Implant moved when abutment tightened for crown placement

[reminisce21]

Was getting a crown on my #3 implant by my dentist and while tightening the abutment, the implant moved.

I can't get in to see my oral surgeon for a few weeks but wondering if this has happened to anyone before and if this is fixable with time, or did I have to do another procedure?? Def don't want to have to remove and redo the whole process

All was well on my previous follow up but I think I messed up by taking excess Vit D inadvertently, I noticed something was wrong when I started getting finger joint pain out of nowhere (was also taking a prental so overdid it)

 

[Dr M]

Was the implant tested before the abutment was tightened? Usually you need to do a torque test to make sure that the implant has integrated in the bone, before starting the restorative process.

 

[reminisce21]

Was the implant tested before the abutment was tightened? Usually you need to do a torque test to make sure that the implant has integrated in the bone, before starting the restorative process.

I'm not sure exactly but I think he had no issue with the adjacent #4 when doing the same thing (tightening or loosening the abutment?) I believe this was after the healing caps had been removed. I just know I felt the tool slip (felt like a wrench ?) so for #3 so knew something was wrong. Does that sound like the torque test?

He was able to place the crown for #4 after, but advised I see the oral surgeon for #3 as he didn't think it was stable enough to take the crown. I'm mainly concerned about what comes next as I can't get in to see the oral surgeon for a few weeks. On the phone he mentioned possibly removing it, and when I baulked, he said he could possibly move it a little when I mentioned I wasn't in pain and it hadn't fallen out.

 

[Kennethk]

If one implants good and the other need redoing you can talk to them about doing a implant double sided crown.

 

[Dr M]

After an implant is placed, you usually see the oral surgeon first. The implant is torqued tested at the oral surgeon and when he is satisfied, he should usually provide some formal confirmation ( letter etc. ) in order to confirm that the implant is ready for restoration. If the one implant moved, it means either loading ( i.e restoration) was done too early, or there is some defect in the bone in that area. The oral surgeon will be the only one to address this issue unfortunately. I would not suggest just going for 2 crowns on one implant, because even though this is an option, it depends on the spacing of the implants and the amount of forces that will be exerted on the crown.

I think it is best to see the oral surgeon in person, so that he can clinically and radiographically evaluate the implant in question and then ask for a formal confirmation letter that the implant is ready for loading.

 

[Kennethk]

After an implant is placed, you usually see the oral surgeon first. The implant is torqued tested at the oral surgeon and when he is satisfied, he should usually provide some formal confirmation ( letter etc. ) in order to confirm that the implant is ready for restoration. If the one implant moved, it means either loading ( i.e restoration) was done too early, or there is some defect in the bone in that area. The oral surgeon will be the only one to address this issue unfortunately. I would not suggest just going for 2 crowns on one implant, because even though this is an option, it depends on the spacing of the implants and the amount of forces that will be exerted on the crown.

I think it is best to see the oral surgeon in person, so that he can clinically and radiographically evaluate the implant in question and then ask for a formal confirmation letter that the implant is ready for loading.

I wonder if the oral surgeon ignored a bone graft causing it to loosen. Every implant I've ever had surgeon recommended bone grafts and not 100% but it looks like there is some empty space in the xray.

 

[Dr M]

It depends. Bone grafts are done if the implant was placed immediately after an extraction or if there was a clear lack in quality/quantity of bone.

 

[Kennethk]

It depends. Bone grafts are done if the implant was placed immediately after an extraction or if there was a clear lack in quality/quantity of bone.

I think it could be a weak bone structure on my xrays it looks as if it flows a bit more better

On theirs it looks like there are some more empty spaces so makes be believe that a bone graft wasn't done when needed

You can see how theirs is a bit more wavy at the bottom.

 

[Dr M]

I have seen this happen in Maxillary implant placements.

 

[MattKW]

Yes, please see amended xray. You didn't have a lot of bone before starting treatment, and from a 2D view, it looks as though some of the thread is protruding into the sinus space and not gripping bone. A sinus lift might've been indicated. Talk to oral surgeon and consider a 3D scan (CBCT).

 

[reminisce21]

Yes, please see amended xray. You didn't have a lot of bone before starting treatment, and from a 2D view, it looks as though some of the thread is protruding into the sinus space and not gripping bone. A sinus lift might've been indicated. Talk to oral surgeon and consider a 3D scan (CBCT).

Do you think this is also something that could've happened from excess vit D causing extra calcium build-up? (I've read that can cause implant failure). I have had bone grafting done, just some poor healing I believe since I was not brushing over on top out of precaution

 

[reminisce21]

After an implant is placed, you usually see the oral surgeon first. The implant is torqued tested at the oral surgeon and when he is satisfied, he should usually provide some formal confirmation ( letter etc. ) in order to confirm that the implant is ready for restoration. If the one implant moved, it means either loading ( i.e restoration) was done too early, or there is some defect in the bone in that area. The oral surgeon will be the only one to address this issue unfortunately. I would not suggest just going for 2 crowns on one implant, because even though this is an option, it depends on the spacing of the implants and the amount of forces that will be exerted on the crown.

I think it is best to see the oral surgeon in person, so that he can clinically and radiographically evaluate the implant in question and then ask for a formal confirmation letter that the implant is ready for loading.

Just curious your thoughts on if waiting another several months can be a viable option as well? I am seeing the oral surgeon this week, but curious to know all options as I would like to avoid surgery again if at all possible. I do think my taking excess vit D might have something to do with it as I was experiencing joint paint to the point of thinking I had early arthritis, which stopped when I ceased taking it (took some time to subside)

 

[Dr M]

It should be fine to wait. Just make sure not to exert any excessive forces om that side when eating.

 

[reminisce21]

It should be fine to wait. Just make sure not to exert any excessive forces om that side when eating.

Okay, thank you! Really hoping waiting will be enough to not have to redo the implant

 

[reminisce21]

Do you think this is also something that could've happened from excess vit D causing extra calcium build-up? (I've read that can cause implant failure). I have had bone grafting done, just some poor healing I believe since I was not brushing over on top out of precaution

This is an updated CT scan btw I declined the torque test as I had wanted to a wait a couple of months for it to further re-stabilize. Said it looks good and didn’t seem to be a rejected curious on your thoughts?

 

[reminisce21]

It should be fine to wait. Just make sure not to exert any excessive forces om that side when eating.

Hi, just to update I did an updated CT scan and oral surgeon said it looked good and tapped on it a little bit with no issues and I declined the torque test as I wanted to wait a bit longer for it to further re-stabilize.

Wondering your thoughts please on how the scan looks and how long you think was sufficient to recheck the torque test for the crown placement? Thanks very much

 

[Dr M]

How long ago was the implant placed?

 

[reminisce21]

How long ago was the implant placed?

Mid September, and I experienced in December finger joint pain which is when I realized excess Vit D was the culprit (took a couple of months for symptoms to completely subside after stopping)

 

[Dr M]

I think you can wait another 6 weeks and then go to re-check the torque.