Académique Documents
Professionnel Documents
Culture Documents
n the past, there were only the replacement of a missing tooth with a fixed bridge. In my
ment crowns in the studies cited around the tooth preparations is crowns for implants are no more
earlier, but caries obviously irritated. Similarly, most of my difficult to clean than are natu-
would not be a failure factor patients who receive single ral teeth.
with the implants. On the basis implants inform me that there is
of my observations across sev- mild discomfort and awareness ESTHETIC RESULT
eral decades of placing crowns of the surgical area for the first This subject could fill an entire
on both natural teeth and few days, but the pain disap- book. Either procedure has limi-
implants, I suggest that single pears after that time. In my tations relative to the eventual
crowns placed over implants experience, most patients re- esthetic result. Either procedure
should last at least 20 years ceiving a single implant do not can be excellent or poor estheti-
from a functional standpoint. feel it is necessary to take the cally, depending on the bone and
However, their esthetic lon- analgesics prescribed on an as- soft tissue present, the clini-
gevity may be some years cian’s skill and the laboratory
shorter owing to tissue technician’s skill. Each of the
shrinkage, which causes an I suggest that single crowns procedures may have esthetic
unacceptable esthetic appear- limitations related to the pres-
placed over implants should
ance and loss of superficial color ence of anatomical anomalies,
fired onto the crowns. last at least 20 years from tooth malalignment, soft-tissue
a functional standpoint. irregularities or lack of adequate
DIFFICULTY OF THE underlying bone. Often, surgical
TREATMENT
However, their esthetic
longevity may be some procedures are necessary to cor-
As a prosthodontist who has years shorter owing rect the defects before treatment
placed many single-tooth begins for either an FPD or a
to tissue shrinkage.
replacement implants and the single crown over an implant. It
subsequent abutments and is my opinion that in a typical
crowns, I can state that the pro- clinical situation, either tech-
cedure is relatively easy to needed basis. Regarding discom- nique can produce adequate-to-
accomplish for healthy patients fort or anxiety on the patient’s excellent esthetic results, but
who have adequate bone. Simi- part, the implant and the subse- that occasionally prerestorative
larly, average three-unit FPDs quent abutment and crown may oral surgical or periodontal
are relatively easy to accom- seem more painful than the treatment is necessary to
plish. I judge that the two tech- three-unit FPD because of the achieve optimum esthetic
niques are similar in complexity, stigma associated with the word results for either therapy.
except that many dentists whose “surgery,” which frightens some
orientation is restorative care do patients. OTHER FACTORS
not place implants, and so they The following factors also can
must delegate that aspect of the ORAL HYGIENE influence the decision to select
procedure to a dentist competent My experience with many pa- one therapy over another:
in surgery. tients receiving either of these dsmoking, which usually is
treatments leads me to conclude considered to be negative rela-
DISCOMFORT FOR THE that the two treatments, if tive to placement of implants;
PATIENT
accomplished well, do not differ dpoor oral hygiene history,
When observing the many clin- in permitting the patient to which may indicate that implant
ical procedures of individual accomplish adequate oral placement could be better than
dentists and typical patients hygiene. However, pontics on repair and retention of question-
requiring the replacement of one FPDs often are made in so- able teeth;
tooth, I have noted that either called “ridge lap” forms, which dphysical activities, such as
technique can be almost pain- commonly are observed coming potentially traumatic athletic
less—or painful, if the dentist from laboratories and, unfortu- activity, which may require res-
uses more intensive procedures. nately, are accepted by some torations that resist breakage;
Most patients tell me that for a practitioners. Such ridge-lap dretained, mobile, periodon-
day or two after crown prepara- anatomy is difficult to clean on tally treated teeth that may be
tion procedures, the soft tissue an FPD. Properly fabricated better restored with conven-
tional FPDs than with implants; supported crown to replace a 8. Soderfeldt B, Palmqvist S. A multilevel
analysis of factors affecting the longevity of
dbruxism and clenching that single missing tooth. ■ fixed partial dentures, retainers and abut-
usually indicate the need for ments. J Oral Rehabil 1998;25(4):245-52.
Dr. Christensen is the director, Practical 9. Napankangas R, Salonen-Kemppi MA,
high-strength restorations. Clinical Courses, and co-founder and senior Raustia AM. Longevity of fixed metal ceramic
consultant, CR Foundation, Provo, Utah. He bridge prostheses: a clinical follow-up study. J
SUMMARY also is the dean, Scottsdale Center for Den- Oral Rehabil 2002;29(2):140-5.
tistry, Ariz. Address reprint requests to Dr. 10. Holm C, Tidehag P, Tillberg A, Molin M.
Historically, three-unit FPDs Christensen at CR Foundation, 3707 N. Longevity and quality of FPDs: a retrospective
Canyon Road, Suite 3D, Provo, Utah 84604. study of restorations 30, 20, and 10 years after
have served patients well in insertion. Int J Prosthodont 2003;16(3):238-9.
replacing a single missing tooth. The views expressed are those of the author 11. Khayat PG, Milliez SN. Prospective clin-
and do not necessarily reflect the opinions or ical evaluation of 835 multithreaded tapered
However, the three-unit FPD official policies of the American Dental screw-vent implants: results after two years of
procedure is invasive if teeth Association. functional bonding. J Oral Implantol 2007;
33(4):225-31.
adjacent to the space are not in 1. American Dental Association, Survey 12. Schulte J, Flores AM, Weed M. Crown-
need of restorations. The tech- Center. 2007 Survey of dental fees. Chicago: to-implant ratios of single tooth implant-
American Dental Association; 2007:25-6. supported restorations. J Prosthet Dent 2007;
nique of implant placement and 2. American Dental Association. CDT 2007- 98(1):1-5.
restoration of the missing tooth 2008 Current Dental Terminology. Chicago: 13. Doyle SL, Hodges JS, Pesun IJ, Baisden
American Dental Association; 2007. MK, Bowles WR. Factors affecting outcomes
with an implant-supported 3. Mazurat RD. Longevity of partial, com- for single-tooth implants and endodontic resto-
crown is replacing the three- plete and fixed prostheses: a literature review. rations. J Endod 2007;33(4):399-402.
J Can Dent Assoc 1992;58(6):500-4. 14. Levin L, Sadet P, Grossmann Y. A retro-
unit FPD procedure. Research 4. Maryniuk GA, Kaplan SH. Longevity of spective evaluation of 1,387 single-tooth
appears to indicate that the restorations: survey results of dentists’ esti- implants: a 6-year follow-up. J Periodontol
mates and attitudes. JADA 1986;112(1):39-45. 2006;77(12):2080-3.
single-implant procedure and 5. Priest G. An 11-year reevaluation of resin- 15. Degidi M, Piattelli A, Iezzi G, Carinci F.
implant-supported crown have bonded fixed partial dentures. Int J Peri- Wide-diameter implants: analysis of clinical
odontics Restorative Dent 1995;15(3):238-47. outcome of 304 fixtures. J Periodontol 2007;
greater longevity than does the 6. Fayyad MA, al-Rafee MA. Failure of 78(1):52-8.
FPD restoration on natural dental bridges: III—effect of some technical 16. Degidi M, Piattelli A, Gehrke P, Felice P,
factors. J Oral Rehabil 1996;23(10):675-8. Carinci F. Five-year outcome of 111 immediate
teeth. It appears that the state 7. Libby G, Arcuri MR, LaVelle WE, Hebl L. nonfunctional single restorations. J Oral
of the art is, whenever possible, Longevity of fixed partial dentures. J Prosthet Implantol 2006;32(6):277-85.
Dent 1997;78(2):127-31.
placing a single implant-