I have cemented a crown on an implant with long term temporary cement. When I screwed the abutment, the final screwing with the hand screwdriver rotated a little the abutment - so that I cannot fix the crown in the right position. After minutes of 'ultramilimetric positioning' I found the right position, and I cemented the crown (no , it is not a screwed-retained crown). Now the patient came back to the office because the crown is rotating. I have tried to take it off, but it didn't come out and I didn't want to force very hard. What solutions do you advise? 1. take off the crown and 2. make the abutment to do not rotate? The implant brand is Anthogyr.
Cut off the crown, and make a new SRC (screw retained crown) or new crown and abutment. Your abutment is not fitting properly, and that is why the abutment is rotating. Depending on whether you are using a stock abutment or a custom milled abutment - the error could be in the blank used by the lab to create the custom abutment, or in the selection of the proper stock abutment.
Are you certain you selected a non rotational abutment or a rotational one? If you have a Non rotational abutment it should lock into the implant hex. If you have a rotational abutment it will spin around and you'll never get it to the same location. Check it out! Also is there a possibility the implant is rotating if so it's non salvageable, take it out, graft, and start over.
If the implant and the abutment have an indexing system such as an internal hex, there should be no rotation.
Also the final tightening should be done with a torque wrench to the number recommended by the manufacturer, not by a hand held driver.
Drill a hole through the crown for access to the abutment screw and remove both. If you cannot figure out why it rotated, ask a more experienced dentist to help you with it.
Dr Zoobi comments:
Your abutment is not seated properly because of the interproximal bone is in the way. If you take a radiograph with crown and abutment in place, you will see that. You need to redo this implant. Too many wrongs here that should have been addressed at time of implant placement. You also have an abscess on adjacent tooth. This implant will ultimately fail.
I tend to agree with Dr Zoobie, except I’m not convinced adjacent tooth has an abscess. Get a CBCT to make sure, it will also show more accurately the implant position. Was this an immediate placement? If adjacent tooth is not abscessed and although implant position is not ideal you can profile down the mesial bone to get the abutment to fully seat.
For the sake of the patients who trust their oral health care to you, please, please, doctor, avail yourself of additional training. There are many deficiencies here, the least of which is that the radiograph submitted does not even show the abutment and crown.
a technicians oppinion (lab-owner in switzerland): this work failed from the beginning. 100% agree with plangford
Wow. Lots wrong here. The solution begins with a proper exam and x-rays and treatment plan. Perhaps after the loss of that fractured??? premolar and restoration of other teeth, that implant might be able to function as a bridge abutment, with a second implant. Who knows ... clean it up first. Its not possible to make that implant work by itself in that position.
Rianne Poodt comments:
Here is a picture of the case with the crown(that rotates).
After i cut the crown and i removed the abutment, i’ve placed an healing abutment.
Note for critics: the implant is not placed by me. IT WAS REFFERED TO ME by the dentist who is now pensioned…i only placed the crown, and now we are trrating the adjacent infectwd teeth.