1. References Conclusions Background and Aim 1. Gary Greenstein, DDS, MS; John Cavallaro, DDS; Richard Smith, DDS; and Dennis Tarnow, DDS Connecting Teeth to Implants: A Critical Review of the Literature and Presentation of Practical Guidelines, Compendium, September 2009, Volume 30, Issue 7 2. Naert IE, Duyck JA, Hosny MM, et al. Freestanding and tooth-implant connected prostheses in the treatment of partially edentulous patients. Part I: an up to 15-years clinical evaluation. Clin Oral Implants Res. 2001;12(3):237-244 3. Chee WW, Cho GC. A rationale for not connecting implants to natural teeth. J Prosthodont 1997; 6:7–10. It is generally agreed that partial mobile dentures could be regarded as an inappropriate solution for young people regarding their quality of life and self – confidence. In these cases functional and esthetic demands are usually very high and detailed planning as well as multidisciplinary approach is crucial for successful outcome of implant therapy. Although there are many controversial statements regarding splinting teeth and implants individual approach and taking into account the cost/benefit ratio (Figure 1) is mandatory. According to Naert et al. there is no significant difference between freestanding and connected implants in terms of loss of implants (10 out of 339, 1 out of 329 respecitvely). Morover cumulative succes rates for implant supported prostheses (ISP) and tooth- implant supported prostheses (TISP) were 98,4% and 94,5%. The aim of this case report is to present implant supported bridges in conjuction with natural teeth as the best option within the limits of patient’s oral condition and dental status. It is generally agreed that partial mobile dentures could be regarded as an inappropriate solution for young people regarding their quality of life and self – confidence. A 40- years old patient had partial mobile denture for over ten years due to a massive failure of teeth caused by improper life conditions induced by civil war. After anamnestic, clinical and x-ray examination, severe loss of teeth and bone both in the maxilla and mandible, was found. In the upper jaw sinus lift with lateral approach was carried out on the left side with two implants placed simultaneously in the region of teeth #25 and #27. On the right side 3 implants were placed in regio #11, #14 and #15. Due to patient’s refusal to undergo another extensive surgical procedure to gain adequate amount of bone, implants were not placed according to previous prosthetic planning. In the posterior region of lower jaw three implants were placed. It was decided to exploit natural teeth with good prognosis to assist implants for adequate occlusal distribution. After 2- years follow up implant survival rate was 100%. Implant supported bridges in combination with natural teeth presumably could be proper solution for the patients with limited anatomical and financial resources. Implant supported bridges in combination with natural teeth presumably could be proper solution for the patients with limited anatomical and financial resources. Although it has been under disscusion for many years, recent studies showed that it is not contraindicated to splint natural teeth with implants, as long as they have positive longterm prognosis (survival after 10 years), both endodontically and periodontally. Abstract Methods and Materials Results Implant supported bridges in a patient with compromised oral function and aesthetics as a consequence of civil war - case report Miroslav Dragović, Svetlana Dostanić, Marko Pejović, Snježana Čolić, Aleksandra Špadijer - Gostović School of Dental Medicine University of Belgrade Implant supported bridges in a patient with compromised oral function and aesthetics as a consequence of civil war - case report Miroslav Dragović, Svetlana Dostanić, Marko Pejović, Snježana Čolić, Aleksandra Špadijer - Gostović School of Dental Medicine University of Belgrade 467 Presented at 1. Splinting teeth to implants broadens treatment possibilities: a. When anatomic limitations restrict insertion of additional implants (eg, maxillary sinus, mental foramen). b. Lack of bone for implant placement. c. Patient refusal to undergo a bone augmentation procedure. 2. Desire to splint a mobile tooth to an implant. 3. Teeth provide proprioception. 4. Reduced cost for teeth replacement. 5. Additional support for the total load on the dentition. 6. Reduction of the number of implant abutments needed for a restoration. 7. Possibly avoid the need for a cantilever. 8. To preserve the papilla adjacent to the tooth for esthetic or functional concerns (eg, phonetics). Technical Problems 1. Implant fracture 2. Tooth intrusion 3. Intrusion of teeth with telescopic crowns 4. Cement bond breakdown 5. Abutment tooth fracture 6. Abutment screw loosening 7. Fracturing of veneers 8. Prosthesis fracture Biologic Problems 1. Peri-implantitis 2. Endodontic problems 3. Loss of an abutment tooth 4. Loss of an implant 5. Caries 6. Root fracture Figure 1 A 40- years old patient had partial mobile denture for over ten years due to a massive failure of teeth caused by improper life conditions induced by civil war. After anamnestic, clinical and x-ray examination, severe loss of teeth and bone both in the maxilla and mandible, was found. It was the right side of the upper jaw that was affected most of all. In the upper jaw sinus lift with lateral approach was carried out on the left side. Two implants were placed simultaneously in the region of teeth #25 and #27 (Bredent 3.5 x 12mm, 4.0 x 10mm). Two months later on the right side sinus lift using transalveolar approach described by Summers was conducted and 3 implants were placed in regio #11, #14 and #15 (Bredent 3.5 x 12mm, 4.0 x 10mm, 4.0 x 10mm). Due to patient’s refusal to undergo another extensive surgical procedure to gain adequate amount of bone, implants were not placed according to previous prosthetic planning. Moreover, implants were inserted where it was possibile to obtain optimal primary stability (Figure 2). In the posterior region of lower jaw three implants were placed (Bredent 3.5 x 12mm, 4.0 x 10mm, 4.5 x 8mm). Uneven resorption of bone in the upper jaw, immense sagital discrepancy between two jaws and huge interocclusal space, imposed complex prosthetic solution. Thus, it was decided to exploit natural teeth with good prognosis to assist implants for adequate occlusal distribution. Teeth were prepared both endodontically and periodontally. After 2- years follow up implant survival rate was 100%. Patient’s satisfaction and quality of life were improved to a great extent. Results showed that prerequisites for excellent oral hygiene and maintaining longterm success were achieved (Figures 3 – 7). Figure 2 Figure 7 Figure 5 Figure 4 Figure 3 Figure 6 Practical guidelines if splinting of implants and natural teeth is inevitable: 1. Select healthy teeth 2. Rigidly connect the tooth and implant 3. Avoid telescopic crowns 4. Provide retention form with minimal taper of axial walls on abutment teeth 5. Use permanent cementation 6. The bridge span should be short. 7. Occlusal forces should be meticulously directed to the opposing arch. 8. Do not use TISPs in patients with parafunctional habits. 9. TISPs in patients with uncontrolled caries should be avoided; ISPs are preferred 10. Pulpless teeth with extensive missing coronal tooth structure or root canal anatomy that is inadequate to predictably retain a core or post and core should not be used in a TISP 11. High-risk TISPs (eg, multiple adjacent pontics, double cantilevered pontics) or prostheses with minimal abutment support should be expected to have a higher failure rate even though these treatment plans may benefit certain patients. 12. In the esthetic zone, if a papilla or papillae is crucial for esthetics or function (eg, phonetics), consider using natural teeth (TISPs) because the supracrestal gingival fibers associated with healthy teeth will provide interproximal soft-tissue support