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Anon asks:
The surgeon placed a dental implant in #8 position and the surgery and healing were uneventful. When I went to torque down the abutment, the patient felt a sharp pain. I stopped torquing and the pain went away. I then cemented the crown.
Did I do the right thing here? Should I have backed out the abutment screw and let the implant heal longer? Should I have given antibiotics?
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8 Responses to “ Torquing Produces Pain? ”
Anon,
Sharp pain on torquing an abutment could mean
1. …the implant was not adequately osseointegrated and rotated. If your abutment has ‘cylindrical symmetry’ and you were able to cement the crown with a good fit to the adjacent teeth and occlusion, then the implant may re-integrate if the forces of occlusion are kept low for a few months, percuss in a few months.
2. …the implant has a predominately connective tissue connection to the bone and the implant will fail eventually, percuss in a few months.
3. …the implant site could be infected from an adjacent tooth with a necrotic pulp, test them!
4. …the implant is impinging upon a vital structure such as the nasopalatine foramen or an adjacent tooth, take a pan or pa.
Good Luck
Jim
James C Cope, DDS
I had 2 implants put in on Jan. 2004, I am now having the same problem I had with another tooth [so I thought] the tooth was removed but I am still having a lot of pain I think the implants are the problem. My dentist says they are ok.
I have never seen a painful implant that was integrated. There are painful implants that cause no infection or bone loss, however if you anesthesize the area and apply moderate torque pressure they most often will unscrew their way out.
Many times final torquing of the abutment can cause irritation to the surrounding gingiva. Most labs will fabricate an abutment that tapers out more than a healing abutment, so as the abutment fully seats and clamps down, the patient can feel stretching and sometimes tearing of the peri-implant gingiva. This occurs more often with custom abutments, more often with external hex implants, and more often with flat-to-flat interface implants (such as Nobel biocare). I always torque slowly, giving some time for the soft tissue to adapt, and I have started using an implant system that incorporates a flared healing abutment (which better mimicks the final restorative emergence profile) and a platform switch. I haven’t had any problems since.
This problem may be eliminated by using the correct instrument to hold the abutment stable so that there is no torque on the implant. I was fortunate to learn of this in my training and always use it.
It is my view that if at the time of prosthetics the imolant is mobile with “prosthetic torque” or painful during torque procedures less than 40-50N/cm
…you have a failure
Beyond this point it is wishful thinking ..the implant has failed
If you torque beyond this force depending on time and area you will cause a failure
SS
It is my view that if at the time of prosthetics the implant is mobile with “prosthetic torque” or painful during torque procedures less than 40-50N/cm
…you have a failure
Beyond this point it is wishful thinking ..the implant has failed
If you torque beyond this force depending on time and area you will cause a failure
SS
I am 39 years old, healthy non-smoker and I had implants to replace congenitally missing #7 and #10. The oral surgeon ran a very disorganized office. They did not communicate to me or to my dentist that they do not handle custom abutments until after the implant procedure, and my dentist had never done abutments either. The OS agreed to loan the tools to my dentist to install the custom abutments. When the time came for the abutments and crowns, a rep from the implant company was there watching and the dentist started with the implant on my left side, torquing quickly. There was much resistance and it hurt so bad that I almost passed out. She then stopped with that one and tried the right side implant, this time proceeding more slowly. It hurt less and clicked into the “35″ spot in no time. When she went back to the left side implant, she seem to proceed more slowly. However, the implant began to spin. My question is, is it proper for the dentist to attempt to place abutments with no previous training? I had no issues with the implant healing (was placed in mid November 07) and I am wondering if the dentist may have not known when to “stop torquing”.
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