• Dental Implants Q&A
• Topics
• New! FREE Webinars
• Products
• Courses
• Online CE

Abutment Not Fully Seated: Leave as Is or Drill it Out?

posted in Abutments, en

« Bisphosphonates: What is the Latest Protocol? | Attached Gingival on Left and Alveolar Mucosa on Right: Proper Technique? »

Dr. R. asks:
I placed a dental implant fixture and it osseointegrated completely and uneventfully. After uncovering the implant fixture at 4 months, I attempted to torque down the abutment with a titanium screw. I hand-tightened the abutment screw and then I torque it down to 35Ncm. I realized then that I had made 2 errors. A radiograph demonstrated that the abutment was not fully seated when I torque it to 35Ncm. Also I realized that I was only supposed to torque it to 20 Ncm. I have not been able to back out the abutment screw. Should I leave the abutment as is and restore it with a single crown? Should I attempt to drill out the abutment screw?

8 Responses to “ Abutment Not Fully Seated: Leave as Is or Drill it Out? ”

• Dr.Serge December 2nd, 2008

  
  

  Remove your abutment, when it is not fully seated that means that there is a gap that will lead to a bacterial growth with all complications that will result, second the stress will be much more increased on the screw due to increased micromovement of the abutment…removing the abutment should not be a problem

• doctorberg December 2nd, 2008

  
  

  remove it, cut it if you must, if you dont you and your patient are on the way to a small hell.

• DRMA December 3rd, 2008

  
  

  Why is it interesting? If you place an implant without abutment, you can torque it under bone level. After uncovering, the bone will not let you to fit the final abutment on the implant platform. Worse is, if you don’t realize that on a control x-ray. The bone will go down and you have got a fixation screw loss. (or fracture)

  If you use an implant with fixture mount (implantdirect, zimmer…), it shows you if there is no place for the abutment. (which has grater diameter) First you think the FM makes you difficult to place the implant, than you realize, it helps…

• Don Callan December 3rd, 2008

  
  

  Remove it–it will harbor the periodontal pathogens and there is a good chance the screw will fracture anyway–it may go down the wrong way.

• Dr. Powers December 3rd, 2008

  
  

  As mentioned above, you have to take the abut off and reseat it properly. Always, Always take a check film prior to torquing to verify the abut is seated all the way. If the hex is not lined up right and you torque it down, you can damage the hex on the abut or worse the hex on the implant. You should be able to get the screw out by placing a hand driver in the screw and grabbing the driver w/ a hemostat to give you some leverage. If you strip out the hex of the screw you’ll have to removed the abut the hard way with a hand piece and bur. Use lots of water, new burs, and a light touch so you do not cause excess heat on the implant. I would also use a brand new screw when replacing the abut the 2nd time. The old screw will now be stretched since being torqued already. One of two things keeps abuts from seating, hex not lined up, or bone in the way. If bone is in the way it will need to by removed by using a special mount and bur that your implant compy will have. Good luck

• Dr.V December 10th, 2008

  
  

  Well thats a good question.You SHOULD take it off but it won’t be easy.You can easily damage implant hex,internal threads or when you torqued you had already damaged the internal threads or hex and thats catastrophic.35Ncm is nearly enough to turn even osseointegrated implant.
  Extremely careful removal of the abutment can solve the problem(if no damage had been occured).After that of course new screw and abutment should be used.Good luck

• Fabe December 11th, 2008

  
  

  Reading those questions always scare the hell out of me.
  I know this is a website were Docs can share info, but still…
  Treat your patient like if you were the patient. If you would not want to be treated by yourself, refer out.
  Yes, I know, another “refer out” non constructive type of answer.

• coxsakie December 14th, 2008

  
  

  Keeping this in place means one thing—> periimplantitis!

Leave a Comment

Comment Guidelines: This is a forum for dentists for intelligent discussion. No insults. No outside links. No promotional comments. Though we require an email to route questionable comments to our editors, we will NEVER publish your email. Patients: Please do NOT post dental questions here. Instead Ask Us or Find a Local Dentist.