©

 COPYRIGHT 2017 EDIZIONI MINERVA MEDICA

not permitted. It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, logo,
means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use is
This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one file and print only one copy of this Article. It is not permitted to make additional copies
(either sporadically or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any other

© 2016 EDIZIONI MINERVA MEDICA Minerva Stomatologica 2017 February;66(1):35-42

Online version at http://www.minervamedica.it DOI: 10.23736/S0026-4970.17.03953-X

REVIEW

Tooth-implant connection in removable denture

Dario MELILLI *, Giuseppe DAVÌ, Pietro MESSINA, Giuseppe A. SCARDINA

Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
*Corresponding author: Dario Melilli, Department of Surgical, Oncological and Oral Sciences, University of Palermo. Via del Vespro
129, 90127, Palermo, Italy. E-mail: melilli@odonto.unipa.it

A B S TRACT
When the patient cannot be rehabilitated with a fixed denture, or when he does not succeed in adapting to a traditional
removable denture, a possible alternative solution consists in the use of a limited number of implants, placed in strategic
positions in the arches of the patient, and subsequently connected to their residual teeth. The aim of this review is to
evaluate the progress made on connections between teeth and implants in removable denture, to analyze their advantages
and disadvantages and to compare the survival rate, both of the teeth and of the implants used as abutments, present in the
various studies taken into examination, with the aim of being able to evaluate the effectiveness of this rehabilitative op-
tion. The concept of preserving residual teeth, even if these are unfavorably distributed, and inserting a minimum number
of implants in strategic positions, thanks to which an area of favorable support for the denture can be created, seems
reasonable; this will guarantee a better adaptation of the patient to the denture, as well as an improvement in the quality
of life. The study of articles present in literature suggests that the survival rate of the implants in removable dentures, sup-
ported by teeth and implants through traditional systems of anchorage, appears to be quite high. However, further studies
with a higher level of evidence, more representative test subjects and a longer follow-up period are necessary, in order to
confirm the validity of this rehabilitative solution.
(Cite this article as: Melilli D, Davì G, Messina P, Scardina GA. Tooth-implant connection in removable denture. Minerva
Stomatol 2017;66:35-42. DOI: 10.23736/S0026-4970.17.03953-X)
Key words: Dental implants - Denture, partial, removable - Survival rate.

G iven the increase in life expectancy and im-

provements in prevention and in personal
oral hygiene, the percentage of the completely
edentulous population is in decline, while the
number of patients who preserve some teeth,
even at an advanced age, is increasing.1
In those cases where the conditions for ap-
plying a fixed denture are not present, the con-
struction of a partially removable denture can
represent a valid alternative.
or other proprietary information of the Publisher.
support (dental and osteomucosal) with differ-
ing degrees of resiliency.3
Therefore, when the patient cannot be re-
habilitated with a fixed denture, or when he
does not succeed in adapting to a traditional
removable denture, a possible alternative so-
lution consists in the use of a limited number
of implants, placed in strategic positions in the
arches of the patient, and subsequently con-
nected to their residual teeth.

Quite frequently, removable dentures dis-
play a reduction in stability and retention,
especially when the patient has a very large
edentulous area with an unfavorable distribu-
tion of the few residual teeth that should serve
as abutments.2 Another limit of the traditional
partially removable denture regards its double
There are a number of articles present in
literature which concern the combined use of
teeth and implants as abutments for a fixed
denture.4-8 Instead, few studies have been
made with the aim of evaluating the possibility
of supporting a removable denture with teeth
and implants.

Vol. 66 - No. 1 Minerva Stomatologica 35

 ©
COPYRIGHT 2017 EDIZIONI MINERVA MEDICA
not permitted. It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, logo,
means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use is
This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one file and print only one copy of this Article. It is not permitted to make additional copies
MELILLI TOOTH-IMPLANT CONNECTION IN REMOVABLE DENTURE
(either sporadically or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any other
The aim of this review was to evaluate the
progress made on connections between teeth
and implants in removable denture, to ana-
lyze their advantages and disadvantages and
to compare the survival rate, both of the teeth
and of the implants used as abutments, present
in the various studies taken into examination,
with the aim of being able to evaluate the ef-
fectiveness of this rehabilitative option.
Design of the denture
The choice of using both teeth and implants
to support a manufactured denture permits to
have a variety of rehabilitative options.
In particular, descriptions of both partially
removable denture and overdentures that are
anchored contemporarily to teeth and implants
through the use of different systems of anchor-
age can be found in literature.
The desire to combine teeth and implants
in a partially removable denture is present for
a long time. In fact, already in 1996 Giffin 9
described the case of a class II Kennedy reha-
bilitated with a partial denture, supported and
held by an implant in the molar area and an ex-
tracoronal resilient attachment; Giffin reported
that the patient perceived the side of the im-
plant supported denture to be more natural and
preferred to chew on that side.
The same satisfaction is also found in the
partially endentulous patients in the study by
Mitrani et al.10
The studies of Mijiritsky 2 and other au-
thors 3, 11 confirmed that the use of a limited
number of strategically positioned implants
connected to the teeth is a possible solution for
improving the aesthetics and the design of par-
tial removable denture.
Therefore, the partial removable denture is
a valid option for the rehabilitation of patients
with few teeth, considering that the longevity
or other proprietary information of the Publisher.
does not only depend on the number of teeth,
but also on their distribution in the maxilla.12
In fact, when an asymmetrical distribution of
the teeth in the arch is present, the percentage
of the loss of teeth is significantly higher than
in cases in which the teeth are symmetrically
distributed.
36 Minerva Stomatologica February 2017
It must also be considered that as well as
connecting with the implants, the preservation
of the natural tooth also permits to prevent re-
sorption of the alveolar bone, guarantees a bet-
ter distribution of pressure on the underlying
structures, improves sensorial feedback and
optimizes the retention and the stability of the
denture.13-16
In addition, a psychological improvement has
been seen due to the fact that maintaining some
teeth allows the patient not to consider himself
completely edentulous. Furthermore, keeping
some teeth to be exploited as elements of reten-
tion, it means that fewer implants will have to be
used, with a consequent reduction in costs.
Bearing in mind these considerations, the
concept of preserving residual teeth, even if
these are unfavorably distributed, and insert-
ing a minimum number of implants in strategic
positions, thanks to which an area of favorable
support for the denture can be created, seems
reasonable,13, 17, 18 this will guarantee a better
adaptation of the patient to the denture, as well
as an improvement in the quality of life.18
The positioning of the implant is a concept
of notable importance in this type of prosthetic
rehabilitation because the implants act both as
direct anchorages, favoring the denture resis-
tance to pressure displacement, and as indi-
rect anchorages, improving the stability of the
denture. Nevertheless, the aim of the implants
is not only to improve the retention and the
stability of the denture, but also to guarantee
a suitable distribution of stress among all the
abutments, reducing the risk of overloading
any abutments.
Therefore, when the implants are used to
support a partial removable denture, there is
an increase in retention, and this ensures the
possibility of avoiding the use of clasps in aes-
thetical areas.2
Furthermore, thanks to the tooth-implant
connection, unfavorable conditions such as
class I and II Kennedy can be turned into the
more stable class III Kennedy.10, 11, 19 The teeth
present in the arch are less subject to unfavor-
able horizontal forces and their prognosis and
permanence in the arch appear to be signifi-
cantly improved.10, 20, 21
 ©
COPYRIGHT 2017 EDIZIONI MINERVA MEDICA
not permitted. It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, logo,
means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use is
This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one file and print only one copy of this Article. It is not permitted to make additional copies
TOOTH-IMPLANT CONNECTION IN REMOVABLE DENTURE MELILLI
(either sporadically or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any other
With regard to the design, we have to dis-
tinguish between implant supported prosthesis
and implant assisted prosthesis.21 In the first
case, the implants incorporated in the design of
the partial removable denture provide support
by exploiting the healing abutment.
Therefore, when a patient with distal eden-
tulism still has some anterior teeth that guar-
antee a good retention of the denture, the im-
plants positioned distally along the edentulous
ridge will serve to give greater stability.10
In many studies that analyze this rehabilita-
tive option, the dentures used include a lingual
bar, to which the direct anchorages are con-
nected for the anterior dental abutments, and
distal resin bases, which contain the anchor-
ages for the implants.3, 10, 22
For the tooth-abutment, intracoronal or ex-
tracoronal anchorages can be used, but the
former guarantee that the tooth is subject to
smaller solicitations during mastication.23
Instead, in the case of partial removable im-
plant assisted prostheses, the use of resilient
attachments is required (OSO attachments, o-
ring or similar, or Locator), which are neces-
sary since in this case the residual teeth do not
guarantee optimal retention.
In both cases, the mutually protected occlu-
sion is the occlusal scheme to pursue.10
As for the choice of site for the insertion of
the implant which will have to act as an abut-
ment for the denture, there are several studies
in literature.
Some authors think that placing the implant
in the proximities of the dental abutment al-
lows a better distribution of forces, reducing
accumulated stress on both the abutments and
the tissue.11, 24-26
For others, the best position in which to in-
sert an implant is the area between the canine
and the first molar because it can guarantee
a better configuration, turning a class I or II
or other proprietary information of the Publisher.
Kennedy into a more advantageous class III 27
and also because this area has a more suitable
quality and quantity of bone.28
For Cunha et al.,24 placing the implant in the
region of the first molar would ensure the sta-
bility of the denture, reducing the risk of dis-
location.
Vol. 66 - No. 1 Minerva Stomatologica 37
Other authors on the other hand 25 consid-
ered it is necessary to insert the implant in the
region of the second molar in order to reduce
resorption.
Grossmann 11 recommended to place the im-
plant as distally as possible, but he also recom-
mends a more mesial position if bone height
is unsuitable, or in case future denture is an
option, or to improve aesthetics avoiding the
use of clasps.
Grossman identified a series of key factors
that should be considered during the design of
the denture (Table I).11
In the design of the overdentures, however,
the root abutment is provided with coping and
ball anchorage, while the implants can be pro-
vided with a single ball anchorage, conometric
abutments or connected through bars (for ex-
ample Dolder bar).
In the mandibular cases a classic overden-
ture is used, while for the upper jaw the den-
ture can be “palatal free” or have a major a
connector.29
In literature, various systems of anchorage
have been described for this type of prosthetic
rehabilitation (ball attachments, Locator, bar),
which, however, may make it difficult and
complex designing the denture. Another way
to connect teeth and implants provides the use
of telescopic crowns both on the implants and
on the teeth; this allows the construction of a
denture with a system of homogeneous anchor-
Table I.—Guidelines for designing an implant-tooth re-
tained removable partial denture.11
  1. Place implants in area of second molars in distal exten-
sion patients.
  2. Place implants adjacent to distal abutment in case future
fixed restoration is an option, distal abutments are poor,
or patient is concerned about clasp showing.
  3. Place implants medially in Kennedy Class IV arch.
  4. Use short or narrow-body implants if necessary.
  5. Use resilient attachments on the implants.
  6. Design a simple RPD; use rest seats and guiding plates
similar to conventional RPD.
  7. Use rigid major connector design for maxillary arch.
  8. Minimize mandibular lingual flange if difficult for patient
to adjust.
  9. Incorporate retentive elements to denture base under
functional load.
10. Schedule patient for checkups and maintenance appoint-
ments.
 ©
COPYRIGHT 2017 EDIZIONI MINERVA MEDICA
not permitted. It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, logo,
means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use is
This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one file and print only one copy of this Article. It is not permitted to make additional copies
MELILLI TOOTH-IMPLANT CONNECTION IN REMOVABLE DENTURE
(either sporadically or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any other
age, therefore making the choice of connect-
ing implants and teeth simpler,17 also ensuring
a more uniform distribution of the occlusal
loads. In addition, the frequency of technical
complications is significantly lower with tele-
scopic crowns compared to ball attachments.30
According to Kaufmann,13 the problems
found in the use of ball attachments could be
linked to the fact that they are less rigid com-
pared to telescopic crowns. As a result, the im-
provement in rigidity and the stability of the
system of retention can help to reduce the per-
centage of technical complications.
The telescopic system foresees the use of a
secondary crown (female) that is inserted on a
primary one (male) and can be built with paral-
lel walls (cylindrical) or convergent ones with
different angles (conic or conometric).
The retention of the double crowns is due
to the effect of different physical forces: the
most important is the mechanical one and
consists in adhesion (or sliding friction),
while the forces involving the cohesion of
fluids have a marginal role. These are repre-
sented by the viscosity and the negative pres-
sure of saliva.
If telescopic crowns are used, the teeth are
prepared with an angle of about 6°. On this
preparation, the primary crown is cemented
with a golden alloy, while the secondary crown
is included in the structure of the denture. As
for the implants, the primary crowns can be
screwed or cemented.31-34
In addition, thanks to the telescopic system,
it is easier to perform correct oral hygiene, es-
pecially in elderly patients, because access is
simpler around the implants and the teeth 30,34
compared to bar anchorages, where high-lev-
els of plaque have been found in proximity of
the abutments.36
or other proprietary information of the Publisher.
Biomechanical differences
between implants and teeth
Implants and teeth present some biome-
chanical differences that have to be taken
into consideration when deciding to perform
a prosthetic rehabilitation that foresees a con-
nection between these two different forms of
38 Minerva Stomatologica February 2017
Biomechanical differences between teeth
Table II.—
and implants.
Tooth Implant
Axial mobility 8-28 micron 0-5micron
Lateral mobility 150-200 micron 17-66 micron
Type of movement Two phases: linear and elastic
1st phase: rapid movement
movement
2nd phase: linear
and elastic move-
ment
Movement modes Abrupt in phase 1 Gradual
Progressive in
phase 2
support units. Some of these differences are
listed in Table II.
Connecting implants and teeth, a biome-
chanical inequality is created because the nat-
ural teeth are connected to the bone through
the periodontal ligament, which gives rise to a
horizontal mobility ranging from 73 to 108 mi-
crons, greater for the anterior teeth and lower
for the posterior ones;36 axial mobility is 8-28
microns.
Instead, the implants are rigidly anchored to
the bone: their axial mobility is 0-5 microns,36
while their horizontal movement ranges from
17 to 66 microns.37
In addition, teeth and implants show differ-
ent models of mobility under physiological
stress. The teeth have a two-phase movement;
the first phase is rapid, within the confines of
the ligament, while the second is much more
linear.37, 38
Instead, the implants, due to the lack of the
periodontal ligament, do not show the initial
rapid movement, but they move in proportion
to the load in a linear way, apparently because
of the deformation of the bone.
This movement varies according to the point
of the arch in which the implant is placed. In
fact, the implants in the anterior area of the
mandible show a smaller movement in com-
parison to the implants located in other areas,
because of the different quality of the bone.37
The difference in the type of movement be-
tween implants and teeth has a significant im-
pact on movement under stress.
Even under minimum load (<20N), the
 ©
COPYRIGHT 2017 EDIZIONI MINERVA MEDICA
not permitted. It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, logo,
means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use is
This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one file and print only one copy of this Article. It is not permitted to make additional copies
TOOTH-IMPLANT CONNECTION IN REMOVABLE DENTURE MELILLI
(either sporadically or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any other
structure of the periodontal ligament allows
the tooth to intrude about 50 microns, because
of the visco-elastic nature of the periodontal
ligament and the consequent sliding of the
tissue, while an implant intrudes about 2 mi-
crons; this concept has greater importance in
bruxers patients.37
Tooth-implant connection:
advantages and disadvantages
Advantages
Despite the controversies on the possibility
of connecting teeth and implants, several stud-
ies in literature evaluated its potential advan-
tages.2, 3, 14, 15 Consequently, the fact that the
tooth-implant connection can represent an al-
ternative therapeutic option cannot be ignored.
It is necessary, however, to underline that
many of the advantages described in literature
concern the tooth-implant connection in fixed
denture, while the use of this system as an-
chorage for a removable denture is still largely
unexplored.
The choice of using implants and teeth to
support a denture combines the advantages of
both, fixed and removable denture, improving
aesthetics and function, as well as the stability
and the retention of the device.
Other advantages are that the patient’s teeth
are maintained, complex invasive surgical pro-
cedures are avoided, the hard and soft tissues
are easily replaced by the flanges of the den-
ture, the hygiene procedures are carried out
more easily,33 the masticatory function appears
to improve, the satisfaction of the patient in-
creases and the economic costs are reduced.2, 39
One problem with removable denture is the
possible resorption of the alveolar process.
Various studies confirm this tendency, which
however can be slowed down thanks to the use
or other proprietary information of the Publisher.
of implants.
The strategic location of implants allows
to design a partially removable denture with
a better rotation axis; this would prevent rota-
tion towards tissue while in use and therefore
reduce the pressure load placed on the alveolar
bone, with the consequent reduction of resorp-
Vol. 66 - No. 1 Minerva Stomatologica 39
tion and of the necessity of relining the den-
ture.2
In addition, in these edentulous areas, the
bone has the tendency to preserve itself bet-
ter, not only because of the better rotation axis,
but also thanks to the stimulus of remodeling
that is registered around the osseointegrated
implant; this concept is important for the pos-
terior areas of the mandible, where bone height
is often reduced.3, 21, 39
Disadvantages
It must be remembered that teeth and im-
plants respond differently to occlusal stress
(both to physiological and parafunctional pres-
sure), because of their different biomechanical
characteristics.
This different behavior causes a different
distribution of pressure that can induce the
fracture of a part of the denture or the intrusion
of the tooth.18
The main disputes involving the connection
between implants and teeth in fixed denture
have emerged as a response to clinical cases
of intrusion of natural teeth, which, for many
authors, represents the main reason why con-
nection of teeth and implants in fixed denture
should be abandoned.40-42
Nevertheless further studies are necessary to
show if this event can also influence the tooth-
implant connection in removable denture.
Survival rate
The study of the articles present in literature
suggests that the survival rate of the implants
in removable dentures, supported by teeth and
implants through traditional systems of anchor-
age, appears to be quite high. After a follow up
of 31 months, Grossman reported a 95.5% sur-
vival rate,19 while Mijiritsky reported a 100%
survival of the implants at 15 years.21
With regard to removable dentures sup-
ported by telescopic systems, recent studies
reported an average survival rate of implants
connected to residual teeth at 99.1%, while the
survival rate of the teeth was around 94.14%
(Table III).2, 13, 17, 29, 31, 33-35
 ©
COPYRIGHT 2017 EDIZIONI MINERVA MEDICA
not permitted. It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, logo,
means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use is
This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one file and print only one copy of this Article. It is not permitted to make additional copies

MELILLI TOOTH-IMPLANT CONNECTION IN REMOVABLE DENTURE

(either sporadically or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any other

Table III.—Survival rate of teeth and implants in tooth-implant retained removable denture.
Follow up
% survival % survival Number Number of
Author of implants of teeth period of patients implants Number of teeth
(years)
Mijiritsky et al. 2005 2 100 / 2-7 15 33 /
Hug et al. 2006 29 100 96.8 2 14 20 32
Krennmair et al. 2007 17 100 100 3.2 22 60 48
Kaufmann et al. 2009 13 96.7 97.6 3 60 130 93
Bernhart et al. 2012 31 100 100 2 63 (16 tooth-implant 40 44
supported dentures)
Rinke et al. 2014 34 100 85.19 >5 14 24 27
Rammelsberg et al. 2014 35 98 85 2.7 61 234 107
Frisch et al. 2014 33 98.36 86.36 6.12±3.80 23 61 66
Mijiritsky et al. 21 100 / 15 20 42 /

In 2014, Schwarz et al.32 published a paper
on the incidence of survival and complications
for removable dentures supported by a combi-
nation of implants and teeth and then compared
it to the incidence of complications in remov-
able dentures supported solely by implants.
The patients were divided into two groups:
the first one (solely implant-supported) in-
cluded 20 dentures on 129 implants, while the
second (combined tooth-implant-supported)
included 36 dentures on 80 implants and 102
teeth. The survival of the superstructure was of
92.3% after two years and 78.5% after 5 years
in group 1, while it was of 93.3% after 2 years
and 82.9% after 5 years in group 2.
Complications
The values of the survival rate of the im-
plants and teeth, reported in the various stud-
ies, are calculated also considering the onset
of a series of complications that can occur on
the abutments.
According to Bernhart,31 the most frequent
problems regarding tooth-implant supported
removable dentures are the loss of the aestheti-
cal aspect (“loss of facing”) and the abutment
screw loosening.
or other proprietary information of the Publisher.
odontitis). In Rinke’s study 34 21% of the im-
plants (N.=5) showed signs of mucositis and a
patient showed a progressive bone loss around
an implant (4%). Fractures of the crowns were
identified to be the predominant cause of tooth
loss (N.=4). Nevertheless, it was observed a
reduced number of complications, which how-
ever were not able to alter the performance of
the dentures in any way.
As for the resinous components of the den-
tures, from the evaluation of the various stud-
ies it can be seen how the frequency of compli-
cations to these parts is minimal. This might be
explained by the fact that the maintenance of
the natural abutments ensures the preservation
of tactile perception; consequently, this would
allow to maintain an adequate neuromuscular
feedback, so as to avoid excessive masticatory
force, which could lead to a mechanical over-
load, especially on the resinous components of
the denture.34
Frisch et al.33 reported the loss of 9 teeth
(13.64%) due to caries or fracture after an av-
erage of 6.12 years, while only one implant out
of 61 was lost because of peri-implantitis dur-
ing the observation period.
Moreover, none of these authors reported
phenomena of intrusion.

Rammelsberg 35 reported that 6 implants

(2.6%) were removed due to extensive bone
loss, 11 (4.7%) suffered from peri-implantitis,
while 12 (5.1%) suffered from mucositis with-
out bone loss; four teeth (3.7%) were extracted
and another 3 (2.8%) suffered from serious
complications (such as fractures or apical peri-
Conclusions
From the comparison of these studies it can
be seen that all have limited follow up periods
(from 2 to a maximum of 8 years) except for
Mitrijski’s study 21 (15 years).

40 Minerva Stomatologica February 2017

 ©
COPYRIGHT 2017 EDIZIONI MINERVA MEDICA
not permitted. It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, logo,
means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use is
This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one file and print only one copy of this Article. It is not permitted to make additional copies
TOOTH-IMPLANT CONNECTION IN REMOVABLE DENTURE MELILLI
(either sporadically or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any other
The comparison between the various studies
is even more difficult due to the small number
of patients recruited, to the different types of
prosthetic design, to the different systems of
anchorage used and to the residual teeth.
Therefore, as a result of these limitations,
it is difficult to draw any certain and absolute
conclusions as to the real validity of the use
of the various systems of anchorage taken into
examination as connecting systems.
Nevertheless, the evaluation of the survival
rates suggests that increasing the number of
abutments and using strategically placed im-
plants can induce a reduction of the risk of
failure or of the occurrence of other implant
complications and an improvement in the
prognosis of the teeth and of the prosthetic
structure.
In addition, we can deduce that the fre-
quency of complications in the tooth-implant
supported removable dentures is minimal, and
in any case acceptable if compared to the pos-
sible benefits.
Although this approach can be a cheaper
alternative treatment and advantageous for
the rehabilitation of patients with partial tooth
loss, evidence is scarce and not very clear be-
cause of the lack of controlled and randomized
clinical trials.
Therefore, in order to confirm the validity of
this rehabilitative solution, further studies with
a higher level of evidence and more represen-
tative test subjects are necessary.
References
  1. Müller F, Naharro M, Carlsson GE. What are the preva-
lence and incidence of tooth loss in the adult and elderly
population in Europe? Clin Oral Implants Res 2007;18
Suppl 3:2-14.
 2. Mijiritsky E, Ormianer Z, Klinger A, Mardinger O.
Use of dental implants to improve unfavorable remov-
able partial denture design. Compend Contin Educ Dent
or other proprietary information of the Publisher.
2005;26:744-50.
  3. Gonçalves TM, Campos CH, Garcia RC. Implant reten-
tion and support for distal extension partial removable
dental prostheses: satisfaction outcomes. J Prosthet Dent
2014;112:334-9.
 4. Lang NP, Pjetursson BE Tan K, Brägger U, Egger M,
Zwahlen M. 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. Clin Oral Implants Res
2004;15:643-53.
Vol. 66 - No. 1 Minerva Stomatologica 41
  5. Nickenig HJ, Schӓfer C, Spiekermann H. Survival and
complication rates of combined tooth-implant-sup-
ported fixed partial dentures. Clin Oral Implants Res
2006;17:506-11.
  6. Pjetursson BE, Brӓgger U, Lang NP, Zwahlen M. Com-
parison of survival and complication rates of tooth-sup-
ported fixed dental prostheses (FDPs) and implant-sup-
ported FDPs and single crowns (SCs). Clin Oral Implants
Res 2007;18 Suppl 3:97-113.
  7. Brӓgger U, Aeschlimann S, Bürgin W, Hӓmmerle CH,
Lang NP. Biological and technical complications and
failures with fixed partial denture (FPD) on implants and
teeth after four to five years of function. Clin Oral Impl
Res 2001;12:26-34.
  8. Steven M. Davis, Alexandra B. Plonka, Hom-Lay Wang.
Risks and Benefits of connecting an implant and natural
tooth. Implant dent 2014;23:253-7.
  9. Giffin KM. Solving the distal exten- sionremovablepar-
tialdenturebasemove- ment dilemma: A clinical report. J
Prosthet Dent 1996;76:347-9.
10. Mitrani R, Brudvik JS, Phillips KM. Posterior implants
for distal extension removable prostheses: a retrospective
study. Int J Periodontics Restorative Dent 2003;23:353-9.
11. Grossmann Y, Nissan J, Levin L. Clinical Effectiveness
of Implant-Supported Removable Partial Dentures—A
Review of the Literature and Retrospective Case Evalua-
tion. J Oral Maxillofac Surg 2009;67:1941-6.
12. Mericske-Stern R. Oral tactile sensibility recorded in
overdenture wearers with implants or natural roots: a
comparative study. Part 2. Int J Oral Maxillofac Implants
1994;9:63-70.
13. Kaufmann R, Friedli M, Hug S, Mericske-Stern R. Re-
movable dentures with implant support in strategic po-
sitions followed for up to 8 years. Intl J Prosthodont
2009;22:233-41.
14. Crum RJ, Rooney GE. Alveolar bone loss overdentures: a
5 year study. J Prosthet Dent 1978;40:610-3.
15. Mericske-Stern R, Zarb GA. Overdentures: an alternative
implant methodology for edentulous patients. Int J Pros-
thodont 1993;6:203-8.
16. Scotti R, Melilli D, Pizzo G. Overdenture supported by
natural teeth: analysis of clinical advantages. Minerva
Stomatol 2003;52:201-10.
17. Krennmair G, Krainhöfner M, Waldenberger O, Pi-
ehslinger E. Dental implants as strategic supplementary
abutments for implant-tooth-supported telescopic crown-
retained maxillary dentures: a retrospective follow-up
study for up to 9 years. Int J Prosthodont 2007;20:617-
22.
18. Wolfart S, Moll D, Hilgers RD, Wolfart M, Kern M. Im-
plant placement under existing removable dental pros-
theses and its effect on oral health-related quality of life.
Clin Oral Impl Res 2013;24:1354-59.
19. Grossmann Y, Levin L, Sadan A. A retrospective case
series of implants used to restore partially edentulous
patients with implant-supported removable partial den-
tures: 31-month mean follow-up results. Quintessence
Int 2008;39:665-71.
20. Shahmiri RA, Atieh MA. Mandibular Kennedy Class I
implant-tooth-borne removable partial denture: a system-
atic review. J Oral Rehabil 2010;37:225-34.
21. Mijiritsky E, Lorean A, Mazor Z;Levin L. Implant Tooth-
Supported Removable Partial Denture with at Least 15-
Year Long-Term Follow-Up. Clin Impl Dent Rel Res
2015;17:917-22.
22. Chang LC, Wang JC, Tasi CC. Removable Partial Den-
ture on Osseointegrated Implants and Natural Teeth.
Chang Gung Med J 2007;30:274-9.
23. El Mekawy NH, El-Negoly SA, Grawish MEL-A, El-
Hawary YM. Intracoronal Mandibular Kennedy Class I
Implant- Tooth-Supported Removable Partial Overden-
 ©
COPYRIGHT 2017 EDIZIONI MINERVA MEDICA
not permitted. It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, logo,
means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use is
This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one file and print only one copy of this Article. It is not permitted to make additional copies
MELILLI TOOTH-IMPLANT CONNECTION IN REMOVABLE DENTURE
(either sporadically or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any other
ture: A 2-Year Multicenter Prospective Study. Int J Oral
MaxIlofac Implants 2012;27:677-683.
24. Cunha LD, Pellizzer EP, Verri FR, Pereira JA. Evaluation
of the influence of location of osseointegrated implants
associated with mandibular removable partial dentures.
Implant Dent 2008;17:278-87.
25. Ohkubo C, Kurihara D, Shimpo H, Suzuki Y, Kokubo
Y, Hosoi T. Effect of implant support on distal extension
removable partial dentures: in vitro assessment. J Oral
Rehabil 2007;34:52-6.
26. De Freitas RF, De Carvalho Dias K, Da Fonte Porto Car-
reiro A, Barbosa GA, Ferreira MA. Mandibular implant-
supported removable partial denture with distal exten-
sion: a systematic review. J Oral Rehabil 2012;39:791-8.
27. Brudvik JS. Advanced removable partial dentures. Chi-
cago, IL: Quintessence; 1999.
28. Bortolini S, Natali A, Franchi M, Coggiola A, Consolo
U. Implant-retained removable partial dentures: an 8-year
ret- rospective study. J Prosthodont 2011;20:168-72.
29. Hug S, Mantokoudis D, Mericske-Stern R. Clinical eval-
uation of 3 overdenture concepts with tooth roots and
implants: 2-year results. Int J Prosthodont 2006;19:236-
43.
30. Krennmair G, Weinländer M, Krainhöfner M, Piehslinger
E. Implant-supported mandibular overdentures retained
with ball or telescopic crown attachments: a 3-year pro-
spective study. Int J Prosthodont 2006;19:164-70.
31. Bernhart G, Koob A, Schmitter M, Gabbert O, Stober T,
Rammelsberg P. Clinical success of implant-supported
and tooth-implant-sup- ported double crown-retained
dentures. Clin Oral Investig 2012;16:1031-7.
32. Schwarz S, Bernhart G, Hassel AJ, Rammelsberg P.
Survival of Double-Crown-Retained Dentures Either
Tooth-Implant or Solely Implant- Supported: An 8-Year
Retrospective Study. Clin Implant Dent Relat Res
2014;16:618-25.
33. Frisch E, Ratka-Krüger P, Wenz HJ. Unsplinted implants
Conflicts of interest.—The authors certify that there is no conflict of interest with any financial organization regarding the material
discussed in the manuscript.
Article first published online: September 1, 2016. - Manuscript accepted: August 24, 2016. - Manuscript received: January 29, 2016.
or other proprietary information of the Publisher.
42 Minerva Stomatologica February 2017
and teeth supporting maxillary removable partial den-
tures retained by telescopic crowns: a retrospective study
with >6 years of follow-up. Clin Oral Impl Res 2015;26:
1091-7.
34. Rinke S, Ziebolz D, Ratka-Krüger P, Frisch E. Clini-
cal Outcome of Double Crown-Retained Mandibular
Removable Dentures Supported by a Combination of
Residual Teeth and Strategic Implants. J Prosthodont
2015;24:358-65.
35. Rammelsberg P, Bernhart G, Justo Lorenzo Bermejo,
Schmitter M, Schwarz S. Prognosis of implants and abut-
ment teeth under combined tooth-implant- supported
and solely implant- supported double-crown-retained re-
movable dental prostheses. Clin Oral Impl Res 2014;25:
813-8.
36. Ramoglu S., Tasar S., Gunsoy S., Ozan O., Meric G.
Tooth-Implant Connection: A Review. Hindawi Pub-
lishing Corporation ISRN Biomaterials; 2013 [Inter-
net]. Available frm: http://www.hindawi.com/journals/
isrn/2013/921645/ [cited 2016, Sep 7].
37. Sekine H, Komiyama Y, Hutta H, Yoshida K. Mobility
characteristics and tactile sensitivity of osseoIntegrated
fixture-supported systems. In: van Steenberghe D, editor.
Tissue-integration in oral and maxillofacial reconstruc-
tion. Amsterdam: Elsevier, 1986. p.326-32.
38. Richter EJ. Basic biomechanics of dental implants in
pros- thetic dentistry. J Prosthet Dent 1989;61:602-9.
39. Mijiritsky E. Implants in conjunction with remov-
able partial dentures: a literature review. Implant Dent
2007;16:146-54.
40. Chee WW, Cho G. A rationale for not connecting im-
plants to natural teeth. J Prosthodont 1997;6:7-10.
41. Cho GC, Chee WW. Apparent intrusion of natural teeth
under an implant supported prosthesis: a clinical report. J
Prosthet Dent 1992;68:3-5.
42. Sheets CG, Earthmann JC. Tooth intrusion in implant-
assisted prostheses. J Prosthet Dent 1997;77:39-45.