Pain on Torquing Down Implant: Bone-to-Implant Interface Affected?

If you do enough of them you will sooner or later experience this. This is most likely due to the quality of bone and the degree of bone maturation around the implant and implant-bone interface. I would suggest a gradual loading protocol with a temporary to allow you to later come back and tighten the abutment to the correct torque before the final prosthesis is placed.

Pain in insertion of the abutment can be due to three things.... 1. soft tissue being pinched between the implant and abutment 2. implant in soft bone and the torquing results in stress within the bone and this is picked up as pain 3. failure to acheive osseointegration and there is fiberous tissue at the interface.

Hello If u do gradual loading & tightening as per Misch u'll be having very less problems. But the only problem nowadays is the time factor.

As an addendum to Dr. Kurtzman's comment. Pain can also be caused by "expansion" of the tissue if the emergence profile of the restoration has a greater circumference than the previous restoration or healing cap. If you temporize you will often see this when going from healing cap to temp. If you slowly tighten and give time for the tissue to expand, you can usually go to full seating and at the very end feel the screw "bottom out" without pain. You can also see this if the emergence profile of the final restoration has a greater circumference than the temp. This will be avoided by making sure to "copy" the tissue contours to your final crown which also makes for better predicatbility in esthetics and function anyway. By using a temp phase in all cases I feel I can get a "trial run" on my restoration and most of the time I can differentiate between this and/or the aforementioned possibilities. (Not to mention that it helps to foresee many other complaints patients may have such as occlusal, esthetic, B-L witdth and "feel") Once the tissue is expanded and out of the way of my path of insertion, I rarely if ever (I never say never) remember a pain response on final insertion. The temp phase is invaluable to me, and I would look at this closely because you don't want to be "shy" about full torque as I think this could lead to bigger problems in the long run.

dr kurtzman is right.i also have experienced this some times with two stage implants but by placing a healing abutment after implant exposure and letting the gum heal up prior to abutment fixation and torquing,the soft tissue pinching pain(which can cause the patient to jump)can be minimmized.

yes i experienced this , make me to torque the screww lesser than recomended , so i do temporization for three or four week , then try to torque to recommended , every possibility that the implant is fibrointegrated , or soft tissue pinching ao stress the bone was explanation as mentioned above .

i encounter pain mostly during placement of the crown. its because of the change in the emergence from the healing abutment to the definitive crown. but once i have encountered a disruption of the implant bone interface during early loading. during the trial of the crown with the abutment everything was fine. upon final torquing of the abutment, the patient experienced pain. i could see the rotation in implant even though it was stable. the abutment no longer was in the same position and had rotated.

There is another scenario I have seen several times. With major sinus grafting (allograft,xenograft,prp) meaning

sorry but i dont use any abutement in any time. I use oly one piece transmucouse implants in the correct place and eventually refined distally or/and mesially with a carborundum cutter. so i can place a provvisory crown and wait the healing of the site( one or two weeks ) . note: why i use one piece implant of every kind in my surgery professional activity? Becouse i dont need any abutemnt and i can modify the piece of the implant emerging from a healty mucosa simplpy with a carborundum cutter.

Any pain on torqueing an implants after integration ( especially with any rotation) I feel requires removal for long term success. Best cut your losses early , wait to heal and re-do. You cannot hope and pray here take the medicine....

Dr. Romano, I have done this too with a high degree of success. I used thE STR implant from Pacific Implants and had over a 90% success rate. I have also used the Uno from MIS.. I had one patient that returned from Vietnam with one stage surgery performed. Implants placed in the maxilla annd mandible, all single stage all worked. I restored her with cementable crown and bridge. The key factors are immedate fixation, crossed arch stability and stable occlusion.

Do u torque abutments of short implants , for example to 30 Ncm, placed in posterior maxilla?