Dr. A. asks:
I did a sinus lift and installed 3 Anthogyr AXIOM implants in the maxillary right posterior 4 months prior. The implant fixture in #5 site [maxillary right first premolar; 14] had the cover screw become exposed and dislodged. The premature exposure and loosening and subsequent loss of the cover screw may be due to the patient chewing on that side. What do you recommend I do now with the implant fixture in #5 site?
Bone loss around implant
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Provided it didn’t fracture it seems that you should just replace the cover screw. if it did fracture that is a different story.
From the radiograph provided, what you have placed are not cover screws, but Healing Collars, and it seems to me that the shaft of the most mesial Healing collar is broken in the threaded hole of that implant.
Leave the implants alone while they are being osseointegrated, and when it comes time to uncover, you will be able to massage the broken screw out with an endo explorer turning counter clockwise
Who is editing these entries? This is a fractured implant, unless I’m lookIng at an artifact . If it is in fact fractured at the coronal aspect, the fixture should be “canned”. If I were a betting man, and I am, the implant was fractured upon placement, but not noted until dr. Ruddick pointed it out. I’m going to encourage a bit more didactics, before you place anymore implants. Albiet, this maybe considered “overkill”, but I take a dig. pa film, at the end of every case, to make sure the cover screw or abutement has been seated completely and to medico/legally document the final position. Bv
Disregard my late night response, it has been a long four days. I’m not certain, that it is fractured . I would suggest, however using true cover screws and not abutements. I believe integration is much more predictable . You are essentially immediately loading these things, if the patient is not 100% compliant. They lost these teeth for a reason. Please except my apology? Bv
Tri-lobed Anthogyr Axiom implants are quite similar to Ankylos implants esp with regards to its soft tissue care concept.
I agree with Dr Rudick that those are transmucosal healing collars and not cover screws. Cover screws are much smaller (with no neck) and usually at the same height as the platform of the fixtures when fully inserted. Cover screws enable the implants to be buried easily in a 2-stage procedure.
You seem to have used transmucosal healing collars of different gingival height. We tend to make do with what we got in the drawer without paying appropriate attention to the concept of tissue care. The healing collar at #5 is fractured, probably as a result of hyper-occlusion.
These implants would have osseointegrated by now after 4 months. The broken healing collar is of no consequence if you can retrieve it and start your prosthetic restoration. Good luck.
i agree with dr rudick and dr chan , this is a fractured healing abutment not healing screw
the healing screw never comes out due to chewing
my recomendation is to remove tke broken part after the osseo integration period and complete the prothetic phase
good luck
If situation is not pathological clinically (intraorally), do splinting temporary crowns. This X ray does not reflect a negative bone reaction.
the cover screw has a strenge shape. it is constricted at the area were it connect with fixture i think it must be as wide as fixture in this area of stress concentration, and this may the cause of the cover screw fracture (or gingival former). my advice: in future case is to chenge your implant systeme.