assisted prostheses J Prosthet Dent 1997;77:39-45.
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Force (P) impacts on connecting prostheses. Becauseof the lack of energy dissipation, natural tooth receives a relativelyhigh amount of mechanical stimulus.
Cherilyn G. Sheets, and James C. Earthman.Tooth intrusion in implant-assisted prostheses J Prosthet Dent 1997;77:39-45.
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Treatment options
Keyway is located on implant supported crown. Copingis used on natural tooth and superstructure is temporarilycemented for retrievability.
Intrusion phenomenon in combination tooth-implant restorations: A review of the literature Trudy L. Schlumberger, DDS, John F. Bowley, and Glenn I. Maze,(J
Prosthet Dent 1998;80:199-203.)
05/02/2023 Intrusion phenomenon in combination tooth-implant restorations: A review of the literature Trudy L. Schlumberger, DDS, John F. Bowley, and Glenn I. Maze,(J
Prosthet Dent 1998;80:199-203.)
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Key and keyway sections can be locked together withU-shaped locking pinIntrusion phenomenon in combination tooth-implant restorations: A review of the
literature Trudy L. Schlumberger, DDS, John F. Bowley, and Glenn I. Maze,(J Prosthet Dent 1998;80:199-203.)
05/02/2023 Intrusion phenomenon in combination tooth-implant restorations: A review of the literature Trudy L. Schlumberger, DDS, John F. Bowley, and Glenn I. Maze,(J
Prosthet Dent 1998;80:199-203.)
Precision stock or custom-milled locking blockassembly can be used to provide rigid attachment withretrievability of implant segment.
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conclusion• The dentist can and should consider
connecting natural teeth to implants if there is no other option, if the patient’s implants need the support or if this course of action would help the dentist manage esthetics more predictably
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References Cherilyn G. Sheets, and James C. Earthman.Tooth intrusion in implant-assisted prostheses J Prosthet Dent 1997;77:39-45.Serhat Ramoglu, Simge Tasar, Selim Gunsoy, Oguz Ozan, and Gokce Meric .Tooth-Implant Connection: A Review ISRN Biomaterials September 2012.
W. Chee and s. Jivraj .Connecting implants to teeth, British dental journal volume 201 no. 10 nov 25 2006.
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Oliver Hoffmann, Gregory-George Zafiropoulos.Tooth-Implant Connection: A Review, Journal of Oral Implantology,Vol 38/No. 2/2012.
Frank Spear. Connecting teeth to implants.The truth about a debated technique JADA, Vol. 140 may 2009.
Gary Greenstein, John Cavallaro, Richard Smith, and Dennis Tarnow. Connecting Teeth to Implants: A Critical Review of the Literature and Presentation of Practical Guidelines, Compendium ,September 2009—Volume 30, Number 7.
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Giulio Menicucci, Alexei Mossolov, Marco Mozzati, Massimo Lorenzetti, Giulio PretiTooth–implant connection: some biomechanical aspects based on finite element analyses, Clinical Oral Implants Research / 334–341/ may 2001
Werner Lill, Michael Matejka, Katharina Rambousek, Georg Watzek, The Ability of Currently Available Stress-Breaking Elements for Osseointegrated Implants to Imitate Natural Tooth Mobility JOMI, 1988 Apr (281-286 )
Per Åstrand, Kenneth Borg, Johan Gunne, Morgan Olsson. Combination of Natural Teeth and Osseointegrated Implants as Prosthesis Abutments: A 2-Year Longitudinal Study, JOMI , 1991 Mar (305-312 )
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Vidya Kamalaksh Shenoy, Shobha J. Rodrigue, Prashanti E,Sharon J. R. Saldanha.Tooth implant supported Prosthesis:A Literature review,Journal of Interdisciplinary Dentistry / Sep-Dec 2013 / Vol-3 / Issue-3
Intrusion phenomenon in combination tooth-implant restorations: A review of the literature Trudy L. Schlumberger, DDS, John F. Bowley, and Glenn I. Maze,(J Prosthet Dent 1998;80:199-203.)
DF Clarke ST Chen AJG Dickison Use of dental implant as abutment in three unit implant tooth supported fixed partial denture; A case reportand 32 month follow up; australian dental journal;2006;51;03.263-267