Is Splinting an Implant and Natural Tooth Sometimes Acceptable?

In my practice I`ve used implants and natural teeth in big bridges (#2 or #3 to # 14 or #15). But always kept stable, uncompromised teeth. Most of the load was beared by the implants. Butthis is an exception, due to (mostly) financial reasons. I would strongly advise to keep off splinting natural tooth to an implant. The tooth will behave like a cantilever in this situation. And we all know how long cantilevers last, dont`t we? Best case scenario- you will probably see faster crestal resorption around the implant in the first couple of years. If you can`t create papilla (with connective tissue graft),try speaking with your ceramist about other options.Pink ceramics is never the best option. It`s a myth-esthetics will still be compromised. Good luck! D-r Dimitrov

I have been splinting natural teeth with implants for 18 years and cases to numerous to count, with no problems. You do have to have the occlusion under control.

Dr. E, While I would submit that most do not recommend the practice, it can be done with carefully selected cases. Just keep in mind that the teeth will move and the implant will not. That alteration in load distribution can cause issues with bone stress / resorption, restorative fractures, ect...

Dear colleague, I would say that there is no major issue splinting lateral and central incisor in your case if the technician can produce good esthetics and hygiene design in the same time?!

Feel free to splint. The only caveat is to splint rigidly and do not use a temporary cement. I would recommend Improv for the implant. Dr. G

I would splint it but it will not be my first option. The question is: why is there no papilla? probably because of no proximal bone between #8 and 7? My concern is if you splint these teeth and achieved good esthetic results, what will be the case if splinting causes more bone loss (either around the tooth or the implant). Of course without looking at any exray or photos it's hard to give an accurate suggestion. I will advise that you look into other options (if they exist) and share it with the patient. regenerating the papilla with ortho extrusion (this is case specific) maybe an option. also in specific cases soft tissue grafting may help a little. It depends on the reason there is no papilla. you don't need to regenerate the whole papilla but if you can gain a little back then 2 separated crowns with long contact may work. Because you are redoing the crowns for esthetic reason, I don't think it's a bad time to look at other options that may have more long term results. However, Splinting the teeth maybe the more practical for the patient. I will suggest reading some of Salama and Sclar publications.

splinting for me is always only a last option. don't do many of it, but have had quite good results over years. 2 rules: 1.implant must always be the distal anchor 2. always use copings

Also splint to a sound tooth. Do not consider a mobile tooth as an abutment.

it'll work. make sure your rct'd tooth is posted w/ a big, long post.also check for canine rise in excursive and protrusive movements. if he's riding off the incisal edges on these movements you have to make the incisals of 7,8 a hair shorter than the rest.

Joining implants to natural teeth can definitely be done and can certainly work satisfactorily in many situations and I have commented on this subject on previous posts relating to bridging an implant to a natural tooth. I however do not understand why splinting is necessary to develop esthetics. A better option would be address the reason for why no papilla exists and to redevelop tissue architecture if possible and to reprepare the tooth and implant abutment for a better gingival form and for better emergence profile. If it is a strictly a matter of compromise your laboratory technician should be still be able to create a pseudo papilla adjacent to each tooth in gingival colored ceramic without the need to splint. Freestanding unsplinted teeth will have a more favorable response to functional loading forces and certainly will be a lot more favorable to maintain with a direct interproximal access to flossing.

Yes to Dr. Nimchuck.

Splinting of natural teeth to implants always be a challenge for implantologist. although several studies go around the subject it is not clear to used to or not and this question was never clarified till now.i alert you to this main concept that teeth always moved in mesio-buccal(MB) direction; a motion which is named ant component of force will always move the teeth in MB direction.this movement is always greater in upper teeth specially in Ant. Area. so cautions must be paid to implant placement in this area. jointing several teeth or using attachments is only make the situation worthy and some FEM analysis showed that the attachments will not work as well regarding implants. but in every situation when the teeth have enough C/R ratio, the occlusion is prepared so the force simultaneously applied to both implants and teeth, there is no parafunctional habits, correct occlusal schemes are exist or corrected as needed, the occlusal contacts are favarouble, theere is no interference in any movement we can rely on joining the implants to teeth.

I feel u cud go ahead with splinting the two with a rigid connection as movable connectors will cause tooth intrusion. Also using temp bond will cause the crowns to be more passive which is much appreciated. Also the framework undergoes some flexure and movement and bone is visco elastic so movement difference between tooth and implant should not be a problem. The only precaution is to give a group function or canine guidance with shallow cingulum to cause immediate disoccluion of the posteriors and give a good anterior guidance.

i think you should not splint the tooth where the prognosis for both is different.Also find out why the papilla is not there .pink ceramic is not for replacing papilla but for cervical gingiva only.modified tissue flaps can help you create papilla.

This is not something I would do as teeth move whereas implants do not. Connecting natural teeth to implants will result in higher risk of failure.