Tooth implant supported prosthesis – TISP

Tooth implant supported prosthesis or TISP is a dental bridge that connects a natural tooth to a dental implant. They are not the first choice but there may be times when one makes sense as long as the patient is aware that it’s not the most ideal treatment. Many dentists that see one think it’s terrible but if you look at the research on survival rates it’s not the worst thing we as a profession can do.  For example Naert found only a 5-10% difference in complications over 15 years for a TISP vs ISP, which is not very high over that time period.

The tooth implant supported prosthesis, TISP, recommendations for fabrication.

Greenstein Lit Review 2009 TISP most suggestions same as Lane below (likely where they come from)

1. Tooth is periodontally solid.
2. Use a rigid connection, which means no stress breakers.
3. No telescopes/copings
4. Avoid bruxers
5. Permanent cement

Lang Systemic Review 2004 but data easier to see in above link. Another review comparing tooth implant supported fixed dental prostheses (TISFDP) and implant supported bridges found them to be equal. Alsabeeha JOMI 2020

Case study of a tooth implant supported prosthesis, TISP.

This is one of the few TISP we have in our practice but the only one that we did from start to finish. The others are decades old and doing well. The reasons we chose a tooth implant supported prosthesis here is multi-factorial. Firstly, the patient is not hard on his teeth; he is not a grinder or a clencher. Secondly of all the sinus in tooth number 3 position is very low and there is probably only 1-2mm of bone there, making the surgery tougher and more expensive. In addition to the clinical presentations there is the reality that this patient is in his mid-eighties. The reality is that we do not need a 30, 20, or likely even a 10 year solution here. There simply are not a lot of years left for complications to develop.

We use all of the above criteria from Greenstein to help provide the longest lasting TISP possible. This is a standard bridge, nothing fancy to muck things up.

Personal opinion here – I think case selection is very important on these. Older patient that would need a substantial sinus lift to get an implant in the area connecting to a tooth that already has a crown and is vital.

Lane’s thoughts on a TISP                                        

Use a retrievable rigid connection for your tooth implant supported prosthesis. The tooth has a permanently cemented coping and the bridge is cemented on to that coping with temp cement. The bridge will be attached to the implant terminal abutment with a screw. If and/or when the temp cement works loose, unscrew the prosthesis and re-cement. Re-call is mandatory in these cases. Avoid bruxers then tend to get intrusion of tooth. Avoid semi-rigid connections. DT post Lane info

Lane’s work – What he recommends

Other research and information on the tooth implant supported prosthesis

324 patients comparing TISP, standard implant bridge and a cantilever bridge show all three have similar survival rates and chipping rates. Rammelsberg JPD 2021

Not worth the trouble Block IJOMI 2002

No problems no matter how do – 14 years Hosny 2002 IJPros

Spear course on splinting natural tooth to a dental implant

Chee 2006  Are these true telescoping crowns?  Uwe Mohr thoughts.