• Home
• Advice
• New! FREE Webinars
• Products
• Courses
• Online CE
• Videos

>>Advertise

Bacteria Collecting on Abutments?

posted in Abutments

« Placing Implants Into Infected Area | Understanding Implant-Abutment Attachments »

Print This Post

John asks us:
I’ve heard that there is a problem around the abutment margin junction on dental implants where bacteria tend to collect.

This can lead to a sulfur like “smell” there (I guess due to the toxins the bacteria emit). Have many of the dentists that visit this site noticed that sulfur “smell” around the implant abutment juncture? Is bacteria the real cause of the smell?

What other negative effects could this have on one’s health if there is bacteria there? Could this bacteria migrate into other places, like our heart valves? How can this bacteria and smell problem be fixed? Could gargling with strong mouthwash kill the bacteria at the implant abutment junction? If
not, why not? What are some other suggestions. Thanks for any thoughts from all the experts out there.

18 Responses to “ Bacteria Collecting on Abutments? ”

• Anonymous October 17th, 2006

  
  

  I have checked with several CD in Colorado Dr. Lori Kemmet and Dr. Adam Almeida. They said that they have never heard of any cases like this.

  I would be a bit more conservative or wait a little longer to go through the implant process. This is possible that bacteria will gather on the abutment…it does not matter how well you clean the area such as brush, floss, mouth wash and see the dentist regularly.

  The screw sort of acts like a drain plug and keeps the smell trapped but when the abutment is removed the smell comes out. At least that is how the dentist said it was in the blog from this site. The area the is hard for dental hygienist to access and clean.

• Don Callan October 17th, 2006

  
  

  Implants are just like teeth. They will collect bacteria and will get periodontal disease. You must see the dentist on a regular time frame for cleanings

• lt October 17th, 2006

  
  

  Dr. Callan,

  But don’t you think that it collects and build bacteria much faster than our own teeth? Not only that but it is a haven to store bacteria.

  With your normal teeth, you you can get it clean but with the implants, if it builds up and it is much harder to access for cleaning.

  If you have one tooth loss (baby tooth), would you opt for a bridge or an implant.

  Please let me know your thoughts.

• Anonymous October 17th, 2006

  
  

  It is a haven for bacteria and I would never have one placed after learning of an acquaintance’s horrendous ordeal after getting one.

• Alejandro Berg October 17th, 2006

  
  

  Dear John:
  Sometimes there is some bacteria gathering in that area, but when the abutments are of good quality that is minimal.After 40 years of use there are no bad statistics on that event and there is to my knowledge not a single illness or study that relates any disease to that bacteria.
  Your implants are more resistant to periodontal disease than your own teeth and if they were correctly restored they will last you a lifetime.
  In terms of the smell, we avoid that placing a little antibiotic ointment in the screw before screwing the restoration in place.
  If your abutment is gathering bacteria is probably not well polished or of bad quality so it should be replaced, gargling will do nothing to fix the smell problem since the junction is probably subgingival and therefore the mouthwash wont get to it unless you push it with an irrigation system.
  Titanium abutment are naturally covered by titanium oxide that has anti bacterial and anti inflamatory effect.
  Zirconia oxide abutments have the property of getting a great gingiva attachement so that fixes the problem also.
  Implants that are correctly restored,collect less bacteria than teeth and if I lost a tooth i would almost never consider a bridge over an implant.
  Cheers

• Richard Wiggs , DDS October 17th, 2006

  
  

  My implant patients use a natural product called mangosteen -a juice from the mangosteen fruit which has powerful anti-inflammatory properties,is among the strongest anti-oxidants and is a Cox 2 inhibitor. Not only does this benefit the entire oral mucosa but their forty Xanthones are beneficial to the cells and organs of the body. See Xanthones under www.pubmed.org

• Toby October 17th, 2006

  
  

  From what I have read above in the posts, it looks like bacteria do grow around the abutment margin, and that there is no way for a patient to access this area to clean out the bacteria. Thus, the bacteria will thrive in that particular area and this is not a good thing from a health perspective.

  Are their any implants systems on the market now that totally eliminate this abutment junction bacteria issue? If so, how do they accomplish this?

  Is this abutment bacterial issue being currently addressed by the implant makers? It would seem that this is a big problem.

• SMSDDSMDT October 17th, 2006

  
  

  Periodontal disease does not occurr in or around endosseous rootform implants. They do not have a periodontal ligamentous attachment and the route of transmission of that disease therefore is not possible. If you don’t have the organ you can’t get the disease. However, what about the area within the implant body as a collection zone. Almost a small “uterous” within the implant body. I suspect this is the case and that perhaps in some rare and unexplainable implant failures could be a thought. However, rare.

• Norman Kwan October 18th, 2006

  
  

  Limitation of Technology

  Traditional implant technology served us very well over the past 30 some years; implant,abutment and restoration. As long as we have these assemblies in the mouth, there will be gaps, voids, recesses, spaces etc, etc. The abutment or the connection between implant and restoration has been the weakest link in implant dentistry.

  At the best of time when we would consider a “successful” implantation and restoration, there are many issues such as micro-gaps, bacteria, odours, crestal bone lost etc. This is evident by the frequent discussions on this and other forums. In not so successful scenarios, we would have crown or abutment screw broken or loosening, gingival recession, unstable restorations etc.

  As a profession, we have to admit there are problems with these gaps. Then research and developed new approaches to eliminate these junctions. It takes money and most of all…time and the questions is who is going to pay for it.

  The recently “developed” one-piece NobelDirect implant (abutment integrally joined to the implant) was a step in the right direction, however, the problem with any Corporation developing new products is that their primary objective was to increase sales, very little or not enough research was done to develop the device but a lot of money was spent promoting the product. This compounded by the relatively short time clinical trail (one or two years in couple of not so independent clinics). When there appears to have some problems with these one-piece product, the best time and place to deal with it would have been in a clinical trial situation and not while they are in wide circulation. The result was that it actually done a disservice to the industry and cause the profession to move couple of steps backwards. Now for most front line implant dentists they are very skeptical and prejudice them with any other one piece device.

  The good news is that all the basic and animal researches done at some Universities are pointing to all the advantages of the absence of the micro-gap.

• SMS October 19th, 2006

  
  

  Norman, well thought. In the end we are well served with this treatment modality. The % loss we have experienced that could be associated with gaps and biologic losses is so far shadowed with poor planning and techniques. Yet, there is always room for change for the better and improvement…

• Peter October 21st, 2006

  
  

  Hi John
  I think SMS makes some intelligent comments. I find that too many implant systems rely on a screw attachment of the abutment to the implant which invites problems such as you describe. I notice many operators complain about ‘perimplantitis’ and saucers of bone destruction around the neck of implants and advise that implants should never be closer than 3mms or risk the loss of papilla and cause the black triangle. So why not use a differant method of attaching the abutment?

• Robert J. Miller October 22nd, 2006

  
  

  Part of the reason for fluid and bacterial invasion of the abutment/implant interface is micromotion of the abutment in function. Implant abutments that are flat against flat have the greatest micromotion and gap opening as shown in close up microvideo research. The second greatest gap opening occurs in morse taper abutments where the crown shoulders are on the implant body. The least micromotion occurs in morse taper or cone fit abutments where the prosthetic platform is away from the implant shoulder. If you attend any of the academy implant conferences, spend some time in the research lectures and peruse the brilliant work done by clinicians and PhD’s who will never get any glory for their work but who ultimately will drive this discipline.

• Anonymous October 23rd, 2006

  
  

  Can anybody help me with any implant related
  Project/Thesis,preferably a non-clinical topic.You can e-mail me off-list at:
  dental_clinic2000@yahoo.com

• Anonymous October 24th, 2006

  
  

  Morse tapers help to eliminate Micro Movement. They are not the cause of Micro Movement. Solid form abutments like the Straumann Solid Abutment are spun into place creating the same kind of bond that we expect from lug nuts on our cars. If your wheels come flying off it is because the lug nuts were not tightened down properly or the bolts have sheered off. A single stage implant restored with a solid abutment will only have a single Microgap where the crown meets the implant. If this point is 2-3mm sub-gingival then the patient will have no problem cleaning away bacteria from this single Micro-gap. The same cannot be said for other designs that create two Micro-gaps one at the abutment and implant connection and another at the abutment crown connection. Especially when one considers the morphology of those connections and the gap between them. A properly placed and designed implant that takes into consideration the issue of the microgap should not have any more bacterial issues than the patients adjacent teeth.

• Matt October 25th, 2006

  
  

  I see the term “Morse Taper” used regarding implant-abutment interfaces. A true Morse taper is about 5/8″ per foot, roughly 1 1/2 degrees (3 degrees included angle). Actually there are eight sizes of MT ,0-7, all very similar in angularity.
  The Straumann (and clones) have an 8 degree (16 degree included) taper. Just a little taper trivia.

• Laura December 23rd, 2006

  
  

  I have a dental implant - two teeth, upper right (I think #’s 6&7) which were put in about 5-6 years ago. In the last two weeks, I feel a sort of vibrating feeling, above the implants. Not a pain, but as though something is loose, like a feather tickling up there. It’s gotten more noticeable over the last few days and whenever I move my head forward or back I can feel this strange feeling. What on earth can this be? Due to holiday, won’t be able to see my dentist until Tuesday at earliest. I am petrified that something terrible has happened. The implant itself does not seem loose. Does anyone out there have any idea what might be happening?

• Anonymous December 26th, 2006

  
  

  The only implant design that has been PROVEN to eliminate the microgap by virtue of its 1.5 degree taper connection (and no screw) is the BICON implant which has existed with this locking taper connection since 1981.
  Studies show that the gap between the implant and abutment is too small for bacteria to pass through (essentially it’s a cold weld as the metal surfaces are so well opposed)which is why you will often see bone growing up and over the implant-abutment interface.

• Bill Schaeffer December 26th, 2006

  
  

  If you notice an unpleasant smell when you unscrew an abutment - then your implant/abutment has a septic connection.

  If you expect to lose 1-2mm of crestal bone (”down to the first thread”) when you place an implant - then your implant/abutment has a septic connection.

  If you routinely have pocketing around your abutments - then your implant/abutment has a septic connection.

  THIS DOESN’T HAVE TO BE THE CASE.

  There are a number of implant systems out there that either use tapered internal connections (e.g. Bicon, Ankylos, Astra) or bring the I/A connection supracrestal (e.g. Straumann) and avoid these problems.

  I have NEVER removed a Bicon abutment and noticed an unpleasant smell - that’s got to tell you something - and it’s not something that most “implantologists” can say.

  Kind Regards and Happy New Year,

  Bill Schaeffer

---

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. Consumers & Patients: Please do NOT post dental questions here. Instead Visit ChooseDentalImplants.com to get Expert Advice for Implants.

Name (required)

Email (Required, Will NEVER be published)

Website

Message:

Note: At times your comment may not appear on the website immediately, because it has been sent to our editors for approval. Once approved, we will publish the comment. There is NO need to resubmit your comment, if it does not appear on the website immediately.