Launch of the AMS-MOH

Management of Edentulism with Dental Implants

6 October 2012, Saturday

Connection of Dental Implants to Natural Teeth

Dominic Leung
Organized by the AMS-MOH Management of Edentulism with Dental Implants Clinical Practice Guidelines Workgroup
under the auspices of Ministry of Health Singapore

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Mechanism of implant and tooth support

 Ericsson I, Lekholm U, Branemark P I, Lindhe J, 1986

 Sullivan D Y , 1986
 Babbush C A, Kirsch A, Mentag, Hill B, 1987
 Reider C E, 1990
 Astrand J, Astrand P, Ahlen K et al, 1992
 Kay H,1993

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Increase failures when connected to tooth

 Naert I E, Duyck J A, Hosny M M et al, 2001

 Naert I E, Duyck J A, Hosny M M, Van Steenberghe D,
2001
 Block M S, Lirette D, Gardiner D et al, 2002
 Bragger U, Karoussis I, Persson R et al, 2005

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Most common design:

Tooth to implant connection

with attachment placed
between the pontic and the
tooth

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 Connecting implants to teeth

W. Chee and S. Jivraj British Dental Journal (2006); 201, 629-632

Implants and teeth have differential mobility and support.

Fixed prostheses supported by implants and teeth suffer more implant failure.
When implants and teeth are connected there is a phenomenon of tooth intrusion.
An understanding of these points will aid in treatment planning.

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tooth to implant connection
with attachment placed
between the implant
supported restoration and
pontic.

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implants to teeth with
connection using a deep
removable partial denture-
type rest with the rest seat
on the implant supported
restoration
- Chee W

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Retrospective evaluation of complete-arch fixed partial dentures
connecting teeth and implant abutments in patients with normal
and reduced periodontal support.

Cordaro L; Ercoli C; Rossini C; Torsello F; Feng C

Section of Periodontics and Implant Dentistry, Eastman Dental
Hospital, University of Rochester Eastman Dental Center,
Rochester, NY, USA.
J Prosthet Dent. 2005; 94(4):313-20

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Survival and complication rates of combined tooth-implant-supported
fixed partial dentures.

Nickenig HJ; Schäfer C; Spiekermann H

Department of Prosthodontics, School of Dental Medicine, University of
Aachen, Pauwelsstrasse 30, G-52074 Aachen, Germany.

Clin Oral Implants Res. 2006; 17(5):506-11

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A systematic review of the survival and complication rates of fixed
partial dentures (FPDs) after an observation period of at least 5
years. II. Combined tooth--implant-supported FPDs.

Lang NP; Pjetursson BE; Tan K; Brägger U; Egger M; Zwahlen M

School of Dental Medicine, University of Berne, Berne, Switzerland.

Clin Oral Implants Res. 2004; 15(6):643-53

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Prof. Gisbert Krekeler
of the Periodontology department in
Freiberg University:

there are three exceptions to

connecting implant to natural teeth

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 Exception 1

 In order to avoid extraction of a key tooth in

borderline cases, we can fix it to a series of
implants.
 This can only be done if certain criteria are
met e.g. number, length and diameter of the
implants and bone quality. by Prof. Gisbert Krekeler

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 Exception 2

 In order to retain the natural feeling of

chewing, the remaining teeth should be
included in the superstructure of the implants
to get a feedback system that obtains it by PDL.
by Prof. Gisbert Krekeler

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 Exception 3
 Where for anatomical reasons, the implant
cannot stand alone i.e. the number, length or
diameter of the implants are insufficient. In
those cases the natural teeth help to support
them. This connection is a compromised
treatment method. by Prof. Gisbert Krekeler

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 2002

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2003 2002

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 2005

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2009 2009

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 2009

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 2012

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 2002

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 2002

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 2009

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 Dr C M Lee

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 Dr C M Lee

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 Dr C Goh &
S K Kaan

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 Dr C Goh

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Dr S K Kaan

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1985

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1983 1985 2007

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2009

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 1985

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 1986

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 2005

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 2006

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 2011

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 Clinical Practice Guidelines
11. Connection of Dental Implants to Natural Teeth

implant-implant connection wherever possible

rigid implant-tooth connection is recommended in
indicated situations, but
more biological and mechanical complications are
expected in the longer term

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Thank You

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