Bridge on prep and abutment

[zero_zero]

Got a phone call today from a dentist wondering if we could make a 3 or 4 unit cemented bridge (canine to the first molar) supported by a prep on the front and a custom abutment on the back. I don't remember ever fabricating such thing, natural teeth can move a lot more than an implant could resulting in tensions during function. How will it work on the long run ? Any experiences ? Thanks in advance

 

[JMN]

Got a phone call today from a dentist wondering if we could make a 3 or 4 unit cemented bridge (canine to the first molar) supported by a prep on the front and a custom abutment on the back. I don't remember ever fabricating such thing, natural teeth can move a lot more than an implant could resulting in tensions during function. How will it work on the long run ? Any experiences ? Thanks in advance

Generally I've always been told that it's a very bad idea long term..

The periodontal membrane allows the tooth to move, but the implant won't move (hopefully!) so you have an increased chance for super-eruption as the tooth continues to move with the masticatory force wanting to move the bridge as it does all teeth. The natural abutment will move.

The implant will experience additional stress as the implant attempts to hold fast against the movement the natural tooth is biologically afforded. This doubtless increases the chance of abutment or implant failure by a few percentage points.

Screwmenting will make it a bit less hairy with at least reducing some of the failure rate chance by nearly eliminating peri-implantitis as a likely event.

That's the longwinded version of why I'd always shied away from them. For whatever that's worth.

 

[2000markpeters]

Should not do. Implant ankylos, tooth has movement. You will either break the bridge over time or break the cement seal on natural toorh. You could use stress breaker but better the dr just places anorher implant.

 

[zero_zero]

What if I make the whole thing out of labially layered PEEK (minus the non engaging Ti insert) till the patient can afford a second implant, kinda like a long term temp ? Could the shock absorbing and flexing properties of PEEK alleviate the stress issues ? The canine is already crowned BTW.

 

[sidesh0wb0b]

"CAN" be done
no warranty

 

[JMN]

What if I make the whole thing out of labially layered PEEK (minus the non engaging Ti insert) till the patient can afford a second implant, kinda like a long term temp ? Could the shock absorbing and flexing properties of PEEK alleviate the stress issues ? The canine is already crowned BTW.

Float it as an option.

It is a better solution than metal.

Edit: but it may be a worse solution. More flex, more movement...

 

[zero_zero]

Float it as an option.

Trying to come up with a few alternative treatment plans ,then we can weigh the pros and cons before pulling the trigger.

 

[CatamountRob]

I don’t think this is a do or don’t thing. There are factors that should be considered. Mobility in the natural tooth, size of the implant and how well it’s integrated, bruxism. Age of the patient is certainly a factor. I would have no problem making this as long as everyone understood the risk potential.
I wouldn’t even consider a stress breaker.

 

[JMN]

Trying to come up with a few alternative treatment plans ,then we can weigh the pros and cons before pulling the trigger.

Depending on how long the patient will be waiting to sink the other implant don't write off a removable solution.

 

[sidesh0wb0b]

I don’t think this is a do or don’t thing. There are factors that should be factored in. Mobility in the natural tooth, size of the implant and how well it’s integrated, bruxism. Age of the patient is certainly a factor. I would have no problem making this as long as everyone understood the risk potential.
I wouldn’t even consider a stress breaker.

who uses those nasty stress breakers anymore? yuck

 

[rkm rdt]

Got a phone call today from a dentist wondering if we could make a 3 or 4 unit cemented bridge (canine to the first molar) supported by a prep on the front and a custom abutment on the back. I don't remember ever fabricating such thing, natural teeth can move a lot more than an implant could resulting in tensions during function. How will it work on the long run ? Any experiences ? Thanks in advance

Since the canine is the vital tooth and existing crown, perhaps you could fabricate the screw retained bridge with a lingual wing on the canine?
Maybe even non engaging on the abutment.

 

[Tayebdental]

Should not be done, implants on implant abutments only as I know it.

 

[Brett Hansen CDT]

Best plan of action is to make sure the doctor is aware that using an implant and a natural tooth as abutments to a bridge lowers the percentage of long term success. I have done a couple of these in the past and they are still functioning as far as I am aware. Both times I told the doctor that this wasn't an ideal way to restore a case, but I went ahead with fabricating the bridge after he approved it.

There are no 100% in restoring implant cases. Lots of factors go into determining long term success. We also have to deal with patients who may be on a limited budget. As long as we are informing the doctor to the risk factors in cases like this, then we are doing our job in making sure the patient gets the best possible outcome.

 

[lcmlabforum]

Just a cautionary tale. Acrylic interim on natural teeth will likely result in cement wash out,
and the canine will get caries/decay and potentially lose that tooth.
If canine already has a crown - unlikely you can bond a 'wing' on the cast or milled restoration.
If redone splinting implant, on a natural tooth, from molar, will mean long arm leverage and
lack of equivalent support from anterior abutment, and prone to cement failure of the implant;
if not infra-occlusion of the canine resulting in a gap that will get caries/deday.
I would personally stay away from this and if pt not ready for something fixed, make an RPD
that hopefully has enough occl clearance that can connect to the implant with an attachment.
My 2 cents.
LCM

 

[rkm rdt]

metal wing,not zirconia

 

[lcmlabforum]

I know, but not sure how to bond on existing crown
"The canine is already crowned BTW."
LCM

 

[rkm rdt]

I know, but not sure how to bond on existing crown
"The canine is already crowned BTW."
LCM

I wouldn't. I think a lingual/cingulum rest/wing to a new crown might be an option.
However I think we can all agree that another implant would be the best solution.

 

[Jason D]

Just do it, it will be fine 99% of the time.

This periodontal ligament argument has been around forever and had gone in and out of fashion depending on the times and region.

From a physics standpoint the argument is without merit. The stresses come down from above the splinted units, how would mobility even matter?

If it were true we would not splint natural abutments unless they had comparable mobility numbers and I have literally never had that conversation in 40 years.

We splint every single day on cases where we are counting on the more stable abutment to help support the more mobile one. Every dentist I know does this.

Call myth busters because this one needs to be debunked once and for all.

 

[rkm rdt]

Forces From above?
Zero never mentioned whether it was a mx or md bridge .

 

[ztech]

I was reading an article about this a few weeks back and the study indicated no greater incidence of the bridge failing from tooth/implant to tooth/tooth.