4 unit bridge supported by a natural tooth and an implant

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Brett Hansen CDT

Brett Hansen CDT

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I have a case in the lab where the doctor has prepped #3 and has implants placed at #6 and #7. The doctor wants a bridge from 3-6 with a single crown on #7. I haven't done a bridge that involves an implant and a natural tooth before. I know this isn't an ideal situation. My thoughts are to put a stress breaker in the bridge. How would you handle this case?
 
rkm rdt

rkm rdt

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I would make the bridge wihout a stress breaker.
 
Labwa

Labwa

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I have been to a lecture by a prosthedontist that seemed to think in these cases the implants keep the natural teeth situated where the bridge is made to while offering great support. he showed photos of his cases and they looked good after 5-10 years. im not sure how many photos he didn't show though. On that i would say no stress breaker.
 
Gdentallab

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stress will be concentrated on the superior portion of the implant.
breakdown of osseointegration.
screw or abutment loosening.
fracture in the connector area of prosthesis.
so mainly it will affect the implant zone, I will not do it.
 
Tom Moore

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Did a bunch like this in the beginning of implants and they seem to last long enough to blame the failure on the patient. That sucks but is the world we live in. If you inform your dentist this is outside the GMP's of the materials and design (your supposed to)and they will sign off on that and say go forward with it.

That's their license in jeopardy. LMAO!

In the end it's your lab and you can say no but don't be a crybaby if the result is not what you expected.
 
French Cadman

French Cadman

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Some pictures please ?

I like it ! ;)
 
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rhicks3302

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The natural tooth has a periodontal membrane, the implant is ankylosed. You have something that's rigid connected to something that moves. Something is going to give sooner or later. I've heard clinicians speak of certain cases in which they would do this. I'm not crazy about it. Just know what you're getting into.
 
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patmo141

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Believe it or not, our Perio book says it's totally fine, yet our fixed professors say NEVER.

Here is an excerpt from the text.


"Based on the evidence available today it can be stated that a combination of implant and tooth support for FDPs is acceptable (Belser et al. 2000). While a recent systematic review (Lang et al. 2004) indicated that tooth–implant reconstructions reveal a 5-year survival rate of 94.1%, comparing very well with the 5-year survival rate of implant–implant reconstructions of 95.0% (Pjetursson et al. 2004),the 10-year survival of tooth–implant reconstruc-tions (77.8%) appears to be signifi cantly lower than the 10-year survival of implant–implant reconstruc-tions (86.7%). However, owing to the fact that the former 10-year survival rate was based on only 60 (I-T) FDPs and the latter on only 219 (I–I) FDPs, the reliability of such 10-year survival has to be questioned."

I don't necessarily agree with the last bit..."well, study size is too small, so we will ignore it" because it could just as easily be worse than better.
 
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labmanmike

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It's ultimatly the Dr's responsibility so I would do the bridge if thats what he wants but I would sure not use an attachment of any kind on it. It will "creep" and potentially cause problems...good luck my friend
 
Brett Hansen CDT

Brett Hansen CDT

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I just got done talking to the periodontist and the dentist. We are gonna fabricate a thin metal coping over the natural tooth. That will be cemented in with permanent cement. Then we will fabricate a bridge from #3 to #6(implant) and #7(implant). We will keep only light balanced occlusion in centric and balanced excursive contacts.

The periodontist said that a doctor at The Ohio State University did a study of his patients(5000+) and found that bridges between an implant and a natural tooth had a "clinically insignificant" rate of failure when compared with implant to implant bridges. He said the failure rate was like .02% more.
 
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