Title	For Patients Who Receive A Mandibular Posterior Implant Restoration, A Higher Incidence of Loss of Proximal Contact Between Implant Restoration And Adjacent Natural Tooth Was Observed
Clinical Question	In patients requiring a mandibular posterior implant restoration, should a clinician anticipate a loss of proximal contact strength over time, when compared to an all-natural dentition?
Clinical Bottom Line	For patients who receive a mandibular posterior implant restoration, a higher incidence of loss of proximal contact between implant restoration and adjacent natural tooth was observed. These results are consistent with CAT #849 published in April 2011, which found that “Loss of proximal contact was observed between implant supported fixed prosthetics and adjacent natural teeth.”
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 26562738 Greenstein/2016 273 adult patients in 5 included studies. Systematic review of non-randomized trials Key results Incidence of interproximal loss of contact between an implant restoration and adjacent natural tooth was higher than originally anticipated. The studies investigated in the systematic review provided evidence of an open contact forming in 34%-66% of cases where an implant was placed next to a natural adjacent tooth. The implant is believed to act like an ankylosed tooth which upon anterior vector forces and mesial drifting of the teeth will remain stationary resulting in a higher incidence of mesial contact loss occurring more commonly in the mandible than the maxilla.
Evidence Search	Search ("Dental Implants, Single-Tooth"[Mesh]) AND "Dental Prosthesis, Implant-Supported"[Mesh]
Comments on The Evidence	The authors of this article used information from 5 observational studies that assessed interproximal contact loss between an implant and adjacent tooth. A total of 273 patients were assessed in the clinical trials. They did not include control groups, and the presence of open contacts at time of implant placement was not always recorded. Data interpretation is therefor limited by the lack of consistency in the use of differential statistical methods by each of the 5 studies in addition to the use of unlike populations, duration in which the participants were monitored and tightness of the contact.
Applicability	The 5 studies are relevant to a patient who has previously received a mandibular posterior dental implant or a patient contemplating an implant as a treatment option. The dental professional should inform the patient of adverse effects related to loss of proximal contact of the implant. Such consequences include, impacted food particles that can lead to development of caries, periodontal problems such as attachment loss and increased probing depths, tooth migration, and necessary repairs of the prosthesis. It is important to have the patient understand the risks associated with the procedure in order to assess his/her level of compliance.
Specialty	(General Dentistry) (Prosthodontics)
Keywords	implants; restorative dentistry; operative
ID#	3038
Date of submission	03/13/2016
E-mail	marder@livemail.uthscsa.edu
Author	Ariel Marder
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Kevin M. Gureckis, DMD
Faculty mentor e-mail	gureckis@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available