12 Years Post op Non-Splinted Screw Retained Posterior Implants

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Posted on By Maurice Salama In Implants

Patient presents today 12 years after Bone Grafting and Implant replacement in the mandibular and maxillary posterior regions. The patient desired non-splinted restorations. Implants were inserted after BG healing and using a GUIDED SURGERY approach. Most interesting is to view the Bone to Implant contact radiographically at 12 years. It is multi-factorial indeed and we often can not understand the reasons for crestal bone loss at the implant abutment junction following loading. Thoughts? Dr. Salama

12 year post load PA
PA without enhancement

Maxilla PA Molar Implants
PA enhanced Maxilla

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Mo. Splinting of implants based upon occlusal forces really dosen't make sense biologically.There is no PDL or movement to compensate for with Osseointegration. Mechanically it could be an advantage for management of contact points and proper seating, but on the other hand line of draw and passive fit could be an issue for splinted cases. IMO passive fit without micro-motion are the key factors. Beautiful case and follow up! Thank you for sharing. Best regards. Chuck


Maurice, your case shows a supracrestal margin and this could be a good reason per se. But also quality of occlusion and bone wall thickness around implant. Today, connection, switching Platform, subcrestal positioning of implant and reduction of screwing procedures (as 1A1T) may add on succes criteria. My personal add is 3D site study in advance. It is a great case for discussion. Armando


Great images, Mo.
For me, the mucosal barrier position after conexion/reconexion makes sense , so,
Do you remember the protocoll that you used? How many times you connected/disconected the abutments?
Thanks for posting
The mucosal barrier following
abutment dis/reconnection
An experimental study in dogs
I. Abrahamsson, T, Berglundh and
J, Lindhe
'Department of Periodontology, Goteborg


Look at the tissue around implants vs. Natural teeth??


Wow, i hope that i will have some cases that look like this at 12 years :) :)
The problem is that there are so many factors to consider: Connection and micromovement, platform switching, thickness of buccal bone, band and thickness of KG, one abutment one time concept. I believe that all of these are factors worth consideration, and i think that KG is one of the under appreciated ones. I would love to know the percentage of cases that look this stable after 12 years, would be interesting.

Beautiful work and thanks for sharing :) ...55555



Hi Maurice;
Superb surgical skills combined with an understanding of occlusion. Very few dentists take the time to equilibrate an occlusion...perhaps they don't know how.

Isn't dentistry fabulous when done right?