Splinting dental implants: experiences?

>>>Can anyone share their experiences regarding splinting implants when they are right next to each other? Benefits - significant reduction of chair time at delivery (cement retained) - improved esthetics in area of flat gingiva / minimal papilla - improved short term stability - less lateral food impaction issues Negatives - records must be high fidelity (especially screw retained) - may require master cast verification (larger cases, especially screw retained) - repairs to crowns may be difficult or impossible - increased home hygiene difficulty >>>Also if there are several implants in a line, has anyone had difficulty with seating the crowns, since parallelism is so crucial? Custom abutments make strict parallelism a relatively minor issue for cement retained restorations. Screw retained restorations are always easier, and often more esthetic, when the implants are more parallel. However, some evidence suggests screw retained bridges will have less screw related issues (fracture and loosening) if the implants are NOT in a straight line.

Splinting distributes the occlusal load over a much larger osseous surface to make an overload much less likely. This may be especially an issue as the implant case ages and there may be marginal bone loss thus reducing support.

I always aim to place single unit abutments and crowns (screw retained). I never cement crowns because I think the main advantage of implant crowns is their retrieveability. I use single units for maintenance reasons and better aesthetics in most cases (in regards to allowing space for cleaning). After 30 years of removing implant bridges and seeing and smelling what is on the impression side of these prostheses, I would not want them in my mouth or in any of my family’s mouths. I acknowledge the path of insertion problems but these are usually solved with a good lab technician.

" Right next to each other".....I think that there is a distinct advantage to splinting implants...… very often single implant crowns tend to get loose because the crown size in relation to the implant/abutment connection is way out of proportion, and the connecting screw tends to twist under pressure of the load, and the crown becomes loose...…. when several implants are next to each other, and with some degree of parallelism at time of placing the implants, this problem does not happen.