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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 9  |  Issue : 3  |  Page : 137-140

Tooth implant connected fixed partial denture: 3-year follow-up


1 Department of Prosthodontics, Priyadarshini Dental College and Hospital, Thiruvallur, Tamil Nadu, India
2 Department of Prosthodontics, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India

Date of Web Publication27-Sep-2018

Correspondence Address:
J Brintha Jei
Department of Prosthodontics, SRM Dental College, Ramapuram, Chennai, Tamil Nadu
India
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DOI: 10.4103/srmjrds.srmjrds_19_18

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  Abstract 

The natural tooth implant connected fixed partial denture is subjected to debate. Literature was suggestive of both for and against the connection. The connection of implant to natural tooth has advantages and disadvantages. The intrusion of the teeth, biomechanical mismatch between tooth and implant, and marginal bone loss are associated limitations in implant tooth connection. The reduction in cost, anatomical limitations, and reduced surgical intervention were of suggestive of the connection. This clinical report was discussed on the 3-year follow-up of the tooth connected implant-supported fixed partial, and the procedures were followed in the fabrication of prosthesis that aided in the success of the restoration.

Keywords: Matrix, nonrigid connector, patrix, tooth implant connected prosthesis


How to cite this article:
Kumar T A, Chander N G, Jei J B. Tooth implant connected fixed partial denture: 3-year follow-up. SRM J Res Dent Sci 2018;9:137-40

How to cite this URL:
Kumar T A, Chander N G, Jei J B. Tooth implant connected fixed partial denture: 3-year follow-up. SRM J Res Dent Sci [serial online] 2018 [cited 2018 Dec 18];9:137-40. Available from: http://www.srmjrds.in/text.asp?2018/9/3/137/242448


  Introduction Top


Variable options are available in rehabilitating the partially edentulous patients. The treatment plan varies from a removable denture to fixed denture supported by tooth and implants. With the advancements, the implants have become established treatment option. The implant prosthodontics has evolved significantly with reduced limitations and with relatively no contraindications. The implant and tooth connection is subjected to discussion. Literatures have justified the connection with definitive evidence-based decisions.[1] Few reports have followed the criteria.[2],[3],[4] This clinical report followed the established criteria to obtain successful prognosis.


  Case Report Top


A 60-year-old male patient was referred to the Department of Prosthodontics, SRM Dental College, Ramapuram, Chennai, with a chief complaint of the missing teeth. The intraoral examination revealed missing mandibular left second molar (37) and right mandibular first molar (46) [Figure 1]. The treatment options for missing teeth were explained to the patient. The patient consented for implant-supported prosthesis. The patient was explained on the comprehensive dental management of oral hygiene and restoration of caries teeth. The patient consented to the treatment options. The radiograph around 37 and 46 regions displayed good bone support for all the teeth to be used as abutment and adequate bone for implant placement. The surgical placement of implant was done in 37 and 46 regions following delayed loading protocol [Figure 2]. During the healing phase, the patient had a failed endodontic treatment in 36, and the tooth was extracted. The treatment modalities of the teeth replacements were explained to patients. The patient was unwilling for additional implant in the 36 region due to financial constraints. Hence, the clinical scenario resulted with 35 being present, edentulous space in 36 bounded posteriorly by implant in 37.
Figure 1: Preoperative

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Figure 2: Postimplant surgery

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The treatment of the patient with implant-supported fixed partial denture (FPD) with nonrigid connector was decided as the final prosthetic option. The benefits and limitations of the treatment were explained to the patient, and the consent was obtained for the treatment.

Procedure

  1. 3.5 mm × 10 mm implant was placed in the second molar region. (37) Requisite surgical protocol for delayed loading was followed (before 36 extraction)
  2. Following tooth extraction (36) and adapting the delayed loading protocol, the tooth preparation of second premolar (35) was done for the metal-ceramic FPD. A nonrigid connector between the implant in the second premolar region and second molar was planned The distal of the second premolar was prepared to accommodate a nonrigid connector
  3. The implant abutment was milled for prosthetic clearances. The implant abutment was torque to 30 N. Indirect impression was made involving prepared tooth and implant for making the type 4 stone working model (Kalabhai Karson Pvt., Ltd)
  4. An acrylic provisional restoration was cemented connecting the tooth from 35 to 37 (implant)
  5. The wax pattern was made for the metal-ceramic FPD with the nonrigid connector from 35 to 37. The connector between the 35 and 36 was sectioned. The matrix of attachment was luted to 35 wax pattern [Figure 3]. Conventional casting procedure was followed and casting made. The retrieved casting was tried on the patient. After the metal try in. The casting was transferred to the cast and patrix of attachment is fixed to the casting. The sectioned wax pattern was luted to the patrix. The wax pattern was reevaluated for the fit and casting was made. The final metal frame work with both matrix and patrix was re-checked on patient [Figure 4]
  6. Ceramic layering was done. Care was observed in reducing the buccolingual width of crown, establishing the centric occlusal contacts, removing the eccentric and deflective occlusal contacts. The finished metal ceramic FPD was checked on the patient, glazed and luted with zinc polycarboxylate cement [Figure 5]
  7. The patient was instructed on maintenance protocol and periodically reviewed for 3 years [Figure 6], [Figure 7], [Figure 8].
Figure 3: Matrix try in

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Figure 4: Metal framework try in

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Figure 5: Metal ceramic fixed partial denture cementation

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Figure 6: Postinsertion radiograph

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Figure 7: Postoperative 24-month follow-up

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Figure 8: Postoperative 36-month follow-up

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  Discussion Top


The tooth and implant connection in prosthesis provides a biomechanical challenge. Studies and reports on both success and failures were reported.[5],[6],[7] The abutment tooth fracture, abutment screw loosening, intrusion, prosthesis fracture, fracture of veneers, and implant fracture were potential complications reported in the literature. The procedure has several advantages alike widening the treatment modalities, aids in splinting, improves proprioception, esthetic, improved biomechanics, and reduces cost. Several evidence of meta-analysis, animal studies, controlled clinical trials are available in connecting the tooth and implant.[8],[9] Reports of failures were due to improper case selection and prosthesis design. The evidence-based data in the fabrication of tooth implant connected prosthesis were followed for the successful prognosis.[8] The adaptation of these guidelines aids in more successful prosthesis.[6],[9]


  Conclusion Top


This case report provides a 36-month follow-up with no potential complications either in tooth or implant in a tooth-implant connected FPD. An observation period is continued with and periodic maintenance and surveillance of clinical situation.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Pjetursson BE, Brägger U, Lang NP, Zwahlen M. Comparison of survival and complication rates of tooth-supported fixed dental prostheses (FDPs) and implant-supported FDPs and single crowns (SCs). Clin Oral Implants Res 2007;18 Suppl 3:97-113.  Back to cited text no. 1
    
2.
Akça K, Cehreli MC. Two-year prospective follow-up of implant/tooth-supported versus freestanding implant-supported fixed partial dentures. Int J Periodontics Restorative Dent 2008;28:593-9.  Back to cited text no. 2
    
3.
Naert IE, Duyck JA, Hosny MM, Quirynen M, van Steenberghe D. Freestanding and tooth-implant connected prostheses in the treatment of partially edentulous patients part II: An up to 15-years radiographic evaluation. Clin Oral Implants Res 2001;12:245-51.  Back to cited text no. 3
    
4.
Hosny M, Duyck J, van Steenberghe D, Naert I. Within-subject comparison between connected and nonconnected tooth-to-implant fixed partial prostheses: Up to 14-year follow-up study. Int J Prosthodont 2000;13:340-6.  Back to cited text no. 4
    
5.
Misch CM, Ismail YH. Finite element stress analysis of tooth-to-implant fixed partial denture designs. J Prosthodont 1993;2:83-92.  Back to cited text no. 5
    
6.
Greenstein G, Cavallaro J, Smith R, Tarnow D. Connecting teeth to implants: A critical review of the literature and presentation of practical guidelines. Compend Contin Educ Dent 2009;30:440-53.  Back to cited text no. 6
    
7.
Akça K, Uysal S, Cehreli MC. Implant-tooth-supported fixed partial prostheses: Correlations between in vivo occlusal bite forces and marginal bone reactions. Clin Oral Implants Res 2006;17:331-6.  Back to cited text no. 7
    
8.
Lindh T, Dahlgren S, Gunnarsson K, Josefsson T, Nilson H, Wilhelmsson P, et al. Tooth-implant supported fixed prostheses: A retrospective multicenter study. Int J Prosthodont 2001;14:321-8.  Back to cited text no. 8
    
9.
Chee WW, Mordohai N. Tooth-to-implant connection: A systematic review of the literature and a case report utilizing a new connection design. Clin Implant Dent Relat Res 2010;12:122-33.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]



 

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Abstract
Introduction
Case Report
Discussion
Conclusion
References
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