Teeth chattering after implant crown delivery?

I delivered this implant crown #30 last week. Torque was between 35 and 40 N.cm. Interproximal contacts and occlusion were passive. Two days later she came back, reporting that her teeth have been chattering for the last 2 nights. She could not sleep and had to take sleep medicine. She could not tell me if the chattering happened the same day the crown was delivered. Even at my office I observed her teeth spontaneously chatter. When biting on a cotton roll, they stopped. I took the crown off, placed a healing abutment back. I asked her to observe if she still have chattering at night again. Today, she told me that the chattering has stopped. I placed the crown back and ask her to see if her teeth will chatter again. I thought that if they don’t then may be due to some other reasons. But, what if they do?

Have you encountered this situation? What could be the reason? Patient is 81 years old, in good health.

Thanks for your help!

Check occlusion. She has interference some where. Remove all mesio-lateral and protrusive excursions. Or make them minimal, and see if teeth still chatter.

Situations like this are always frustrating for everyone.
Agree with the above suggestion.
Another possibility is contacts too tight which you seemed to have addressed. The angular inclination of this implant makes it difficult to have proper contacts since the central axis of the implant is not parallel to the adjacent contacts. Either they will be too tight or too loose. Which can cause the patient to have a pressure sensation that is relieved with clenching.
Other option could be lack of full integration of implant- could be when crown is torqued she is sensing that and why its better when you place the healing abutment.

Please keep us posted on this case- Thanks for sharing!!!

how long ago did she have the missing space for?