Can I construct a PFM bridge from natural tooth 28 to implant 31?
I have a patient who is missing #31, 30, and 29 [mandibular right second and first molars, second premolar; 47, 46, 45]. If #31 were still present I would construct a bridge from #31 to 28 [mandibular right first premoar; 44]. I would like to place an implant in #31 site and construct a bridge to #28 replacing #31 and 29. I know this is controversial. I have heard that you can do this if you are going to use a resin cement. Any thoughts? What do you do in situations like this?
15 Comments on Can I construct a PFM bridge from natural tooth 28 to implant 31?
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CRS
3/17/2013
I would not advise this, place implants at 29-31 keep it implant supported.Spanning double pontics off an implant and a natural tooth is not wise. A better choice would be an implant at 30 with a cantilever at 29, but I would advise the first choice is the smart play. Good Luck!
Richard Hughes, DDS, FAAI
3/18/2013
This is to long a span. Place implants at # 31 and 29 and bridge. Leave 28 alone. It is a weak abutment. It's ok to splint to teeth but keep the spans short.
Tim DePalma
3/18/2013
I agree with Dr. Hughes' comment. This is a much more predictable restoration. Just curious if anyone has done a bridge with mixed retainers (implant/natural tooth) using a non-rigid connector?
Dr Aurangabad India
3/23/2013
In my Implant practice of last 15 years , I had to do two cases like this. It was because after putting two implants , one was not accepted by patients body & pt was not keen to go for the procedure again. Hence I joined natural implants to natural tooth & made a bridge. One case failed after about 5 years .Another is still working for about 3 years. Its not good to join implant to natural tooth. Avoid cutting natural tooth just to save one or few implants. Saving some money at that time lands patient in additional treatment in future.
Perry
3/19/2013
I've seen natural teeth intrude when connected to implant supported crowns. This happens slowly. The tooth basically leaves the full crown slightly, creating a gap between the inside of the crown and the prep. Sometimes this situation is detected only when gross caries is discovered in the portion of the tooth that was contained within the crown.
dr xavier aguirre
3/19/2013
i agree with drs depalma and hughes. i have placed numerous mixed retained bridges and have done so when the natural retainer mimics the implant in its firmness. near ankylosis if possible and informed consent is a must! please remember that site 31 is never going to be as solid as more anterior sites and due to the anatomy of the mandible you will usually be limited to a 8-10mm implant.
Smileartist
3/19/2013
We rarely replace 31 w an implant unless the opposing dentition is entirely intact and #2 requires #31 for contact and to prevent extrusion. It is much more common to place implant at 30, but due to lateral flexion in the second bicuspid region under masseteric loading during chewing, a non-rigid connector (keyway) designed to allow slight torquing moment on the distal of #28 would be required. It is better to place an additional implant at #29 for longevity, less splinted is better anywhere in the mouth. Good luck!
Dr M C
3/19/2013
Natural teeth have PDL, implants don't. If connected Either one or both will show bone loss depending on the load distributed . Replace the 1st molar and at later stage 2nd molar. You need not place both implants together.
Marc
3/19/2013
You can connect tooth to implant as long as you have a rigid connection between implant and abutment like Ankylos. Then the tooth , at the other end will not move under load because of the implant /abutment connection. So in this situation why not just cantilever. If you feel the span is to long , place two implants, it can be a single crown and a shorter cantilever or better a bridge. If you place a stress breaker you will get intrusion of the natural tooth because after intrusion by natural forces of mastication the only forces that brings the tooth back to occlusal plane is hydrolics from blood vessels in the PDL and it as been mesured at about 2N wich is much less than the friction in the stress breaker. So every time you bite the tooth goes in and never return to its original position ( intrusion)
Smileartist
3/19/2013
Show me the cases gentlemen, I'm getting slides out tomorrow....
FCampos
3/19/2013
When connecting an implant with a natural tooth on bridge you are walking a very thin line. When biting on a bridge the portion with natural tooth will have micro movements because of the PDL, implant do not have PDL ? This is all about predictability ,if you have enough bone and have to replace #31 i would place implant on 29,31 and bridge?
Good luck
Tuss
3/20/2013
Linking teeth to implants is not a good idea. Recent review from Italy showed max 5 years success followed by issues with either the implant or the tooth (both can fail). Using a non-rigid connector also has limited benefit as minimal tooth movement will convert it from non-rigid to rigid (stress breaking components). A single unit cantilever - either mesial or distal off an implant is not an issue unlike with teeth. Keep natural dentition and implants independant.
Dr. Alex Zavyalov
3/20/2013
Joining natural teeth to implants is not a problem itself. The problem is adequate loading from opposing teeth. If this patient has an upper removable denture you have nothing to be afraid of.
Gregory dubover
3/21/2013
Implant crown with Pontic 30(29) would be the safest
Jennifer taitt
5/8/2018
Just need some advice, had a bridge done about 5 years ago on my lower right, do to my diabetes I recently had to get a root canal done on #31 and also crown lengthening..#29 &30 is missing, the dentist office told me they will have to make 29 30 but my bones are not strong enough for implants how can they go about replacing 29&30?
