A hygiene recall patient came in today for routine maintenance (he had an implant placed by me, fifteen years ago).
While he was heading towards his prepared operatory, I was coincidentally passing through the hallway to visit another patient when he exclaimed with a slight concern, “Hey doc, my front tooth implant is loose.” Before I had a chance to say good morning, I instantly snapped on a right-handed glove and reached across to wiggle his front tooth with my index finger and thumb “Any pain,” I asked? My young new hygienist, stared in both confusion and curiosity. The patient replied, “No”.
I asked my hygienist to take a radiograph to confirm my suspicions and low and behold…. they were correct! I assured him not to worry and that all was well with his implant and that it was simply a LOOSE ABUTMENT SCREW. I was able to accommodate his issue and concerns, right after his cleaning appointment.”
The abutment screw is a tiny screw that engages the implant abutment. The implant abutment is the structure that is above the gum line and is seated on top of the dental implant platform. An implant crown, is usually cemented onto the screwed down abutment.
On occasion, the little tiny abutment screw “backs out”, thereby releasing the abutment/crown complex from the implant fixture. Patients will interpret that as a wobbly implant crown that clicks ( the clicking is the sound made when the base of the titanium abutment tips on and off the titanium implant screw platform).
Pain is usually an indicator of bad things. Pain upon manipulation of the tooth complex would have indicated a failing implant fixture requiring it’s immediate removal.
In this situation, not to worry. No shot needed to fix the problem. Usually a simple fix. A small access hole needs to be created with the dental drill thru the existing crown to yield a direct straight-line access to the top of the abutment screw head. Then a quick retightening of the screw with a special miniature implant screwdriver. Seal the access hole with a composite resin and done….A ten minute fix!
The abutment screw can loosen due to unbalanced forces on the implant abutment crown or a patient para-functional habit such as bruxism ( tooth grinding).
It’s best that the dentist replaces the abutment screw with a new one. Then, a final bite adjustment is important to minimize extraneous forces on the implant crown (which minimize chances of that recurrence). An abutment screw replacement is suggested because one must assume that the original abutment screw was previously torqued down to the manurfacturers specifics ( 35 Newton/Cms ). When any screw is torqued, it is essentially stretched to a maximum twist before stress tolerances are destroyed yielding a snapping screw. The inherent nature of the screw’s metal contracts back creating tension onto the opposing implant’s internal threads giving a compression force in addition to a mechanical locking of threads of both implant and abutment screw.
A bite guard may be recommended after the new screw is replaced to minimize occlusal lateral forces that could potentially be responsible for stressing the abutment screw and weaken it’s integrity..
Dr. Emilio & Associates, Always Accepts New Patients. He especially exceeds at treating same day emergencies patients suffering from tooth ache pains.
His goal is to keep his patients’ Teeth and Gums Healthy For Life.
Feel Free to appoint a Consultation with the Doctor. Open Six Days A Week
OPEN on Weekdays. 7:30am -8:00pm (M<T<W<T)
Weekends (Saturday only). 8:00am-2:00pm
111 East Avenue, Norwalk, Connecticut 06851.
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Office (203)866-7164 www.robertemiliodds.com
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