Connecting a maxillary posterior implant to a posterior natural premolar: mainstream technique?

Place two implants first molar and premolar. Patients do not dictate treatment plans. The implant is not a tooth no PDL and will extract the natural tooth over time or break the bridge.implants are anklylosed. I have had patients try to treatment plan also, with a little patience and explanation the patient should have buy in. Hope this helps!

Why does the patient want to do that? Because he doesnt want to pay for a second implant. Why you are willing to do that? Because you dont want to lose the patient and Because you are Eager to place implants . But what if for any reason you were not successful ,failed implant,intruded natural tooth, broken bridge ,etc... Will your patient be considerate to your Situation like you were to him ,or will he the least tell you "you are the doctor, why did you listen to me , i just suggested " I've learned from my experience never to compromise the right treatment plan for the sake of the patient saving money . Losing a patient is something but losing you reputation is something else that shoudnt be jeopardized. Either do the right thing or dont do anything at all.

It is acceptable to abut implants with natural teeth. This is a short span, so there should not be a problem. I suggest using a coping on the bicuspid. Yes, there are reports in the literature about natural tooth intrusion, but this happens few and very far in between.

Misch covers this topic very well in his text books!

I have been abutting implants to natural teeth for over two decades, without any issues. I suggest using copings on the natural teeth. Cement the coping with a harder cement than that used for the bridge. Pay close attention to the occlusion and length of span. Do not place implants between teeth and abut them together. You very well may have problems.

I think it is wonderful that you have had so much success in the past twenty years with your protocol. But this a question posed by the poster whether this a mainstream technique and in my opinion it is not. Now based on your comment you have doing this a long time and have a lot of experience. I'm not questioning that, just advising a more conservative approach to most likely a clinician with less experience and on Misch's guidelines which you brought up. I very sincerely hope you did not take it personally which was not my intention. I try to give prudent advice based on my experience which is very different from yours and I try to be authentic and humble. Thank you for reading.

Mainstream...not so much. I think it is reasonable treatment though if you put a stress breaker (tapered keyway, sub occlusal connector, etc.) on one of the abutments for this hybrid bridge so things can move a little. Force factors could really screw this up, so occlusion and habits must be under good control. My experience has been good (25 years) with the "one" bridge I have abutted to implants posteriorly and natural tooth anteriorly, but it was in the mandible (CoreVent implants with internally cemented abutments). Best of luck!

Dr. Hughes, when you bridge like this, do you also use screw retention on the implant end or cement both ends? (Remembering the coping on the natural tooth...)

I cement. I have never used screw retention.

Question was... Is this a mainstream technique, connecting a maxillary posterior implant to a posterior natural premolar? Answer as per my knowledge & experience.... No, Its not a mainstream technique....but its a compromised Technique may be bcoz patient has some financial problem or his mouth not permitting another implant. Que: What is the chance of success? Answer as per my knowledge & experience....This is a very tricky question...In what sense you are expecting Success...if its Longevity then surely not a very long success....over a period of time we can expect failure of Tooth, Implant or both....but the period may vary from patient to patient considering his/her Occlusion, lateral forces, hygiene etc etc.... Que: what complications should I expect? Ans: May not encounter any complication in near future but may face failure of Tooth, Implant or both, Fracture of Bridge etc... Que: Would it be better to replace #4 [maxillary right second premolar; 14] with another implant? Ans: Yes..it will be always better to replace #4 [maxillary right second premolar; 14] with another implant...BCOZ if your patient can afford one implant surely he can dare for second implant also...explain him everything, gain his confidence and go ahead or else put one implant & one crown.... Best of Luck...

This question has come up several times in previous posts in this site and I for one have commented on it before. The short answer is yes, it is a usable treatment and there exists plenty of documented studies to support a very good success rate. Having said that, a free standing implant bridge is always preferable for the obvious reasons of potential stress transference to the implant as a consequence of movement of the natural abutment due to the compression of the periodontal ligament. However a short span bridge anchored to a both a solid root and a solid implant can be a viable service particularly when the patient is placed at unnecessary risk or morbitity such as can occur in the area of the mental foramen or in other anatomically compromised sites. This system however I would suggest is not mainstream and should be reserved for selected cases. There are some mis-statements in this post as to the recommendation of stress breakers or temporary cements which are contraindicated. For combining a natural tooth to an implant abutment, the protocol which I follow and recommend is: • The implant abutment should be of substantial size and should be placed in type II bone to best withstand the increase in shear forces that can arise from this type of hybrid bridge system. • The pontic should have a short span, preferably only a single tooth, to minimize torque forces on the abutments. • The natural root abutment should have good stability, preferably with no mobility and the tooth should preferably be multi-rooted to minimize tooth displacement. • Both abutment connectors should have a rigid connector design. Nonrigid attachments should be avoided as they are associated with a greater incidence of root intrusion. • If telescopes or copings are used, avoid temporary cements; in particular, avoid the no-cement coping technique, as loss or absence of a rigid connection will induce the highest incidence of intrusion. • Use highly retentive cements with superior design features for retentive preparation at the abutment to resist cementation failure. • Eliminate or minimize unbalanced tooth contacts in excursive movements as well as in centric. • Consider bruxism as a risk factor; if present, manage bruxism with an anti-bruxism splint, preferably placed on the arch that contains the bridge.