TOOTH TO IMPLANT

CONNECTION
Prepared by How to think?
Dr.Yamen Nouh
 When do we need?

• Mesial drifted teeth leaving limited space to second implant

• Failed implant between teeth and succeeding implant
• Insufficient bone with no possibility for graft
• Patient cannot afford graft or multiple implants
What is the problem?
differences
 Main differences:
Tooth

• Tooth attachment with PDL acts as viscoelastic shock absorber

• Thus decreasing the amount of stress distributed to surrounding bone
especially in Crestal area.
• And allowing higher degree of movement (up to 20 times more)
 Main differences:
Implant

• Implant direct connection to bone (Osseointegration) is rigid.

• Allowing less movement and absorbing much less stresses.
• Conduction of stresses to bone.
• Concentrating forces at the crestal bone as it is the hinge point in case of
lateral forces
 So...For the implant

Common..

Rare..
For the bridge (Very rare)
Follow up results
 How to think: factors to consider

• Tooth mobility: teeth should not be mobile, if it is, it should be treated as

splinting case (Add more implants to splint). Consider stress breakage
design options.
• level of parafunctional activity
• number of implants and teeth being used in the restoration.
 1- increase number of implants

• Increasing resistance arm (increasing implants to teeth ratio) in a way that

makes the prosthesis does not need the teeth for support
2- Don’t use implant as pier
 Connect only with healthy teeth

• In terms of periodontium and supporting bone

 Decrease lateral forces

Amount of axial movement for teeth: 8-28 micron

Amount of lateral movement for teeth: 65-108 micron

Amount of limited movement for implant: 0-5 micron

A- avoid in patients with para-functional stresses
B- Avoid in cases with high crown root ratio
C- connect implant to distal rather than mesial teeth
(and posterior rather than anterior)
Rigid or non rigid connection?
 Use non rigid connection

non rigid
connection
allows teeth
But..
to move and
act as stress
breaker..
 Allowing intrusion

- Different theories - The rate of

for intrusion intrusion is
between 3-5.2%
- Effect of Rachet:
teeth not returning - It jumps to 50%
to its position due in case of para-
to friction between functional habits
connector parts
 Modification on non rigid connector

N.B: Need to be only in short span cases as if it is long span this will increase stresses on the connector
 Use of rigid connection

• Tooth-tooth cemented bridge has the same mobility rate as tooth-implant

connected bridges as declared by finite element analysis
• Also permanent cementation prevents intrusion.
Non Rigid connection Rigid connection

- Allow teeth intrusion - Prevent teeth intrusion

- May cause relatively more
- Decrease bone resorption bone resorption
Permanent cementation

To prevent teeth intrusion

• Half
crown
design
Say YES or NO and WHY in the following cases:
case 1
Case 2
Case 3
Case 4
case 5
Case 6
case 7
Case 8
Final conclusion!!!!
 References..

• Spear, frank (2015). speareducation.com. Connecting Teeth and Implants:

Yes, No, Maybe?. Retrieved from link
• Serhat Ramoglu, Simge Tasar, Selim Gunsoy, Oguz Ozan, and Gokce Meric,
“Tooth-Implant Connection: A Review,” ISRN Biomaterials, vol. 2013,
Article ID 921645, 7 pages, 2013. doi:10.5402/2013/921645
•