Connected Dental Implant Teeth or Separate Crowns …What is Best? Dentist –Ramsey Amin, DDS Explains

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The best dental implant teeth crowns can be made in a variety of ways.  The teeth can be made separately, like natural teeth or connected as bridges. This post refers to having more than one implant next to another.

In my Burbank dental implant practice, I restore the crowns or bridges for dental implants in a variety of ways depending on your unique situation.

Everyone usually wants separate individual teeth. Separate dental implant crowns allow you to floss normally between your teeth. Another advantage is that if the porcelain crown breaks or is damaged, it is easily repaired or replaced as one isolated tooth rather than having to replace two or more.X52630

There are some disadvantages to individual implant teeth.  If your teeth are long due to vertical bone loss, you may get more food stuck between two implants right next to each other.  It sounds strange to get more food stuck if they are disconnected but it happens because implants don’t have a periodontal ligament which acts a shock absorber.  When your dentist adjusts the space between the implants which is necessary to install the crowns, a good or bad space can be created. Lastly, single unit implant teeth crowns are more likely to break porcelain than connected ones

 

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The above x-ray shows the best of both worlds. In this patient from Burbank, some of the implants are connected and some are individual.

Connected implant crowns are referred to as “splinted.”  Splinted implants have the huge disadvantage that they are connected but that is also their advantage in some ways.  Splinted implants are most commonly used in areas where the bone is soft and the bite forces are strong.  That area is notoriously the upper molars.  If your bone is soft and/or had to be grafted back, splinted implants distribute forces better to the bone.  That will prevent bone loss over time that can happen around dental implants that get overloaded with bite forces such as clenching and grinding.

You can’t floss normally around connected dental implants but that is ok.  If your teeth are designed well and a great lab is used, a floss threader, proxy brush and/or rubber tip works great.  Connected implants are less likely to fracture porcelain.

in general, connected dental implants are better if there is any question  about bone stability.

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So what is the best?  Each situation is very unique.  I recommend different ways for different patients and in different areas of the mouth.  This post is focused on back teeth.  Front teeth dental implants have many other concerns from the cosmetic standpoint far beyond this post.

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow of the American Academy of Implant Dentistry
Burbank, California
http://www.burbankdentalimplants.com


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38 thoughts on “Connected Dental Implant Teeth or Separate Crowns …What is Best? Dentist –Ramsey Amin, DDS Explains

  1. Christina M. Turner

    I am missing 2 adjacent teeth on upper right the 6 year molar and tooth in front. Can one implant be used.

    Reply
    1. RamseyAminDDS Post author

      this would not be a good area to use a single dental implant to replace 2 teeth. This is typically done in an area that is very narrow towards the front of the mouth.

      Reply
  2. Eddie

    Hello Dr. Amin,

    I had porcelain to metal crowns on my four front teeth for the past 17 years. Never had any problems except the gums statting to pull up. So I decided to change them. My dentist suggestes zirconium/porcelain combo. My question is should I have them separate or bridged 2 and 2 or all four together.
    Thanks,

    Reply
    1. RamseyAminDDS Post author

      If they are natural teeth then do smaller segments. If they are implants connect all four.

      Reply
  3. Pam kerr

    I love my dentist and have been using him for a long time but I’m questioning his treatment plan for my upper teeth. All of my upper teeth are crowned with a 6 tooth bridge in front. It started out as 3 tooth bridge that failed and was replaced with a 6 tooth bridge for stability and strength. Now that is failing due to an injury to it. Now he want to crown all my upper teeth with one solid piece. This scares me because what happens if something happens under one tooth. I had a second opinion and that dentist said to never connect all teeth.

    Reply
    1. RamseyAminDDS Post author

      teeth are nature’s is best dental implants. If they can be saved predictably and last few another 10-20 years then that may be an excellent option depending on your age!

      Reply
    1. RamseyAminDDS Post author

      In my office in Burbank, California, I do not charge any extra to connect dental implant crowns together. It is the same price either way.

      Happy Thanksgiving

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
      1. David

        I sure wish I could see you in my home town. I’m dealing with a very serious issue with my options, rather I should say lack of options. I have a treatment plan that was done by someone who did not accept my in surance but I chose to use him as my advisor and I paid him cash. He is well respected but I cannot afford his rates. But I was willing to get the best plan and the option to use the bridged method was something he said would be fine. So I go to the local dentist who accepts my insurance and he is trying to put some prostetic device along with porcelain fused to metal crowns over 7 lower frontal teeth after grinding them down. Don’t ge me wrong, my teeth needed to be fixed but these are the frontal teeth and all are in line with each other. I want the 6 in the center bridged and the 7th is a stray that is not healthy so I said leave it out of the bridge. he wants to keep it in and do a root canal later if necessary. But if it breaks the crown or bridge I am screwed. I rather extract that tooth if it starts to act up to be honest. But why is this guy so insistent on pushing metal crowns on frontal teeth in the form of a bridge like this? And the prostetic partial plate to sorta latch on to that tooth is gonna drive it to it’s doom even sooner. I just question the qualifiations of many dentists anymore and it seems like we patients have to become knowledgeable dentists just to make sure we are not getting ripped off.

        Reply
        1. RamseyAminDDS Post author

          Dental insurance does not do a lot for dental implants so I would not suggest you choose your provider based on this.
          Most dentists do not have any ill intent. I teach a lot of dentists. They have a wide variety of skill level, but most are very good people and have no intention to “rip you off.”
          It sounds like your situation is complex.
          I would avoid bridging your natural teeth together as much as possible. If even one fails, you’re going to have big issues.

          Very respectfully,
          Ramsey Amin DDS

          Reply
  4. A Edgerton

    Is it better to use the same brand of implant? I am having my second implant (some 5 years later) next to a top branded implant. I can go with another ‘cheaper’ brand but would like to know if this will cause problems. Thank you.

    Reply
  5. Mike

    29 & 30 implants were installed angled & slanted TOWARD each other , and
    within a hair or TOUCHING. a $500 customized abutment was made & challanging put on.
    The Bigger issue >>>they are SHORTER than 28 & 27 !
    .. so it has made my teeth post braces fall slant to where they were pre Braces.
    worse using a fabricated pulled #2 and #3 was pulled 2010 -we told I did not need molars that preme molars were enough,( So what I now realise should have been an inexpensive collogen fill & one day implant,… is NOW suggested as a 15$K sinus lift.
    MORE #31 was pulled >> how do I know if it really needed to be pulled?
    . as that 2010 pulled 31..
    combined with delayed #3
    a fabricated pulled #2
    and NOW #29/30 I assumed I could WOULD use for support under #3 I always wanted,..==
    yet another new implant #2 and #31 ( as NEITHER should be needed!
    QUESTIONS:
    1) with NEW 29 and 3 implants angled toward ea other AND shorter ( in height) than the 27 and 28 adjacent natural teeth,…
    and because of a customized abutment. now what ?
    1B) what do I use to make 29/30 implants HIGHER ( same level) as 27 28??
    1C) Since they have this already defect…. do they and how are they going ot be connected with eventual #31 . justified by the surgeon because of pulling fabricated #2 IE wont I need to connect 29 & 30 to eventual 31?
    and are any of these going to be stable long term
    thanks Mike.

    Reply
    1. RamseyAminDDS Post author

      What is shorter? The porcelain crowns or the screws in the bone?
      I am confused by your email…can you summarize it?
      Sorry!
      Dr. Amin

      Reply
      1. Mike

        the screws in the bone are REAL short, -(barely) over the bone level in the panorex picture. And because they are literally ( for NO necessary reason ) angled toward each other and so close to each other literally touching.,.. ONE $500 customized abutment was put on to connect the two short implants. I was going to use #30 to support #3 but now the severity of an angled abutment would be reckless to use it for #3 support.
        With the abutment they are a bit shorter, the bigger issue now is that because of how much time there was between ( the pre invisalign mini implants being removed) —–and getting 29/30 implants uncovered & abutments put on,)).. (during this one & 1/2 hr time period ,..the upper back 4 and 5 had dropped down just a bit into the air space of to be 29/30.
        Would you suggest using a few braces to pull my teeth back up??
        I did not know my entire BITe would collapse down onto ONE side SO DRASTICALLY!! . BUT another question concerns me- in 2012 a Brilliant surgeon fixed a ripped up RIGHT TMJ from a car wreck. an amazing surgeon put an end to 2 yrs of undiagnosed chaos.. BUT in 2002 sick after a violent ankle adjustment ripped my ankle tendons I threw up with pain– popping old scar tissue . Now.. just missing 29 /30 for 1 & 1.2 yrs is that enought to let that entire side of my mouth drop ??
        ( So Im left wondering IF some of this dropping is from stretched out tendons ligiments of the old Right side TMJ???
        AFTERALL– I NEVER had the left side drop and that side had actually had missing teeth for four yrs. 19/20 21. and NO Upper drop down!!
        It makes me concerned why my teeth are dropping only on the right so severe??
        HELP any thoughts?

        2) if you have THREE implants /vertical,.. right next to each other/. are all three supposed to be the same height for a “CONNECTED implant “sprinted” support or just the outer side two END /ends connect.??
        THAnKS so much
        Mark

        Reply
        1. Mike

          for 3 “connected implants to be considered,..”Connected”,do they all three need to touch the top ( or even close??), and how can you see if one is cracked.

          Reply
        2. RamseyAminDDS Post author

          The change in the upper teeth dropping down likely has nothing to do with your TMJ problem. This is called supra-eruption and it can happen fairly quickly but most the time it starts about 1 year later. You could do braces to do some correction if the teeth can be intruded.

          The implants right next to each other don’t have to be the same level of the bone. The abutments will make up for the different levels. Bone topography is often variable and some implants will be closer to the top of than others. That is perfectly okay.

          Reply
  6. elaine

    I have 3 implants done 3 months ago and ready to do the crowns. I have extracted 2 lower molars long time ago and the gum in the area has resided. Because of the big space in between and too close to the nerve, the doctor put in 3 small implants in its place, and suggests to do connected crowns. I am worried that the food particles will get stuck under the crowns and would be harder to clean with connected option. Advantage of separate, if they break, then one at a time can be fixed. Not sure whats best in my case connected or separate?

    Reply
    1. RamseyAminDDS Post author

      Hello Elaine,

      It sounds like you have an excellent treatment plan. It also sounds like you are aware that you have bone loss. Because of the bone loss, more numbers of short dental implants are being used. Short, small dental implants used for back teeth should be connected most of the time. You will have far less food impaction if the teeth are connected rather than disconnected if you have receded bone levels.

      More importantly, if the implants are short and small, connecting them together will distribute the forces of your bite over the bone. This will lead to a better chance of long-term bone stability around her teeth and not create a situation where peri-implantitis can start.

      Yes it will be slightly harder to clean, but the benefits outweigh the risks.

      Good luck and keep me posted

      Reply
    2. Mike

      response to re connected crowns.
      I have three connected,(17 18 19)… Though the dds fibbed initially telling me i could clean them all like reg teeth, (THAT is why I paid for the middle aka 3rd implant,.. he was thinking $$$$.
      BUt regardless now that i have all three and connected You should love it. They are stronger united — I think than alone! I know they did need to be connected and cleaning BETWEEN ( you should not have food underneath but only between–My clean super easy… USE denta PICs by Denta Tak little brush like cleaners they are GREAT!
      its NO big deal. be glad they are connected I think. I would have just appreciated honesty upfront..

      Reply
  7. Lisa

    Hi,
    I have a splinter crown involving the last two back top molars. I had many sinuses problems and colds this past winter. While getting my teeth cleaned they found that on 1st. molar needed a RC. I had it done and had terrible pain so i went to an Endodontic Dr. with a 3D machine. He found another canal that was missed (it has been taken care of) and he also found that my back implant with two posts had gone into my sinus and the connected tooth (through the splinter crown) has a broken root. Now I’m faced with having the crown separated and the tooth pulled. I don’t know if I should go to an Oral Surgeon for this or have my Dentist do it. I’m concerned that the procedure will disrupt the implant and I’m not so excited about having a cut crown left on the implant. Any suggestions Please?

    Reply
    1. RamseyAminDDS Post author

      I wasn’t totally clear with your description. Can you resubmit?? Sorry your reply got delayed due to a server switchover.

      Reply
  8. sandhu

    I had my dental implants done from a dental clinic in India last year. I thought I would save money by going out of the country. It is been a disaster. Every single implant I had done has failed and now no one wants to work on me. I got a really bad infection and had to be hospitalized for 3 weeks when I got back to the United States.

    Reply
    1. RamseyAminDDS Post author

      wow….unfortunately I have heard this same story many times before. Let me know if I can help you in any way.

      Ramsey Amin DDS

      Reply
  9. James Houston

    Question . I had a bad dental job ten years ago on teeth 7 – 10 ( top four front ) . In result I had to get four root canals and my teeth before was shaved down to low . However back then I saw a local dentist who gave me regular individual crowns on teeth 7-10 . Now my current dentist is giving me my brand new smile I always wanted . In the beginning I asked for individuals and now he says the teeth are 2 small and he suggested the porcelain connecting crowns . Will the quality be the same for what I already paid for ???

    Reply
  10. Pete

    Great article.

    I’ve recently had a “splinter” for two top molars. I’ve had bone implants and sinus lift on this. The one thing I notice is there is a gap between the two teeth and the gum line that fills up with rubbish all the time, shouldn’t the gap between the teeth be flush with the gum?

    Reply
    1. Ramsey Amin DDS

      Hello Pete,

      Most of the time connected dental implants cause less food impaction then individual implants in this area of the mouth. My guess is the design of the splinted dental implant crowns may have not accounted for the shape of your gums. If the implants are retained by a screw, the dentist may be able to remove the crowns and add porcelain to fill this gap.

      Almost all of the crowns and Bridges that I designed are fabricated on a 3-D software on a computer and not by hand. The implants are milled from monolithic zirconia if they are back teeth. This is done through a CAD cam milling computerized process. Every single restoration is personally approved by me for goes into a patient’s mouth…. It should never be the decision of the lab.

      It should not be completely filled, because you need access to be able to clean between the implants. If you have vertical bone loss, then it is difficult to eliminate this space altogether. Dental implants are replacement teeth they are not are natural teeth, but they are a very close second place.

      Ramsey Amin DDS Reviews Solid Zirconia Custom Dental Implant Crowns and Abutments Instead of Metal

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  11. Doula O'Donnell

    i currently have 3 crowns in the front of my mouth. the 2 crowns are my two front teeth and the 3rd crown is next to my 2 front teeth. the 3rd crown is loose. i went to the dentist and he suggested that i do a splint on the two crowns. however, i am have all three crowns changed due to receding gum loss. My concern is should i go for the splint or should i go for the implant on the third tooth. i also need to have my two front caps replaced. i have had implants in the back of my mouth which i love. but i am so nervous because these are my front teeth. please let me know what would be the best method to do. much appreciated.

    Reply
    1. Ramsey Amin DDS

      Hello Doula,

      Definitely replace the tooth with an implant. If you only have a problem with one tooth, don’t use a 3 tooth solution.

      Splinting your upper front teeth together is only a good idea if your teeth have periodontal disease and are loose… And that is not always a good idea either.

      Front teeth dental implants or far more complex than back teeth dental implants. I would highly suggest you have a very skilled dental implant provider do this for you. There is no reason that a cannot look great. Expect to have to have some type of a bone graft typically because the bone in the front in the mouth is thinner than the back of the mouth. Of course I don’t know your own unique situation, but I would much prefer to leave natural teeth disconnected.

      When people have multiple dental implants right next to each other, often the best solution is connecting the crowns together for long-term bone health and oftentimes aesthetics is better that way too.

      Front Teeth Dental Implant Samples

      I hope this helps you,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

      Reply
  12. joel

    i used to have gaps between my front four teeth… Instead of getting braces my denstist suggested me to get crowns…. Now i have a connected four in one crown on my own teeth…. I want to replace them with seperate and thinner crowns…. As they look very artificial and gigantic….. I feel shy to smile…. Please suggest…!!
    Joel

    Reply
    1. Ramsey Amin DDS

      Hi Joel,

      Braces are often the best option and may reduce the need for crowns. It may also reduce the cost and yield a better result. It will take more time though. If the teeth are in bad shape, braces may not benefit you.

      Good luck,

      Dr. Amin

      Reply
  13. seema khanvilkar

    I have to get crowns to all my teeth.I need your kind advise as to whether I should go in for connected crowns or splinted ones.I already have a connected crown bridge for 4 teeth (which is now chipped on one tooth)on my upper molars in the left. I have a connected crown for 4 molars on the upper right. I have a connected crown for four molars on the lower right. Now I want crowns on all my teeth—incissors and molars—all in all teeth.
    I want to know which type—connected or splinted,I should go in for. I want a very good cosmetic effect as well as a strong, durable , and comfortable result.
    I stay in Tirunelvelli district, in Tamilnadu state, In India.
    Please suggest me the best.

    Seema.

    Reply
    1. Ramsey Amin DDS

      Hi Seema,

      If the crowns are not on dental implants and are only on your natural teeth, I suggest non-connected single teeth crowns. Natural teeth that are connected often develop gum disease and bone loss.

      Respectfully,
      Dr. Amin

      Reply
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    Reply