By Prim. Dr. Tome Tasevski
Almost every day, every single implantologist around the world will be challenged with the demand coming on several patient cases, and for what? Well, to put either one or two dental implants and connect them with the rest of the remained teeth. This is a huge responsibility not just for me, but, also, I believe, for the general dental world. So, why is this a challenge and do we have to do it or not?
The teeth are naturally designed to act as shock absorbers. They lie into their sockets into the bone and are connected with a periodontal ligament. When bite pressure occurs the tooth moves 360 degrees in all angles, plus it intrudes and extrudes. The elasticity of the tooth structure is much higher than the titanium structure of the implant.
In opposite, the titanium made implant is rigidly fixed to the bone and the surface of the bone is not flexible as much as natural tooth.
So, when we connect the two structures, it is more than clear what will happen i.e. the mobility of the teeth will, in short period of time, take out the implant. The stresses produced by occlusion either distribute or conduct to prosthetic components and bone interface. In addition, mobility of a natural tooth may increase with the occlusion trauma. Tooth may become its original occasion, after eliminating occlusion trauma in spite of the size of tooth movement. Mobility of an implant may be formed in same way under occlusion trauma. After elimination of the factor, implant frequently returns into its original rigid position. Alternatively, mobility of implant may continue, health of surrounding tissues become worse, and usually implant is lost in a short time period.
Now, this above, and more other stuff that we discussed in this topic in our dental world, is all true and are like unwritten law, but does we always follow the rules? Me, personally, I must admit NO! Why? Well, because sometimes, it depends on the case, I connect both structures together. In my 10 years experience, several cases proved in practice that this is not always like described above and my patients still have their implants and perfectly made bridges counter-parted with teeth.
I also have lost some implants this way. On these patients the same was replaced and was reinforced by adding additional implants and were disconnected from the bridge on teeth. Until now the implants are present and stable on those patients.
At the end, the topic is subject to much controversy in dentistry. Of course, it is not good to connect the teeth with the implants, but, based on my experience, if we have some good indications to do it then we can choose both ways to do it. The difference is that You, if you are patient, or you, if you are a dentist must always have or give all the information about the risks involved on doing this.
Nothing is 100% safe, but one is sure: either it will be well done job or it will be a great disappointment!