Was abutment properly seated and tightened?

Nobel Active 5.0 placed. 3 months later healing abutment placed. One month later custom abutment and screw-retained crown placed. Sharp pain when torquing to 30. Access channel closed with cotton amalgam. Three months afterward, the attached image is the result. Does it appear that the abutment-implant junction is ok?

4 Comments on Was abutment properly seated and tightened?

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Guillermo J Molina, DDS
10/3/2013
1) A Bitewing film (smaller with much more detail of a particular area) would be better to determine proper seating of an abutment. Looking at the panoramic and taking into consideration the implant type- Nobel Active -as long as this is an internal conical connection abutment (there are 3 possible connection types for Nobel Active) I would say that the abutment is probably seated correctly. It is normal to see a step at the top of the implant/abutment junction with a conical connection. 2) I would be much more concerned about the sharp pain you experienced during the abutment torquing procedure. This could indicate incomplete osseointegration and an implant that may have a problem. Again, a Bitewing or Periapical film will give much more detail of what is going on around the implant. However, the Panoramic film might indicate areas of low implant-bone contact. 3) That is a large molar opposed by two molars. The setting up and managing the occlusion on the implant crown will be critical to the long-term success of the implant. Guillermo J. Molina, DDS
Gerald Rudick
10/3/2013
As mentioned above, it is very difficult to see detail from the postoperative panorex ......is there a radiolucency on the mesial aspect of the implant? When tightening an abutment, and patient feels a sharp pain at less than 40 ncm....this is an indication that full osseointegration has not yet been achieved, or there is granulation tissue present that is destroying the implant. You have not told us what the patient has been experiencing at three months.... is the pain gone totally?...if so, you may have pinched the gingival tissue at the installation of the abutment....to quote the late Marvin Gaye...."What's Goin On?" Gerald Rudick dds Montreal
Nancy D
10/3/2013
Follow-up re: implant at tooth #31. Pain was totally gone after placement of abutment and crown. However the oral surgeon had to remove on day of the submitted panoramic. "A 15 blade was used to make a sulcular incision. A prosthetic handpiece was used to access the abutment screw. When the abutment screw was tightened, the entire fixture abutment complex moved and the fixture abutment and crown were taken out as one unit. There is a large amount of granulation tissue and purulent tissue at the distal aspect of the implant site. The side was curetted aggressively. Mesial bone was intact and healthy." The explanation given me was "The end result was loss of osteointergration, but this was secondary to infection on the fixture. A non-union would have caused spinning at the uncovering stage. When i exposed the fixture, there was granulation tissue and pus on the fixture and the bone. Usually on the non-intergrated implants we will see a thin area of fibrous non bony union. So yes and no, the was inadequate integration but secondary to infection." Same day, a new, identical Nobel Active 5.0 was placed adjacent. A cover screw was placed and closed with sutures. Cerasorb M mixed with sterile venipuncture was used. Two weeks later Widened PDL (periodontal ligament space) was detected at tooth #30. The cover screw of the new implant became exposed three weeks after placement and sits in a crater. Small ulcer on throat and two canker sores on cheek adjacent to site. So far no pain, blood, swelling or pus, but temp is below normal for me, runny nose and persistent salty taste in mouth.
Guillermo J Molina, DDS
10/3/2013
See #2 in my initial response. The implant was DOA on the day the crown went in. gjmdds

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