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Spear F. J Am Dent Assoc 2009; 140: 587–593

Tenets such as 'dentists must place implants where (there is) bone' and 'a maxillary canine implant cannot serve alone as the primary guidance' have now been revised. This paper explores another paradigm that 'Natural teeth cannot be directly connected to implants'. The original reason for connecting implants to natural teeth was to prevent the superstructure rotating. Such an arrangement is now unnecessary as anti-rotational components such as the internal-hex and external-hex can be incorporated into the implant or superstructure. Notwithstanding this, it is argued that it is acceptable to join implants to natural teeth when 1) spreading unfavourable parafunctional forces, 2) to control dento-gingival aesthetics by keeping the natural tooth, 3) when there is lack of space and 4) financial constraints. However, connecting implants to natural teeth is not without its drawbacks such as the breakdown of osseointegration due to overloading.