ICFDP – implant-supported cantilevered fixed dental prosthesis or much easier cantilever implant bridge
Cantilever implant bridge is a nice solution for someone missing 2 or more teeth adjacent to each other. It is the same idea as a cantilever bridge on natural teeth.
When is a good time to do a cantilever implant bridge?
Anatomical issues and economic constraints are the two biggest drivers of the use of a cantilever implant bridge. Maxillary sinus, inferior alverolar nerve, and the mental nerve are the main anatomical considerations when a cantilever is going to be useful. There are situations were a cantilever makes sense due to just a lack of bone in an area as well. Cantilevers are cheaper than doing another implant so that is the economic advantage. It is importnat to use an implant system with a thick diameter to avoid flowering.
Another good time for a cantilever implant bridge is a case of two missing teeth where you wish to maintain papilla. Testori Perio 2018
When is it not a good time to use a cantilever bridge?
Anyone with parafunctional habits is not a good candidate for anything with a cantilever. This statement is from Roccuzzo IJOI 2023 from references 31 and 32. Those individuals end up with higher mechanical and technical complications. Loss of retention of a cement retained crown can be an issue as seen by Schmid COIR 2020 where 35% of the patients had it occur and several having it occur multiple times.
Cantilever implant bridge research
Aglietta 2009 5-10 year meta-analysis
- 5‐ and 10‐year ICFDP cumulative survival rate of 94.3% and 88.9%
Keep the cantilever mesial distal width to premolar size 7-7.5mm Tarnow article in DT 2013
Little evidence of bone loss but increase in minor technical complications Torrecillas-Martínez IJOMI 2014. Therefore, if between a sinus lift and a 3 unit implant bridge or 2 implants and a cantilever, the cantilever is the way to go. Dereci JOI 2021
A nice discussion about cantilever implant bridges by Bill on DT.
Roccuzzo has the best review article on the topic.
Survival rates for a cantilever implant prosthesis
Survival rates of TISP, cantilever implant bridge and a standard dental implant bridge are the same according to Rammelsberg JPD 2021.
What are the dental codes for an implant bridge with a cantilevered tooth?
For a cantilever crown(s) on dental implant(s), you use a combination of codes. First is the implant crown code(s) (D6065 for ceramic or D6066 for PFM) for the implant-supported part of the bridge. Second is the pontic code (like D6240 for PFM or D6245 for ceramic) for the cantilever tooth. Finally, are the abutment code(s) (D6057 for custom).
- D6057: Custom fabricated abutment
- D6065: Implant-supported porcelain/ceramic crown (for the abutment end).
- D6066: Implant-supported porcelain fused to metal (PFM) crown (for the abutment end).
- D6240: Pontic, porcelain fused to high noble metal (for the cantilevered tooth).
- D6245: Pontic, porcelain/ceramic (for the cantilevered tooth).
Most common example is the case seen above and these are the codes:
Double Implant, Single Cantilever (Three Units):
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- D6057 (Custom Abutment) x2 + D6066 (Implant Crown) x2 + D6240 (Pontic).
- You’re billing for the two custom abutments, the implant-supported crowns (retainer), and the pontic (cantilevered tooth).
