Problem with bridge not fully seated on implant?

Hi, what do you think about this bridge on implants? The abutment on the 15 isn't fully seated… What should I do? Have I to remove the bridge and restart entirely the work or can I just monitor the situation? Thanks for your help


mwroberts1949 comments:

No Comment

timcarter comments:

I would say given that it is the anterior/mesial portion of an initially over-engineered splinted prosthesis this should not be an issue!! The gap is supra crestal and should result in minimal, if any, adverse consequences. Just my opinion...

ajaykashi comments:

I would not touch this again for now. The implants look solid and well positioned. The bridge is seating well and I am assuming that the patient has no occlusal issues. And.....the bridge margin is supracrestal, so, I would only monitor it periodically for the long-term.

smiledr comments:

I would just keep an eye on it and make sure the patient is on top of OH. I seriously doubt there will be a problem

gregkammeyer comments:

In my experience this will be a plaque trap and contribute to crestal bone loss. I would cut the crown loose from the splint, saving the abutment and verify complete seating radiographically on the revision

timcarter comments:

Considering that this "plaque trap" is spracrestal on a seemingly rigid splinted restoration I can not make any sense of your rationale. I assume, based on your response, that you would propose to replace every restoration since they too have imperfect margins and could also serve as plaque traps... for example the distal of #5. In my experience dentistry has proven to be nothing more than an imperfect attempt to restore a once perfect environment so some imperfections must be tolerated. I would consider this an aggressive platform switch and drive on.

timcarter comments:

To be clear I suspect that I approach this from a different prospective. Unlike many in this forum I am a periodontist and treat other providers patients which are referred to me. As such I get to work with many dentist of different skill sets and see a lot of situations that I might tend to want to approach differently. As a result of this I am slow to suggest that existing dentistry be deconstructed simply because I think I might be able to do a better job. With that said I am extremely confident in leaving this minor imperfection alone as this supragingival gap will not be a problem, though any attempt to improve it very well could.

gregkammeyer comments:

Tim, since I too have an implant/perio surgery referral practice and do as much perio as implant work, I respectfully agree: we approach the various skill levels of doctors and their work differently. I favor helping them see that open margins are just like excess cement: they cause problems. As the professionals that have had advanced training, I believe that is part of OUR duty. We learn from journals and advanced courses and pass that onto the GP's. Certainly many of these issues don't amount to anything HOWEVER, yesterday, I had a patient with the exact same problem and even tho she had adequate room for tissue adhesion on the abutment, there are still pain problems with oral hygiene. Having had excellent dentistry myself and some mediocre, I get the value of doing things well. That is my focus in dentistry.

I’m reminded of a younger dentist 20 years ago that I advised to redo a bar OD because of prosthetic miss fit. He sent me a letter detailing all he learned himself, redoing the case. He’s gone onto being a stellar implant provider.

gregkammeyer comments:

I just had a referring Dr that said the open margin was fine, even tho the tissue was inflamed inspite of excellent OH. Magically the tissue got healthy when the crown came off. This site will cause long term problems.