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2024 Top Story in Clinical Dentistry: Should We Splint Dental Implants?
Treatment planning decisions with dental implants impact peri-implant health. Clinicians routinely decide whether to use short implants, splint the adjacent implants, or use platform-switched implants. The splinting of adjacent implants is especially controversial, as some clinicians feel that there is a loading advantage when splinting, whereas others suggest that splinting limits access. We selected the study by Hakkers et al as the story of the year because it is a rare long-term study that evaluated the impact of commonly considered treatment planning decisions on peri-implantitis and implant loss.1
This study was a 15-year prospective evaluation of 122 patients with 223 Biomet 3i implants evaluated at 1, 5, and 15 years following placement. All patients received 8.5 mm–long implants to replace posterior dentition. It is rare to see a 15-year clinical study on short implants. The implants were either splinted or placed as single units with platform switching or matching. Complications were subdivided into biological and restorative, including implant loss, peri-implant mucositis, peri-implantitis, patient satisfaction, screw loosening, and porcelain fracture.
The results at 15 years were determined using the data from 81 patients with 154 implants. Implant loss after 15 years was approximately 10% when patients who were deceased or those lost to follow-up were not included. Platform switching resulted in statistically less bone loss than platform matching, although the clinical impact might have been minimal. Single-unit implant restorations demonstrated less bone loss than splinted restorations; however, the allocation of splinting/no splinting was not randomized and the results might have been impacted by having proximal teeth adjacent to single-unit restorations, which could help preserve bone levels compared with those in larger edentulous spaces where two splinted implants were used. At the 15-year follow-up, patient satisfaction remained high in all patients compared with pretreatment levels.
The decision regarding splinting implants is patient-specific. There are patient and implant factors to be considered.2-4 In general, we recommend no splinting. The checklist below reviews patient, treatment, and implant factors that should be considered. If multiple risks are identified, splinting may become a consideration.
Patient and treatment factors | Implant factors |
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Is the statistically significant difference determined by Hakker et al who evaluated splinted versus non-splinted implants clinically significant? The answer would depend on the clinical situation. For most patients, these measured differences are probably not clinically significant. This is because the measurement error or consistency of the clinician measuring the bone loss is higher than the measured difference.5 However, for some patients, splinting could be problematic. For example, a patient with poor dexterity might have limited access to maintain splinted implants.
With regard to the evidence for platform switching, we would advocate that platform switching is both statistically and clinically significant.6 It is important to carefully identify patient and treatment risks that are modifiable and actively involve patients in understanding the risks so that the patients are committed to the maintenance plan.
Additional Info
- Hakkers J, Telleman G, de Waal YCM, et al. Analysis of 8.5 mm Long Dental Implants Provided with Splinted or Solitary Implant Restorations: A 15-Year Prospective Study. J Clin Med. 2024;13(17):5162.
- Vigolo P, Mutinelli S, Zaccaria M, et al. Clinical evaluation of marginal bone level change around multiple adjacent implants restored with splinted and nonsplinted restorations: a 10-year randomized controlled trial. Int J Oral Maxillofac Implants. 2015;30(2):411-418.
- Rossi F, Lang NP, Ricci E, et al. Long-term follow-up of single crowns supported by short, moderately rough implants-A prospective 10-year cohort study. Clin Oral Implants Res. 2018;29(12):1212-1219.
- Ravidà A, Saleh MHA, Muriel MC, et al. Biological and Technical Complications of Splinted or Nonsplinted Dental Implants: A Decision Tree for Selection. Implant Dent. 2018;27(1):89-94.
- Walton TR, Layton DM. Intra- and inter-examiner agreement when assessing radiographic implant bone levels: Differences related to brightness, accuracy, participant demographics and implant characteristics. Clin Oral Implants Res. 2018;29(7):756-771.
- Vigolo P, Mutinelli S, Stellini E, et al. Influence of Platform-Switched Restoration on Bone Resorption in Patients Treated with Wide-Diameter, External-Hex-Connection Dental Implants: A 10-Year Follow-up Study. Int J Oral Maxillofac Implants. 2023;38(1):46-52.