Loose Bridge Supported by Three Implants: What Can Be Done?

Implants work differently to teeth. They have no 'give' where teeth can jiggle slightly in the bone.First thing I would do is check the occlusion and make sure that when the back teeth are touching Shimstock can be pulled through between the front teeth biting with the bridge. Then when you slide sideways in chewing the canines if possible should take the weight, not the bridge. If the occlusion is adjusted correctly and the abutments are of a standard design even a basic cement should hold the bridge well.

agree 100% with previous comment. If still not working, lab can adjust the abutments and the inside of the bridge to have a "tighter" fit. Still no luck, I would redo the bridge - then make sure occlusion is 100% - and abutments are a little more "square". Good luck!

3 units for 4 teeth? This bridge does not fit or the abutments are too short. This needs to be a remake ..this bridge with that amount of surface area contact should be hard to take off .

Without seeing the bridge or knowing what kind of cement is being used, I don't think anyone can automatically assume a remake is required though with 3 abutments, the fit should be pretty tight. I agree with the first comment. Have your dentist check the bite. Roughen the surface of the abutments and internal surface of the bridge carefully with an air abrader/micro etcher and try cementing it with a permanent modified resin cement like RelyX. If it continues or this leads to breakage then yes, there may be some engineering problem with the size or taper of the abutments, occlusal scheme, or position of the implants that may need to be addressed. Best regards.

Obviously, there is not enough information to promote 'remaking' anything. I would first check with your dentist who placed your bridge. If you are not satisfied with his explanation, seek a second opinion. You will need to have someone experienced to take a look since this is a problem, that A) No one told you about, B) No one knows the answer to, since it continues to happen without an explanation. Other things such as angulation, and retention of the anterior abutments may have to be considered before this is a 'redo' case. Your answers will not be in this forum.

Find a dentist who has a T-scan and know how to use it. This is a device which uses a computer to measure the occlusal forces , without this the bridge will be overloaded or underloaded either is a failure.

As stated above, we do not have all that information to go by.....however, since this bridge has been condemned to having it replaced with a new one....I would try something else before throwing it away. Assuming the occlusion is correct in all excursions, and relieved if possible, so that there is little occlusal interference. Drill holes through the lingual surface of the three retaining crowns to access the abutment screws...assuming that the implants are parallel to each other. Recement the bridge, blocking out the access holes with wax or cotton pellets and be sure it can be removed by taking out the screws. Send it back to the lab, and have them thoroughly dry the porcelain bridge by leaving it near the door of the procelain furnace to fully dry for a few days. The cement bond will break because of the heat.Clean the metal of the bridge and the abutments in acid and have the lab attempt to use low fusing solder to work its way on to the now roughened abutments and inside surfaces of the retainer crowns, so there is a fusion. The bridge in now a screw in prosthesis, and should become more relaiable and hopefully give additional years of service. Gerald Rudick,DDS Montreal Canada

Remake the bridge as a screw retained restoration. Howard Silver, DDS NYC

Check the occlusion as stated previously and use a better cement. I would not want a screw retained bridge. There is no reason that this cannot be cement retained. If the abutments are poor design, than re-do the case.

I do not understand how one can advise screw retained prosthesis in anterior maxilla without knowing orientation of implants. Screw access hole might be on facial or on incisal surface.And you have to deal with aesthetic problem with resin plug. Cleaning,rebaking porcelain and fusion of crowns with an abutments, is more complicated,less precise and may be more expensive and time consuming than simply making a new bridge. I do not have answer to the problem as I do not have enough info.

Not enough data to respond except genericlly. I would like to know more about the patient. Firstly, how did you loose your incisors to begin with? What is the status of your back teeth? Are they worn? Did you have anydentistry done after the FPD was inserted? Were you always able to chew gum? Bite a bagel? Have you been told by a sleep partner that you grind your teeth at night? Do you wear a night guard? Do you have any unusual parafunctional habbits? Is the debonding experience happening with greater frequency? Is there a real patient behind this question?

It is just a mental exercise till more information is provided. The answers/ suggestion listed provided more than enough info. Unless patient has good understanding of restoring implant supported restoration, provided info may be more than he/she can understand. Patient should seek a second opinion from an experienced restorative dentist. It is hard to believe three implants supporting four unit FPD keep loosening. Occlusion? posterior support? Type of cement used, how tapered are the abutments? There should be more info to decide any def. tx. options to be considered.

I never, never ever met a patient that had a good understanding of implant supported prosthodontics unless the patient was a DDS. We as a whole tend to offer mechaincal solutions to problems without a better understanding of cause and effect.

Sounds like the angulation of the implants are causing a poor design of the abutments, which then rely only on cement strength for retention. Over time, that will fail and cause loosening of the implant prosthesis. Stronger cement is not the answer. Look into transverse screw retention as an option before you "redo" the case.

Retention of a bridge is directly related to the how parallel the abutment teeth are and the lengthen of the abutments. The cement is a luting agent and will not hold a bridge in place once the forces of the bite come into play. Best bet is to replace the abutments. Atlantis does an excellent job with a case like this.

I agree with the many comments indicating that it is difficult to condemn the quality of the restoration without evaluating the patient personally. I have a patient with the exact same configuration and his bridge does occasionally come loose. In our situation, his bite is so strong that his lower jaw looks almost as if he has acromegaly. We have opened his bite somewhat, recommended appliances such as night guards (which he refuses to wear) and have repeatedly adjusted the anterior bite so that he is out of occlusion. The situation actually frustrates me more than it does the patient. He is grateful that the bridge stays in as well as it does - compared to previous work that he has had in the area. From the information given, I would suspect that occlusal forces are behind the problem. I'd be a little hesitant to switch to a screw-retained restoration. If the occlusal forces are as strong as they appear, they will still be transferred to the implants and may lead to loosening of the implants rather than the restoration.

I have the same problem as the "Original" question. Except, mine only has 3 units instead of four. Also, I originally had 2 teeth that the bridge fastened to. But one of them broke off while chewing. So my question is... Is there a "Over the Counter" cement or glue that I can use to fasten the bridge back on to the one tooth I still have, and glue the two broken tooth pieces together still inside the bridge? I need it just for long enough to get me through 2-3 weeks. They are my front teeth. So I need something quick. Thanks!