Is a Natural Tooth Connected to an Implant?
The restoration of tooth deficiencies occurring in the anatomy of the mouth and jaw encompasses a complex field of medical engineering that involves redistributing the biomechanical loads on the temporomandibular joint rather than merely filling an aesthetic gap. A frequently researched question in clinical processes and one of the most critical factors in prosthetic restoration planning is, “Can a natural tooth be connected to an implant?” This question essentially probes whether the fundamentally different cellular processes can be integrated under the same bridge structure. While the roots produced by the human body work with a flexible, shock-absorbing biological system within the bone, titanium roots, as a product of medical technology, exhibit an inflexible stability, integrating directly into the jawbone (ankylosis).
Can a Natural Tooth Be Connected to an Implant and What Are the Biomechanical Differences?
In dental practices, prosthetic designs are built upon physical rules and force vectors. When making a bridge prosthesis, it is expected that both sides supporting the bridge (whether two natural teeth or two artificial roots) have the same amount of flexibility in the same direction. If one end of the seesaw is placed on a springy surface and the other end on a concrete surface, when weight is applied, the side on the springy surface will compress, while the connection point on the concrete side will be subjected to a buckling force (lever effect).
This biophysical reality serves as the main guide for treatment planning by oral surgeons and prosthetics specialists. Human teeth are microscopically embedded in the bone when chewing forces are applied, thanks to the fine fibers between the root and the bone, and they return to their original position once the force is removed. However, titanium material is nearly tightly bound by bone cells as if it has been fused. When the patient bites, the side of the bridge that is natural tooth flexes correctly towards the bone; the non-flexing titanium side works to hold the bridge in the air. This resulting unbalanced shear force can lead to major complications such as breaking the bridge in the middle, breaking the connecting screw (abutment) within the titanium, or the movement of the flexible natural tooth from its place.
How Do the Periodontal Ligaments of Natural Teeth Function?The periodontal ligament (PDL) is a flexible connective tissue complex that connects the root of the natural tooth to its socket in the jawbone and contains dense nerve fibers and blood vessels. During chewing, it dampens vertical and horizontal pressures of 50 to 100 kilograms applied to the tooth (acting as a shock absorber), limiting the severe transmission of force onto the bone and allowing the tooth to flex between 50 and 200 microns within the bone.
The natural engineering of the human body has equipped the chewing system with a biological shield to protect against external trauma. The minimal mobility you feel when you try to lightly shake a tooth with your fingers is actually an indicator of the tooth’s health. Thousands of microscopic collagen fibers extending from the root surface to the walls of the jawbone hold the tooth in place like a hammock in the middle of the bone.This fibrous structure not only serves as a mechanical support; it is also an immense neurological sensor network (proprioception). When a hard object (such as a stone or a core shell) comes between the teeth, the periodontal ligament instantly stimulates the brain and the jaw muscles stop contracting in a fraction of a second. This self-control mechanism prevents tooth fractures. Combining a natural tooth with a titanium structure means forcing this delicate sensory network and its elasticity to align with a rigid material that has no flexibility.
How Does Bone Integration of Titanium Materials (Osteointegration) Occur?
Artificial roots made from titanium have hydrophilic micro-pores on their surface that attract blood proteins and osteoblast (bone-forming) cells, directly integrating with the bone matrix without any soft tissue in between. This cellular integration process, known as osteointegration, results in the material becoming a rigid (fixed) anchoring point within the jawbone, with only the tooth’s own elasticity (0-10 microns) allowing for minimal movement.The concept of osteointegration, which revolutionizes dental medicine in medical literature, is the adoption of an inorganic material by the human body’s own skeleton instead of rejecting it as a foreign body. The oxide layer on the surface of titanium is perceived as neutral by the bonding system. A blood clot that accumulates in the area after the surgical procedure turns into hard human bone as a result of a biochemical cycle lasting for months, leading to the precipitation of calcium and phosphate ions.
Biomechanical Comparison of Natural Tooth and Titanium Material Physiological / Biomechanical Property Natural Tooth (Periodontal Structure) Titanium Artificial Root (Osteointegration) Type of Bone Connection Flexible retention through fibers (Suspension). Direct and rigid retention at the cellular level (Ankylosis). Vertical Stretching Capacity Buried within 50 – 200 microns under force. Only as much as bone flexibility under force (0 – 10 microns). Sensation (Proprioception) High neural transmission with pressure detection on a millimeter scale. Limited and reduced perception coming only from surrounding bone (Osseoperception).
What Physiological Reactions are Observed When Two Different Anatomical Structures are Combined with a Bridge Prosthesis?
When these two different biophysical structures are connected by a rigid zirconium or porcelain bridge, it bends towards the natural tooth bone under chewing pressure while the titanium material remains fixed, functioning as a pivot (axis of rotation) point. This asymmetric movement creates a concentrated tension stress in the neck area of the titanium, leading to the loosening or breaking of the internal screw that holds the prosthesis, and ultimately prepares the ground for resorption in the surrounding bone tissue.The force applied on a common supporting platform (bridge) must be distributed evenly between the supports that support that platform. When one leg of the bridge is a natural tooth and the other leg is a titanium root, the balance is completely disrupted. When an individual closes their jaw to chew food, equal pressure is exerted on both legs.
When the natural tooth receives this pressure, it sinks by one-tenth of a millimeter into the periodontal fibers due to its natural properties. The titanium root, on the other hand, does not budge from its position when it receives the same pressure. While one side of the bridge sinks, the other side stays fixed, creating a gigantic “lever force” (cantilever effect) trying to break the porcelain body in half. This force is so destructive that over time either the supporting screw inside the titanium (abutment) tires and breaks, or the bone in the neck region of the fixed titanium starts to resorb due to being unable to withstand this stress.
Why Does the Phenomenon of Natural Tooth Intrusion Occur?
The most prominent biological complication encountered in rigidly anchored systems is the gradual encroachment of the natural tooth into its bone socket over time (intrusion), leading to the prosthesis becoming dislodged. Since the titanium root does not receive mechanical stimulation (function) from the natural tooth, this absence of stimulation leads to the tooth remodeling its support fibers, pulling deeper into the jawbone and causing a severance of its connection with the bridge.The phenomenon of intrusion (submergence) is one of the main reasons for the abandonment of these types of connections in dental literature. All tissues in our body maintain their forms as long as they are functional. When you encase a natural tooth in an unyielding titanium root with a metal/zirconium framework, the entire chewing load is borne by the titanium material. Titanium is so strong and stable that it also bears the load transferred to the natural tooth by the bridge.
In this case, the natural tooth becomes unable to receive the micro-trauma (physiological stimulation) that would allow its fibers to stretch during chewing. The non-functional natural tooth will display a gradual encroachment into the bone over time (months or years). Patients often notice this condition as “my bridge is wobbling” or “my tooth bridge has come out.” Food debris begins to accumulate around the submerged tooth, leading to deep cavities in that area and ultimately resulting in loss of the entire tooth.
How Are These Types of Prosthetic Plans Managed Within Izmir Avrupadent?
In health organizations equipped like Avrupadent, which provide services according to corporate norms in Izmir, the complete restoration of natural teeth and artificial roots independently (freestanding) is adopted as the primary medical protocol to eliminate biomechanical incompatibilities. Using three-dimensional dental tomographs, physiological corridors where an adequate number of titanium materials can be placed without the need to connect to natural teeth are mapped in a virtual environment.In modern clinical practice, not creating problems rather than solving them constitutes the core of medical planning. In past years, when sufficient support could not be provided in regions where the jawbone was thin, doctors were obligated to include the adjacent natural tooth in the bridge. However, advancements in the field of tissue engineering (bone augmentation) have largely eliminated this necessity.
While multidisciplinary assessment boards examine the gap in the patient’s jaw, instead of cutting and reducing the adjacent healthy tooth and connecting it to an artificial root; they seek ways to restore that gap internally. Jaw surgeons expand the area by adding bone powder (graft) to regions where the bone is thin and place an independent titanium screw there. Thus, while the natural tooth maintains its independent flexibility, the artificial root is supported by carrying its independent porcelain tooth, helping the system to be maintained in an isolated manner for many years.
What Medical Methods Are Used If Connecting Is Necessary in Emergency Situations?In rare medical cases where the connection of natural tooth to titanium material is unavoidable due to anatomical constraints, flexible non-rigid connecting devices (stress breakers, precision holders) or telescopic crown systems are used. This medical design limits the destructive leverage forces transmitted to the titanium root by allowing the natural tooth a certain independent movement (flexibility) in its socket.
Although the rules in medicine are generally applicable, there are always challenging exceptions presented by human anatomy. For instance; the jaw bone may have eroded to such an extent that no second titanium screw can be placed in the area, the patient’s overall systemic health may not permit bone graft surgeries, or the anatomical distances of nerves/sinuses may pose too much risk to be exceeded. In such mandatory situations, doctors may opt for engineering designs that employ a ‘stress breaker’ instead of connecting the system rigidly (as a single piece).
In these designs, there is a hidden lock (slide) or a hinge mechanism between the crown on the natural tooth and the body of the bridge. When the patient applies chewing force, this hinge mechanism allows a slight displacement (flexibility) within a few microns inside the bone of the natural tooth, while this bending moment is not transmitted to the titanium screw. While the titanium root remains fixed, the natural tooth achieves the freedom to move within its physiological cycle.
How Do Non-Rigid (Flexible) Connecting Parts Balance Chewing Forces?
Flexible connections (sensitive holder) restrict the concentration of force at a single point by functioning like inner and outer continuous mechanisms. The vertical pressure that occurs during biting is tolerated within this mechanism, and part of the energy is dissipated; thus, the horizontal shearing stresses imposed on the neck (collar) area of the titanium artificial root are minimized, isolating the risks of bone loss and screw breakage.It is possible to compare this mechanism to the connections between train cars. If the cars were welded tightly and immovably, the entire train would derail on curves. The flexible connections in between allow each car to move slightly within itself. In dentistry, these systems, known as “Non-Rigid Connectors,” dissipate the stress between the legs of the bridge.
Medical Functions of Flexible Connection Mechanisms:- Telesopic Crowns (Inner Inner Passing Caps): The natural tooth is covered with a thin metal or zirconium cap, and the bridge is pressed onto this cap like a cover. It provides a tight yet flexible hold.
- Sliding (Sliding/Groove) Attachments: A vertical groove is opened on the lateral surface of the crown on the natural tooth, and the bridge body coming from the titanium root is placed by sliding into this groove like a rail. It allows for vertical forces to leave enough room for downward flexibility.
- Force Breaker Hooks: A small step is prepared on the back surface of the tooth, and the extension of the bridge rests on this step; thus, the load is transferred vertically to the axis of the upper tooth and horizontal stresses are restricted.
How Do Jaw Closure Disorders (Malocclusion) Affect Connected Systems?
Orthodontic contact disorders (malocclusion) that exist between upper and lower teeth cause chewing forces to impact the jaw axis at diagonal and asymmetrical angles. In complex systems where natural teeth are connected to titanium material, these opposing forces exacerbate biomechanical incompatibility, intensifying the lever effect and accelerating the fatigue process of materials (porcelain or screws), leading to premature fractures.The sole factor determining the lifespan of any restoration in prosthetic dentistry is how that restoration comes into contact with the opposing teeth (occlusion). In a healthy bite, all teeth contact simultaneously and evenly distribute the load across the entire skull skeleton. If the patient’s teeth have misalignment or occlusion disorders, when the person closes their mouth, it initially strikes at a single point (early contact) before the jaw shifts to its actual position.
If this early contact point lies on the sensitive bridge where the natural tooth and artificial root are connected, the physiological situation becomes extremely damaging. When there are already two different elasticity modules that do not cooperate with each other in the system, the addition of a lateral (horizontal) shear force results in the complete failure of the weak link (usually the abutment screw or the natural tooth root). Before making such mandatory connections, dentists must digitally or mechanically map the patient’s jaw occlusion to meticulously analyze all asymmetric contacts (occlusal adjustment).
What Data Does Radiological 3D Tomography (CBCT) Provide in Prosthetic Mapping?
Three-dimensional dental tomography (CBCT) maps the vertical and horizontal volume of the patient’s jawbone in millimeters, providing physicians with the opportunity to identify alternative surgical areas (independent bone regions) that will free them from the necessity of relying on natural teeth. Additionally, the existing natural tooth’s root exposure, its position within the bone, and the health of the supporting tissue are examined through objective data from tomography, allowing for the prior analysis of the biomechanical resistance of the bridge.Advanced medical imaging systems have transformed dentistry from a craft based on estimates to a data-driven engineering discipline. In classical two-dimensional (panoramic) X-rays, the thickness of the bone or the positioning of the tooth roots relative to the lip/tongue cannot be seen. A physician might look at a two-dimensional film and decide, “a screw cannot fit here, let’s connect to the adjacent tooth.” However, when a three-dimensional scan of the same patient is taken, it may reveal that a highly suitable, voluminous area exists within the internal parts of the bone.
CBCT scans provide safe corridors for performing “freestanding” implants for the physician. Moreover, if a connection is absolutely necessary, the length of the natural tooth root to be used as support, the density of the surrounding bone (Hounsfield Unit), and periodontal health are scanned millimeter by millimeter. Placing a natural tooth with weak, short roots or one that has started to experience bone loss underneath the same bridge made of a strong material like titanium means signing the death warrant of that natural tooth. Tomography is the strongest medical tool that protects the physician from such clinical errors.
How is this procedure modified for individuals with a Bruxism habit?
In individuals exhibiting nocturnal bruxism (teeth grinding) reactions, the jaw muscles generate enormous horizontal forces, thus avoiding the binding of natural teeth with titanium materials is absolutely necessary. If there is a clinical necessity, occlusal surfaces are produced from monolithic and non-flexible materials, and mechanical devices with hard acrylic protective splints are prescribed for the patient to use at night to limit the destruction of the system.Bruxism is the most devastating biomechanical adversary of prosthetic restorations. While the biting forces are controlled by our brain when we are awake, this control mechanism disappears during sleep, causing the jaw muscles (masseters) to clamp the teeth together with a force four to six times normal and shift them side to side. This horizontal shearing movement generates an enormous torque aimed at separating or crushing the teeth.
If a bridge connecting two structures that are biomechanically incompatible (one flexible, the other rigid) is present in the mouth of a bruxism patient, the metal fatigue at the connection points (abutment screws) of that bridge peaks within months. To manage this situation, doctors add an external protective shield over the system. The “night guard” made of hard plastic is placed between the upper and lower teeth, allowing the jaw to slide freely. The destructive energy created by the muscles is absorbed on this plastic guard before being transmitted to the prosthesis. However, the most reliable medical protocol involves repairing each deficiency independently in bruxism cases.
Why is Long-Term Clinical Maintenance and Routine Check-Ups Important?
The stability of complex biomechanical systems in the oral environment for many years depends on the early detection of the intrusions of natural teeth beneath the prosthesis, looseness in the connecting screws, and potential bone resorption (peri-implantitis) at the gum boundary. Routine dental checks conducted every six months calibrate these mechanical and physiological asymmetries to maintain tissue integrity.The application of medical prostheses and the patient’s discharge from the clinic does not signify the end of treatment; it marks the beginning of an active physiological cycle that needs to be monitored. Especially in systems where the natural tooth is connected to the artificial root or where very close adjacency is established, the organism’s reactions (adaptation) over time should be carefully monitored. Wear on the occlusal porcelain surfaces does not occur uniformly across all teeth.
The natural engineering of the human body has equipped the chewing system with a biological shield to protect against external trauma. The minimal mobility you feel when you try to lightly shake a tooth with your fingers is actually an indicator of the tooth’s health. Thousands of microscopic collagen fibers extending from the root surface to the walls of the jawbone hold the tooth in place like a hammock in the middle of the bone.
This fibrous structure not only serves as a mechanical support; it is also an immense neurological sensor network (proprioception). When a hard object (such as a stone or a core shell) comes between the teeth, the periodontal ligament instantly stimulates the brain and the jaw muscles stop contracting in a fraction of a second. This self-control mechanism prevents tooth fractures. Combining a natural tooth with a titanium structure means forcing this delicate sensory network and its elasticity to align with a rigid material that has no flexibility.
How Does Bone Integration of Titanium Materials (Osteointegration) Occur?
The concept of osteointegration, which revolutionizes dental medicine in medical literature, is the adoption of an inorganic material by the human body’s own skeleton instead of rejecting it as a foreign body. The oxide layer on the surface of titanium is perceived as neutral by the bonding system. A blood clot that accumulates in the area after the surgical procedure turns into hard human bone as a result of a biochemical cycle lasting for months, leading to the precipitation of calcium and phosphate ions.
| Physiological / Biomechanical Property | Natural Tooth (Periodontal Structure) | Titanium Artificial Root (Osteointegration) |
|---|---|---|
| Type of Bone Connection | Flexible retention through fibers (Suspension). | Direct and rigid retention at the cellular level (Ankylosis). |
| Vertical Stretching Capacity | Buried within 50 – 200 microns under force. | Only as much as bone flexibility under force (0 – 10 microns). |
| Sensation (Proprioception) | High neural transmission with pressure detection on a millimeter scale. | Limited and reduced perception coming only from surrounding bone (Osseoperception). |
What Physiological Reactions are Observed When Two Different Anatomical Structures are Combined with a Bridge Prosthesis?
The force applied on a common supporting platform (bridge) must be distributed evenly between the supports that support that platform. When one leg of the bridge is a natural tooth and the other leg is a titanium root, the balance is completely disrupted. When an individual closes their jaw to chew food, equal pressure is exerted on both legs.
When the natural tooth receives this pressure, it sinks by one-tenth of a millimeter into the periodontal fibers due to its natural properties. The titanium root, on the other hand, does not budge from its position when it receives the same pressure. While one side of the bridge sinks, the other side stays fixed, creating a gigantic “lever force” (cantilever effect) trying to break the porcelain body in half. This force is so destructive that over time either the supporting screw inside the titanium (abutment) tires and breaks, or the bone in the neck region of the fixed titanium starts to resorb due to being unable to withstand this stress.
Why Does the Phenomenon of Natural Tooth Intrusion Occur?
The phenomenon of intrusion (submergence) is one of the main reasons for the abandonment of these types of connections in dental literature. All tissues in our body maintain their forms as long as they are functional. When you encase a natural tooth in an unyielding titanium root with a metal/zirconium framework, the entire chewing load is borne by the titanium material. Titanium is so strong and stable that it also bears the load transferred to the natural tooth by the bridge.
In this case, the natural tooth becomes unable to receive the micro-trauma (physiological stimulation) that would allow its fibers to stretch during chewing. The non-functional natural tooth will display a gradual encroachment into the bone over time (months or years). Patients often notice this condition as “my bridge is wobbling” or “my tooth bridge has come out.” Food debris begins to accumulate around the submerged tooth, leading to deep cavities in that area and ultimately resulting in loss of the entire tooth.
How Are These Types of Prosthetic Plans Managed Within Izmir Avrupadent?
In modern clinical practice, not creating problems rather than solving them constitutes the core of medical planning. In past years, when sufficient support could not be provided in regions where the jawbone was thin, doctors were obligated to include the adjacent natural tooth in the bridge. However, advancements in the field of tissue engineering (bone augmentation) have largely eliminated this necessity.
While multidisciplinary assessment boards examine the gap in the patient’s jaw, instead of cutting and reducing the adjacent healthy tooth and connecting it to an artificial root; they seek ways to restore that gap internally. Jaw surgeons expand the area by adding bone powder (graft) to regions where the bone is thin and place an independent titanium screw there. Thus, while the natural tooth maintains its independent flexibility, the artificial root is supported by carrying its independent porcelain tooth, helping the system to be maintained in an isolated manner for many years.
What Medical Methods Are Used If Connecting Is Necessary in Emergency Situations?In rare medical cases where the connection of natural tooth to titanium material is unavoidable due to anatomical constraints, flexible non-rigid connecting devices (stress breakers, precision holders) or telescopic crown systems are used. This medical design limits the destructive leverage forces transmitted to the titanium root by allowing the natural tooth a certain independent movement (flexibility) in its socket.
Although the rules in medicine are generally applicable, there are always challenging exceptions presented by human anatomy. For instance; the jaw bone may have eroded to such an extent that no second titanium screw can be placed in the area, the patient’s overall systemic health may not permit bone graft surgeries, or the anatomical distances of nerves/sinuses may pose too much risk to be exceeded. In such mandatory situations, doctors may opt for engineering designs that employ a ‘stress breaker’ instead of connecting the system rigidly (as a single piece).
In these designs, there is a hidden lock (slide) or a hinge mechanism between the crown on the natural tooth and the body of the bridge. When the patient applies chewing force, this hinge mechanism allows a slight displacement (flexibility) within a few microns inside the bone of the natural tooth, while this bending moment is not transmitted to the titanium screw. While the titanium root remains fixed, the natural tooth achieves the freedom to move within its physiological cycle.
How Do Non-Rigid (Flexible) Connecting Parts Balance Chewing Forces?
It is possible to compare this mechanism to the connections between train cars. If the cars were welded tightly and immovably, the entire train would derail on curves. The flexible connections in between allow each car to move slightly within itself. In dentistry, these systems, known as “Non-Rigid Connectors,” dissipate the stress between the legs of the bridge.
- Telesopic Crowns (Inner Inner Passing Caps): The natural tooth is covered with a thin metal or zirconium cap, and the bridge is pressed onto this cap like a cover. It provides a tight yet flexible hold.
- Sliding (Sliding/Groove) Attachments: A vertical groove is opened on the lateral surface of the crown on the natural tooth, and the bridge body coming from the titanium root is placed by sliding into this groove like a rail. It allows for vertical forces to leave enough room for downward flexibility.
- Force Breaker Hooks: A small step is prepared on the back surface of the tooth, and the extension of the bridge rests on this step; thus, the load is transferred vertically to the axis of the upper tooth and horizontal stresses are restricted.
How Do Jaw Closure Disorders (Malocclusion) Affect Connected Systems?
The sole factor determining the lifespan of any restoration in prosthetic dentistry is how that restoration comes into contact with the opposing teeth (occlusion). In a healthy bite, all teeth contact simultaneously and evenly distribute the load across the entire skull skeleton. If the patient’s teeth have misalignment or occlusion disorders, when the person closes their mouth, it initially strikes at a single point (early contact) before the jaw shifts to its actual position.
If this early contact point lies on the sensitive bridge where the natural tooth and artificial root are connected, the physiological situation becomes extremely damaging. When there are already two different elasticity modules that do not cooperate with each other in the system, the addition of a lateral (horizontal) shear force results in the complete failure of the weak link (usually the abutment screw or the natural tooth root). Before making such mandatory connections, dentists must digitally or mechanically map the patient’s jaw occlusion to meticulously analyze all asymmetric contacts (occlusal adjustment).
What Data Does Radiological 3D Tomography (CBCT) Provide in Prosthetic Mapping?
Advanced medical imaging systems have transformed dentistry from a craft based on estimates to a data-driven engineering discipline. In classical two-dimensional (panoramic) X-rays, the thickness of the bone or the positioning of the tooth roots relative to the lip/tongue cannot be seen. A physician might look at a two-dimensional film and decide, “a screw cannot fit here, let’s connect to the adjacent tooth.” However, when a three-dimensional scan of the same patient is taken, it may reveal that a highly suitable, voluminous area exists within the internal parts of the bone.
CBCT scans provide safe corridors for performing “freestanding” implants for the physician. Moreover, if a connection is absolutely necessary, the length of the natural tooth root to be used as support, the density of the surrounding bone (Hounsfield Unit), and periodontal health are scanned millimeter by millimeter. Placing a natural tooth with weak, short roots or one that has started to experience bone loss underneath the same bridge made of a strong material like titanium means signing the death warrant of that natural tooth. Tomography is the strongest medical tool that protects the physician from such clinical errors.
How is this procedure modified for individuals with a Bruxism habit?
Bruxism is the most devastating biomechanical adversary of prosthetic restorations. While the biting forces are controlled by our brain when we are awake, this control mechanism disappears during sleep, causing the jaw muscles (masseters) to clamp the teeth together with a force four to six times normal and shift them side to side. This horizontal shearing movement generates an enormous torque aimed at separating or crushing the teeth.
If a bridge connecting two structures that are biomechanically incompatible (one flexible, the other rigid) is present in the mouth of a bruxism patient, the metal fatigue at the connection points (abutment screws) of that bridge peaks within months. To manage this situation, doctors add an external protective shield over the system. The “night guard” made of hard plastic is placed between the upper and lower teeth, allowing the jaw to slide freely. The destructive energy created by the muscles is absorbed on this plastic guard before being transmitted to the prosthesis. However, the most reliable medical protocol involves repairing each deficiency independently in bruxism cases.
Why is Long-Term Clinical Maintenance and Routine Check-Ups Important?
The application of medical prostheses and the patient’s discharge from the clinic does not signify the end of treatment; it marks the beginning of an active physiological cycle that needs to be monitored. Especially in systems where the natural tooth is connected to the artificial root or where very close adjacency is established, the organism’s reactions (adaptation) over time should be carefully monitored. Wear on the occlusal porcelain surfaces does not occur uniformly across all teeth.
