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Single-Tooth Implant Restorations

Considerations and Treatment Sequencing

Replacement of single missing teeth has historically been accomplished with a variety of prosthodontic techniques. Traditional and resin-bonded fixed partial dentures (FPDs) have been referred to as the "workhorses" of prosthetic dentistry. While an 86% success rate has been associated with conventional FPDs after 7 years of function, resin-bonded prostheses have been cited to average a lifespan of 84 months.1 Resin-bonded prostheses, however, are considered a conservative alternative for young patients who have lost a tooth as a result of trauma or other structural reasons.2 Although orthodontic treatment and consolidation of the dental arch have also been successful, this modality is more effective for treatment of the mandibular anterior region.3 While replacement of single missing teeth can certainly be accomplished with a removable prosthesis, this is generally indicated as a short-term solution or for situations that are refractory to surgical augmentation.

Replacement of single missing teeth has become predictable with the advent of osseointegrated technology.4-6 Preliminary data of single-tooth prosthetics suggest that this procedure has comparable or superior capabilities over alternative methods  of replacement.7-9 Implant placement must be restoration driven,10 but it is additionally based on several requisites. An adequate volume of bone, soft tissue, and placement positioning are surgical requisites that should be considered. Surgical/prosthetic considerations (eg, indexing, provisionalization, abutment selection, cementation philosophy, and antirotational features)11 should also be anticipated prior to replacement of a single missing tooth with this type of restoration.12 Assuming an implant is osseointegrated, the most common complications to arise from these restorations are abutment screw loosening and porcelain fracture. This complication has been addressed by the advent of antirotational features that reduce screw loosening.

While product development, improved surgical techniques, and higher-quality dental materials have contributed to the potential of implant restoration as a conservative, first-line treatment option, various procedures must be reviewed with the patient to ensure that a collective, informed decision is made. The presentation of available treatment options will enable the patient to make an educated selection. After all, it is the responsibility of today's clinician to inform their patients on how to actively participate in their own dental healthcare.

*Associate Professor, Department of General Dentistry, Louisiana State University School of Dentistry, New Orleans, Louisiana.

References

  1. Lindquist E, Karlsson S. Success rate and failure for fixed partial dentures after 20 years of service: Part 1. Int J Prosthodont 1998;11(2):133-138.
  2. Thayer KF, Williams VD, Diaz-Arnold AM, Boyer DB. Acid-etched resin bonded cast metal prostheses: A retrospective study of 5- to 15-year-old restorations. Int J Prosthodont 1993;6(3):264-269.
  3. Zitzman NU, Marinello CP. Anterior single-tooth replacement: Clinical examination and treatment planning. Pract Periodont Aesthet Dent 1999;11(7):847-858.
  4. Vigolo P, Givani A. Clinical evaluation of single-tooth mini-implant restorations: A five-year retrospective study. J Prosthet Dent 2000;84(1):50-54.
  5. Scholander S. A retrospective evaluation of 259 single-tooth replacements by the use of Brånemark implants. Int J Prosthodont 1999;12(6):483-491.
  6. Polizzi G, Fabbro S, Furri M, et al. Clinical application of narrow Brånemark System implants for single-tooth restorations. Int J Oral Maxillofac Impl 1999;14(4):496-503.
  7. Scheller H, Urgell JP, Kultje C, et al. A 5-year multicenter study on implant-supported single crown restorations. Int J Oral Maxillofac Impl 1998;13(2):212-218.
  8. Misch CE. Endosteal implants for posterior single tooth replacement: Alternatives, indications, contraindications, and limitations. J Oral Implantol 1999;25(2):80-94.
  9. Muftu A, Chapman RJ. Replacing posterior teeth with freestanding implants: Four-year prosthodontic results of a prospective study. J Am Dent Assoc 1998;129(8):1097-1102.
  10. Garber DA. The esthetic dental implant: Letting restoration be the guide. J Am Dent Assoc 1995;126(3):319-325.
  11. Binon PP. The Spline implant: Design, engineering, and evaluation. Int J Prosthodont 1996;9(5):419-433.
  12. Lewis S. Treatment sequencing for implant restoration of partially edentulous patients. Int J Periodont Rest Dent 1999;19(2):146-155.
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