ITI Implants: How to deal with movement in splinted crowns?

I am looking for an accurate evaluation to the x- ray photo below. Two ITI (Tissue level) dental implants are placed in the lower left jaw, and two splinted crowns “molars” on them. Implants were placed in 2003 in an area where molars had been extracted since 1994, the splinted crowns over the implants are cemented with PANAVIA F2 for previous 6 years. They were okay during that period. Now there is a horizontal movement in the splinted crown, and a vertical movement from the right crown according to the attached photo.

How do we securely and safely remove/seperate the crowns from the abutments , then re-cement them, hopefully for additional service period?

Any advice concerning those dental implants, and as a proactive steps for the future, in case I need to replace these dental implants, what is your advice concerning the brand of implants that should be used? Thank you for any advice you can provide.

12 thoughts on “ITI Implants: How to deal with movement in splinted crowns?

  1. Gregori M Kurtzman DDS says:

    Appears both have crestal cupping bone loss but without seeing the radiograph from 2003 when restored we cant tell what changes to the bone occurred. I would drill a hole thru the occlusal and access the abutment screw then unscrew the fixation screw to remove the splinted crowns then you can eval the condition and any mobility on these two implants

  2. Darwin Bagley says:

    Looks like they made be one piece solid abutments – no separate screw.
    In that case you would need to cut the bridge off.

    If you e-mail me I’ll send images.

    Darwin

  3. Dr. Gerald Rudick says:

    From the information you have given, it seems that the two crowns which are soldered together have been cemented on to the abutments for each implant. If there is movement, then probably the abutment screws have loosened, and are not firmly holding the abutments. The cement has not washed out and is secure……. very easy to fix this situation.
    Do not cut holes in the crowns, or cut up the crowns!!!!! Get hold of a spring loaded crown and bridge remover, place the hooked end under the solder joint, engage the spring….and low and behold the crowns will lift off!!!!
    Remove the abutments by unscrewing them, sterilize the abutments and the screws, irrigate the exposed implants wit Dakin’s Solution, replace both abutment, making sure you put them back in the same position they were originally….try on the two crowns ( after you have cleaned out the cement)…. if your abutments are lined up properly, the crowns will fit perfectly…. remove the crowns, put some temporary cement in the crowns, and recement…making sure to floss well and remove all excess cement… should work out perfectly, with no damage.

  4. Dr. Bob says:

    Know what cement was used to place the crowns. If it is an implant cement that is intended to allow easy removal of the crowns from the abutments the use of the crown remover may work. If it is a permanent C&B cement you may fracture the screws that hold the abutments to the implants, removal of the fractured screws may not be easy. Use an explorer to feel if the abutment or the crown is moving. One of the implants may have a loose screw and the other a fractured screw. Be careful because damage to the implant threads or inability to remove a fractured screw could result in the need to remove and replace an implant. The safest way to approach this problem is to cut the crowns. The crowns might be salvaged by cutting through the occlusal to gain access to the screws. The cost of replacing the crowns is far less than replacing implants.

  5. john contino says:

    ever consider that the splinted crowns ( not sure why they are splinted anyway ) were not a passive fit and therefore causing the bone loss and potential failure of the restorations

  6. DRT says:

    I’d add that you want to use new screws, even if the old ones are just loose. Deformation has occurred and they will continue to loosen unless replaced.

  7. jorge balladares says:

    remove the implants , have a poor prognosis to long term .curettage well,and place two more large implants , like 5 by 12 , take ctscan and planning well . bone graft and membrane with prf

    • Robert Buksch DMD says:

      Dr. Bob

      After removing the crowns you can evaluate the health of the implants. If there is no exudate and the implants appear healthy except for a little bone loss, clean them up and narrow the crowns, and adjust to bite to eliminate lateral forces. Of course if the implants look bad remove and replace. Do not just remove them over some cupping bone loss.

  8. Jeff G says:

    I don’t usually respond on this site, but I have some sympathy for this patient who has the potential to be mistreated from some of the advice on this thread. First, the Straumann implants in the radiographs show normal bone levels, not “cupping” or crestal bone loss. The design of these implants incorporates a 1.8mm or 2.8mm transmucosal portion that was never intended to be apical to the alveolar bone crest. The 1mm difference noted above depends on the specifications of the implant which were not supplied in the description of the problem.

    Bottom line, is that it appears that these implants have virtually 100% of the bone support intended at the time the implants were placed in 2003. So making statements about poor prognosis or impending failure are totally incorrect.

    The standard abutments designed for these implants are supposed to be screwed in and engage the taper of the coronal aspect of the inside of the implant. Final restorations are supposed to be cement retained. (And for the record, there is limited published data that indicates that splinting restorations supported by short implants provides a slightly better long term prognosis than non-splinted restorations). Drilling holes through the occlusal aspects of the implants to attempt to tighten them is a complete waste of time and will not help resolve this problem.

    The radiograph that is supplied is odd because it appears that the abutments are more radio-opaque than the implants. Could this mean after-market parts? Maybe the abutments were never fully torqued to specifications? If so, then there could have been movement and wear of the threads leading to loosening.

    Now to solving the problem. The existing crowns must be removed. First try a reverse hammer crown and bridge remover. A pneumatic one will be more humane for the patient and possibly more effective at breaking the cement seal. It is almost impossible to damage the implant at the highest settings of the pneumatic crown and bridge remover on well integrated, mandibular implants. Certainly no risk to fracturing a screw within an implant. And even if you did, Straumann screws in tissue level implants (like these) are exceedingly easy to remove.

    If you can remove the restorations, you might find that the internal aspects of the abutments were cast as non-engaging (internally round) abutments. If so, you can replace the existing abutments with new OEM Straumann abutments of the same size, which are torqued to specifications (35Ncm). Don’t use the same abutments again. If the crowns were cast as “engaging” the flat surfaces of the abutments, you will have to remake the restorations once you replace the abutments and change the orientation of the flat surfaces of the abutments.

    If you can’t remove the restorations with reverse hammer, then you will have to cut them off. Be careful not to damage the collars of the implants. Abutments won’t matter because you should replace them.

    Place new abutments and make new restorations. Your decision as to whether to splint or not. These implants have already succeeded for 13 years in function. Splinting is not likely going to be a significant factor in future success.

    Don’t take out these implants. There is nothing wrong with them.

  9. Richard Hughes says:

    You can try what Dr Rudick suggest. If this does not work then consider an occlusal approach and unscrew the abutments. Change the abutment screws and reattach and seal with composite. Good Luck!

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