In the latest EAO Just Ask session, renowned implant prosthodontist Professor Stefan Wolfart dives into the debate of whether to screw retain or splint implants for long-term stability. The discussion kicks off with a case study where the presenter has opted for screw-retained, splinted crowns on two implants. But Professor Wolfart challenges this approach, advocating for a more nuanced view based on bone quality, implant length, and the forces at play.
Wolfart explains that splinting can reduce mechanical stress on the bone and the implant abutment connection, potentially offering protection in cases of vertical bone loss or high crown-to-implant ratios. However, he cautions against splinting when the biomechanical load doesn't necessitate it, as it can compromise the internal connection of the implant and create issues like screw loosening or debonding. He emphasizes that cementation, especially with customized abutments, could serve as a superior solution in many cases.
The session also highlights the importance of understanding mechanical forces, with Professor Wolfart stressing that while splinting can reduce stress, it's not always the best solution, particularly when the internal connection is compromised. Case studies demonstrate the practical implications of these theories, showing that while splinting can provide stability in some cases, in others, non-splinted crowns are equally effective and less prone to mechanical complications.
In conclusion, the session underscores the complexity of the decision-making process when it comes to implant restoration. Wolfart advocates for a tailored approach, using splinting or cementation based on the clinical situation rather than a one-size-fits-all solution. Ultimately, the aim is to maximize stability, minimize complications, and provide the best outcomes for patients.