{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:03:40Z","timestamp":1760058220490,"version":"build-2065373602"},"reference-count":23,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T00:00:00Z","timestamp":1742256000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background and Clinical Significance: Dental implants are widely used; however, tooth extraction often results in alveolar bone loss and gingival recession, necessitating bone and connective tissue reconstruction, especially in the esthetic anterior regions. To address these issues, implants are occasionally connected to adjacent teeth, but this remains controversial, as complications (e.g., intrusion of natural teeth) have been observed. This report demonstrates the long-term success of implants replaced after removing maxillary bilateral central incisors and connecting them to lateral incisors with reduced supportive bone due to periodontitis. Case Presentation: A 57-year-old woman with root fractures in maxillary bilateral central incisors, periodontitis, and malocclusion was treated with connecting implants and natural teeth. Bone levels surrounding maxillary bilateral lateral incisors were diminished due to root fractures in adjacent central incisors and periodontitis. After initial periodontal therapy, hopeless maxillary central incisors were extracted, replaced with implants using a digitally simulated surgical guide, and guided bone regeneration and connective tissue grafting were performed. Implants were connected to lateral incisors with provisional restorations, and orthodontic treatment was initiated following digital set-ups incorporating implants into the overall strategy. Final porcelain-fused-to-zirconia restorations were placed after orthodontic treatment. At the 5-year follow-up, gingival morphology, coloration, and position of lateral incisors remained stable. Conclusions: This case demonstrates that connecting implants to natural teeth in the anterior region can effectively maintain periodontal tissues around natural teeth and allow for minimally invasive, short-term, and esthetic treatment. However, careful long-term observation through maintenance is necessary due to limited evidence for this approach in the anterior region.<\/jats:p>","DOI":"10.3390\/diagnostics15060765","type":"journal-article","created":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T12:03:06Z","timestamp":1742299386000},"page":"765","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Implant\u2013Natural Teeth Connection for a Patient with Periodontitis and Malocclusion: A Case Report"],"prefix":"10.3390","volume":"15","author":[{"given":"Shogo","family":"Ando","sequence":"first","affiliation":[{"name":"Namiki-dori Dental Clinic, 2-2-1 Toyoda, Minami-ku, Nagoya 457-0841, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5766-1286","authenticated-orcid":false,"given":"Atsutoshi","family":"Yoshimura","sequence":"additional","affiliation":[{"name":"Department of Periodontology and Endodontology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8588, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"681","DOI":"10.11607\/prd.2783","article-title":"Partial extraction therapies (PET) part 1: Maintaining alveolar ridge contour at pontic and immediate implant sites","volume":"36","author":"Gluckman","year":"2016","journal-title":"Int. J. Periodontics Restor. Dent."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1111\/cid.12554","article-title":"A retrospective evaluation of 128 socket-shield cases in the esthetic zone and posterior sites: Partial extraction therapy with up to 4 years follow-up","volume":"20","author":"Gluckman","year":"2018","journal-title":"Clin. Implant Dent. Relat. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/S0022-3913(11)60125-X","article-title":"Nonrigid connection of tooth with implants in the esthetic zone with a ceramic restoration: A clinical report","volume":"106","author":"Spyropoulou","year":"2011","journal-title":"J. Prosthet. Dent."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.jds.2021.05.010","article-title":"Clinical outcomes and complications of posterior three-unit porcelain-fused-to-metal restoration combined with tooth-implant-supported prosthesis: A meta-analysis","volume":"17","author":"Huang","year":"2022","journal-title":"J. Dent. Sci."},{"key":"ref_5","first-page":"1","article-title":"Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period","volume":"16","author":"Hansson","year":"1977","journal-title":"Scand. J. Plast. Reconstr. Surg. Suppl."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1111\/j.1365-2842.2007.01828.x","article-title":"Should we extract teeth to avoid tooth-implant combinations?","volume":"35","author":"Lindh","year":"2008","journal-title":"J. Oral Rehabil."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1034\/j.1600-0501.2000.011S1126.x","article-title":"Prosthetic management of the partially dentate patient with fixed implant restorations","volume":"11","author":"Belser","year":"2000","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1111\/j.1600-0501.2004.01118.x","article-title":"A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years. II. Combined tooth-implant-supported FPDs","volume":"15","author":"Lang","year":"2004","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1111\/j.1600-0501.2004.01117.x","article-title":"A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years. I. Implant-supported FPDs","volume":"15","author":"Pjetursson","year":"2004","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2186\/jpr.JPOR_2019_494","article-title":"Survival and complication rates of tooth-implant versus freestanding implant supporting fixed partial prosthesis: A systematic review and meta-analysis","volume":"65","author":"Pranno","year":"2021","journal-title":"J. Prosthodont. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"685","DOI":"10.11607\/jomi.8091","article-title":"Outcomes and complication rates of the tooth-implant-supported fixed prosthesis: A systematic review and meta-analysis","volume":"35","author":"Alsabeeha","year":"2020","journal-title":"Int. J. Oral Maxillofac. Implant."},{"key":"ref_12","first-page":"53","article-title":"Splinting of implants and adjacent natural teeth for esthetic correction in anterior maxilla: A case report","volume":"9","author":"Venkatesan","year":"2019","journal-title":"J. Sci. Dent."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1563\/AAID-JOI-D-10-00099","article-title":"Splinting osseointegrated implants and natural teeth in partially edentulous patients: A systematic review of the literature","volume":"38","author":"Mamalis","year":"2012","journal-title":"J. Oral Implantol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1111\/j.1600-0501.2004.01067.x","article-title":"Occlusal considerations in implant therapy: Clinical guidelines with biomechanical rationale","volume":"16","author":"Kim","year":"2005","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1111\/j.1708-8208.2008.00144.x","article-title":"Tooth-to-implant connection: A systematic review of the literature and a case report utilizing a new connection design","volume":"12","author":"Chee","year":"2010","journal-title":"Clin. Implant Dent. Relat. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/S0022-3913(97)70205-1","article-title":"Tooth intrusion in implant-assisted prostheses","volume":"77","author":"Sheets","year":"1997","journal-title":"J. Prosthet. Dent."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/j.1532-849X.1997.tb00107.x","article-title":"Intrusion of teeth in the combination implant-to-natural-tooth fixed partial denture: A review of the theories","volume":"6","author":"Pesun","year":"1997","journal-title":"J. Prosthodont"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1034\/j.1600-0501.2001.012003245.x","article-title":"Freestanding and tooth-implant connected prostheses in the treatment of partially edentulous patients Part II: An up to 15-years radiographic evaluation","volume":"12","author":"Naert","year":"2001","journal-title":"Clin. Oral Implants Res."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Goldstein, G., Goodacre, C., Brown, M.S., and Tarnow, D.P. (J. Prosthodont., 2024). Proposal regarding potential causes related to certain complications with dental implants and adjacent natural teeth: Physics applied to prosthodontics, J. Prosthodont., online ahead of print.","DOI":"10.1111\/jopr.13843"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Michalakis, K.X., Calvani, P., and Hirayama, H. (2012). Biomechanical considerations on tooth-implant supported fixed partial dentures. J. Dent. Biomech., 3.","DOI":"10.1177\/1758736012462025"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1111\/j.1600-051X.2008.01283.x","article-title":"Peri-implant diseases: Consensus Report of the Sixth European Workshop on Periodontology","volume":"35","author":"Lindhe","year":"2008","journal-title":"J. Clin. Periodontol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Heimes, D., Schiegnitz, E., Kuchen, R., K\u00e4mmerer, P.W., and Al-Nawas, B. (2021). Buccal bone thickness in anterior and posterior teeth\u2014A systematic review. Healthcare, 9.","DOI":"10.3390\/healthcare9121663"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1111\/jerd.12601","article-title":"The digital POIP concept: Preorthodontic implant placement","volume":"32","author":"Blasi","year":"2020","journal-title":"J. Esthet. Restor. Dent."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/6\/765\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:56:10Z","timestamp":1760028970000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/6\/765"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,18]]},"references-count":23,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["diagnostics15060765"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15060765","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2025,3,18]]}}}