Splint the Crowns or Leave the Crowns Single and Free Standing?

Implant occlusion is adopted from Prosthodontics principles by default and it must be clear from the outset that implants do behave differently under loading. However, there is no contraindication to re-establish the canine guidance and there is no evidence that guidance load is a risk to osseo-integration. The occlusal scheme should ideally allow the canine to guide but not to lock the occlusion, and without non-working side interferences. The guidance angle on the palatal surface of the canine should approximate the contra-lateral condylar angle. Too steep and the occlusion can be locked; too shallow and the guidance may be ineffective. Although it is desirable to spread the loads to as many implants as possible by splinting, it is of no advantages in your case, provided the rest of the arch is intact. Splinting complicates oral hygiene procedure and the establishment of dental papillae.

Nicely put Dr. Chan. The only thing I'd add, is that if your nervous about harmful excursions, remember that those only occur at night. During the day, the teeth only touch when swallowing, and then only lightly. Chewing, biting, etc on an awake person is not destructive in itself. If however, the patient is a clincher, or grinder, you'll find that they are able to destroy just about anything and many times will weaken things until the patient walks in the door with something broken saying "I was drinking water and it just fell out". In those cases, you might want to consider a night time appliance ie orthotic etc. Happy drilling!

A great proffessor said once: Oclussion is vital, Disoclussion is the key. Based on that I would restore canine guidance if you have a well ballanced case. Implant wise I would splint... lateral force can be a killer so why risk it. Better long term results and you can get good aesthetics with splinting and papillae is going to be an issue if you put 2 implants together splinting or not. A good case will be defined by your pinck aesthetics, so I would do flapless hard tissue graft in order to obtain or preserve good bone. and will probably manage the gum to get nice pink attached gingiva. Cheers

No problem splinting here, and yes two implants side by side will always have a compromised papillae anyway...

Hi Alejandro , whist I agree with you and Carl Misch advocates splinting , I never do unless absolutly necessary as the issues of co-axila forces can come into play transmitted from one implant to the other . I have seen a disproportionate number of Implant failures when splinting ahs been used over the years and suspect this may be the cause. Regards Peter

Sorry meant co-axial forces .....Typo Peter

Never ever ever splint teeth or Implants. It is just bad for peri circumferential tissues. Your patient will not keep the area maintained.

What is a practical benefit to restore canine guidance? Don’t be a theoretically dogmatic dentist. Splinting leads to more even mastication force distribution, and I use it when ever possible.