I placed this BioHorizon 4.5×10.5mm internal tapered implant in the mandibular right first molar site a year ago. After 6 months, I restored this with a UCLA abutment and a cement retained crown. The occlusion was fine, but the patient started having soreness under the crown.
I showed her how to clean under it using superfloss and Te-pes. But she said she could not get this underneath the crown, so under local anesthesia I adjusted the crown undersurface and trimmed the crown so that superfloss and Te-pes could get underneath easily. From this she had delayed healing, but then after 2 weeks the gingiva healed. This seemed to make some difference.
Then the abutment screw became loose. I had trouble getting the crown off even though I had used TempBond. So eventually had to use a crown and bridge remover to tap the crown off. She keeps saying ever since using this force to get the crown off, the implant has hurt and when she placed her finger on the cortical plate of the implant there is pain and a constant ache from the area. She says she sometimes has to take analgesics for this.
I have taken the UCLA abutment off and got an Ostell reading of 80. There is no swelling, no purulence, no mobility of the implant. All the radiographs show good osseointegration. I left her in the healing cap, but after 2 weeks she says the pain is still there. Today I removed the cap and placed the cover screw back on to see if this help. My gut feeling as I am am writing this is that the implant has failed. But why are there no physical signs to indicate this? Has anyone had this and what do you recommend that I do?