discussion for connecting implants to natural teeth in dental treatment plan: problems, risk factors, techniques and how to think items

1. TOOTH TO IMPLANT
CONNECTION
How to think?Prepared by
Dr.Yamen Nouh

2. When do we need?
• Mesial drifted teeth leaving limited space to second implant
• Failed implant between teeth and succeeding implant
• Insufficient bone with no possibility for graft
• Patient cannot afford graft or multiple implants

3. What is the problem?

4. differences

5. • Tooth attachment with PDL acts as viscoelastic shock absorber
• Thus decreasing the amount of stress distributed to surrounding bone
especially in Crestal area.
• And allowing higher degree of movement (up to 20 times more)
Main differences:
Tooth

6. • Implant direct connection to bone (Osseointegration) is rigid.
• Allowing less movement and absorbing much less stresses.
• Conduction of stresses to bone.
• Concentrating forces at the crestal bone as it is the hinge point in case of
lateral forces
Main differences:
Implant

7. So...For the implant
Common..
Rare..

8. For the bridge (Very rare)

9. Follow up results

10. How to think: factors to consider
• Tooth mobility: teeth should not be mobile, if it is, it should be treated as
splinting case (Add more implants to splint). Consider stress breakage
design options.
• level of parafunctional activity
• number of implants and teeth being used in the restoration.

11. 1- increase number of implants
• Increasing resistance arm (increasing implants to teeth ratio) in a way that
makes the prosthesis does not need the teeth for support

12. 2- Don’t use implant as pier

13. Connect only with healthy teeth
• In terms of periodontium and supporting bone

14. Decrease lateral forces
Amount of axial movement for teeth: 8-28 micron
Amount of lateral movement for teeth: 65-108 micron
Amount of limited movement for implant: 0-5 micron

15. A- avoid in patients with para-functional stresses

16. B- Avoid in cases with high crown root ratio

17. C- connect implant to distal rather than mesial teeth
(and posterior rather than anterior)

18. Rigid or non rigid connection?

19. Use non rigid connection
non rigid
connection
allows teeth
to move and
act as stress
breaker..
But..

20. Allowing intrusion
-The rate of
intrusion is
between 3-5.2%
- It jumps to 50%
in case of para-
functional habits
- Different theories
for intrusion
- Effect of Rachet:
teeth not returning
to its position due
to friction between
connector parts

21. Modification on non rigid connector
N.B: Need to be only in short span cases as if it is long span this will increase stresses on the connector

22. Use of rigid connection
• Tooth-tooth cemented bridge has the same mobility rate as tooth-implant
connected bridges as declared by finite element analysis
• Also permanent cementation prevents intrusion.

23. Rigid connectionNon Rigid connection
- Allow teeth intrusion
- Decrease bone resorption
- Prevent teeth intrusion
- May cause relatively more
bone resorption

24. Permanent cementation
To prevent teeth intrusion

25. • Half
crown
design

26. SayYES or NO andWHY in the following cases:

27. case 1

28. Case 2

29. Case 3

30. Case 4

31. case 5

32. Case 6

33. case 7

34. Case 8

35. Final conclusion!!!!

36. References..
• Spear, frank (2015). speareducation.com. ConnectingTeeth and Implants:
Yes, No, Maybe?. Retrieved from link
• Serhat Ramoglu, SimgeTasar, Selim Gunsoy, Oguz Ozan, and Gokce Meric,
“Tooth-Implant Connection: A Review,” ISRN Biomaterials, vol. 2013,
Article ID 921645, 7 pages, 2013. doi:10.5402/2013/921645
•