Implant Supported Cantilever Pontics

In a recent article entitled: Confronting Controversial Issues in Dental Implant Therapy, Part I by Dr. Gary Greenstein, Dr. John Cavallaro, and Dr. Dennis Tarnow in Denstistry Today, the authors discussed options and recommendations for implant supported cantilever pontics.

A link to the original article can be found below this article.

Here are some of the highlights that we felt were helpful to us:

Doctor Side Recommendations:

1. Number of Implants: Each cantilever should be supported by at least two to three implants
2. Horizontal Distance Between Implants: 8mm is the ideal spacing between the center of the implants.
3. Implant Width: Increased diameter implants are preferred. Higher fracture rates were shown with 3.3.mm implants.
4. Mesio-Distal Length: Cantilever should be no larger than the size of a pre-molar
5. Preloading: Abutment screws should be tightened after initial torqueing.
6. Implant Design: Implants with a textured surface are ideal as they provide increased retention to bone.
7. Crown-to-Root Ratio: Wider implants should be considered if implant to crown ratio is extreme.

Lab Side Recommendations

1. Material and Thickness: A metal substructure is ideal. Cantilever should be cast as one unit with the implant supported retainers. Lab should place more occlusal-gingival height for the metal connecting the cantilever and doubling the buccolingual width.
2. Occlusion: It is best to leave the cantilever in infraocclusion by 0.1 to 0.2mm (i.e. Out of occlusion)
3. Abutments: Abutments should have maximum axial wall length with minimal taper. This will increase retention and resistance form.