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Medical Forum / General / Dentistry / March 2007Dangerous to remove abutment?
My wife recently had two implants in her front lower jaw. The entire process took well over a year as she needed to have two bone grafts. Not fun. She went with an implant specialist in a different part of the city recommended by her dentist and was reassured that care would be very well coordinated. Unfortunately it was rarely coordinated. And while the implant specialist wanted her to have a porcelin abutment placed, the abutment actually was inserted by a new implant specialist who had recently joined her general dentist's practice. It appears that the message to use porcelin never got passed along and the new implant specialist inserted a metal abutment. The result now is that she has a very visible dark line between her tooth and gum, the metalic abutment. The original implant specialist is upset about that porcelin was not used and does not want his name associated with 'the result'. My wife is upset because after spending thousands of dollars and lots of pain; it is not what she was led to expect and would not have hapenned had they coordinated her care. They have offered to replace the abutment with a porcelin abutment at no charge but told her there is a 25% chance that removing the abutment will cause the implant to come unthreeded because of the torque it was screwed in with; and a new implant would then need to be reinserted with a bigger hole. I think if this chance were a lot less, she would go for it, but having gone through two grafts and a long healing process in between (not to mention missing two front teeth for many months) she is not up for it. They are giving her a year to think about it. Apparently a gum graft is not being recommended. I've found lots of references to abutments being removed, and even broken abutments removed with screwdrivers and no mentions of not removing abutments because it might take out the entire implant. What about drilling the abutment out rather than unscrewing it (I read that this can work if it is broken). Any advice appreciated, please forgive my lack of dental insight. Cheers, Seth > My wife recently had two implants in her front lower jaw. The entire > process took well over a year as she needed to have two bone grafts. [quoted text clipped - 29 lines] > this can work if it is broken). Any advice appreciated, please forgive > my lack of dental insight. Cheers, Seth I hope you get answers here. It may very well depend upon the particular implant brand. I have restored mostly Zimmer (formerly Centerpulse) implants. A large part of the retention of the abutment is from an internal hex element, but there is a small screw there. I have on one occasion had one of these screws strip out on me; it could be tightened, but not to the full recommended torque. I was convinced that it would be sufficient to keep the abutment in, and after a year it appears that things are working out. However, these screws can be stripped, and occasionally they snap. Maybe the others know if some of these fixtures can be tapped for larger screws, or if larger screws are even made. In any case, it certainly would be unfortunate if the fixture had to be replaced in order to replace the abutment. I have removed abutments without incident--not easy, and I haven't done it often, but it is possible. Steve Thanks Steve for your answer(s). Still trying to process it all. It took so long to get the implants to fuse with her jaw bone, I doubt she will risk it again. Short of replacing the abutment with a porceline abutment, or a gum graft, is there any solution to conveling the metal that is showing? > Thanks Steve for your answer(s). Still trying to process it all. It > took so long to get the implants to fuse with her jaw bone, I doubt > she will risk it again. Short of replacing the abutment with a > porceline abutment, or a gum graft, is there any solution to conveling > the metal that is showing? I'm thinking the lab could fabricate a collar on the crown that covers the exposed metal. However, that would make it somewhat more difficult to clean around the gumline. Still, if you're unhappy enough, that is an option that wouldn't require removal of the abutment. Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 On 2月9日, 下午2時36分, manb...@speakeasy.net wrote: > My wife recently had two implants in her front lower jaw. The entire > process took well over a year as she needed to have two bone grafts. [quoted text clipped - 28 lines] > this can work if it is broken). Any advice appreciated, please forgive > my lack of dental insight. Cheers, Seth I hope my answer can help you more understanding the situation. Your situation: Your implant specialist inserted an implant to your wife recently with a metal abutment The eshtetic result is poor. The dentist suggested to remove the abutment and replace a ceramic one without charge. But, he also warn you that the recent inserted implant may have the chance come out with the abutment. Then, a new bigger implant may be needed to put into the implant hole to replace the losing one. Discussion: Once implant insert into the bone. It will go through two phases. The first phase is the implant lock into the bone by mechinical locking. It just like you screw something into a piece of wood. If you need to unscrew it. You have to apply a similar screw-in force to remove it. Because of the biological reactiont, this locking force will decrease day by day. The second phase is the bone growth onto the implant surface. The new bone will provide support to the implant and it should increase day by day. The strength of the new bone will depend on how much, how fast and how well the bone cells growth. Some factors will affect the growth of bone such as the health of the patient, the loading of the restored tooth, the gentle of surgery, any grafting or .. etc. Anyway, in an ideal situation, the implant should be stronger and stronger day by day. Suggestion: In your wife case, in order to avoid the implant loose when he try to unscrew the abutment, you can ask him to wait for months before doing it. If the implant come out even after months healing, it means the bone is not growing well onto the implant and it may fail anyway in the short future. With the help of ceramic abutment, I believe your wife esthetic situation should be improved and the black line will be gone. In some cases, we can also see the gum growth back on the ceramic abutment without any gum surgery. Cheers, Pollux |
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