Dental Implant Crown is Wobbling: what do I need to do?

Please see the x-ray below. I have lost both tooth #19 and #20 due to bone loss in my jaw. My orthodontist placed one implant midway with an oversize crown to save me money on the procedure. Everything went well until I had my permanent crown placement. My general dentist checked the screw holding the abutment, he un-torqed it and re-torqued it. Everything looked fine. The crown was then cemented and placed over the abutment. I noticed some discomfort after the permanent crown was placed, but thought it would subside. A week or two later, I experienced headaches, pain and discomfort in that area.. That was about three or four weeks ago, I still am experiencing pain and discomfort. I visited my original dentist and explained my issue. I also received an x-ray from my general dentist and have asked my general dentist to forward the x-ray to my orthodontist. He is currently evaluating it. How easy (expensive) is it to remove my crown and fix the issue? Will I need to have the entire work re-done? Should I see a third dentist for his opinion? How common is this? Do you recommend two implants vs one? Should I expect the responsible dentist to repay me for this problem?

9 Comments on Dental Implant Crown is Wobbling: what do I need to do?

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dario galli

3/21/2013

well it seems to be a serious lost of bone around the implant; I think you must remove it; start with hygene and drug therapy ( antibiotics, local tretment with corexidine); provide a perio-recostruction ( bone graft); wait 3/4 months and replace a new implant ( perhaps a second short implant in the second molar site). dr Dario Galli Italy

Dr. David Scharf

3/21/2013

It looks from the xray like the implant is no longer integrated. Perhaps you may want to consider seeing someone like a periodontist or oral surgeon for an evaluation.

Frank Avason DMD,MS

3/21/2013

Looks like the implant has failed as you can see a shadow around the threads of the implant fixture (body). Big question, what's moving?, the whole implant/crown complex or the crown only and if he retorqued the abutment screw as you stated, then it's the whole implant/crown complex. Only option is to remove the implant, graft the site, allow it to heal for 4-6 months, then place a new implant fixture. Talk to your dentist and see the surgeon who placed it, most likely NOT an orthodontist as they only place braces on adults/children. Was it an oral surgeon or periodontist that did the implant surgery? Talk, to them as they most likely will replace it for no extra cost out of your pocket. Unfortunately, this does happen from time to time and a 2nd implant is the solution...

barry sporer

3/21/2013

unfortunately, judging from the radiograph, your issue is not a loose crown, but rather a loose implant. it appears that you should have the implant removed as soon as possible and have the site grafted. you should be able to have a new implant placed in approximately 4 to six months. after the new implant is integrated into the bone (approximately 3 months), you will need to have a new crown fabricated. at that time i would consider a screw retained crown over one that is cemented.

Dr. Alex Zavylaov

3/21/2013

There is a typical mastication overloading here, because of massive, over-sized crown. Addition implant is required to cope with powerful bite force.

dr. gerald rudick

3/21/2013

I would not condemn the implant at this time, because it is not absolutely clear in the radiograph if the implant is no longer integrated; just as I cannot confirm whether the second bicuspid mesial to the implant has a radiolucency at the apex...or is it the mental foramen?? I would want to look at the lab model with the analog in place, visualize the glide path of the screw, and ( since this crown is screw retained) if the crown cannot be pushed off ( if temporary cement was used); then drill a small hole through the occlusal surface, and loosen the screw and remove the crown-abutment assembly. Verify the stability of the implant by placing a healing collar......if it is solid, when it is screwed on tightlythen the implant is still good........the pain could be from the inflammation of the gingival tissues because of the crown moving and a small infection, which should clear up by rinsing with peridex.

Gregori Kurtzman, DDS, MA

3/21/2013

it appears that the implant has lost integration based on the angluar bone loss on the mesial and distal and it not the crown loose but the implant it self. Would suggest remove the implant currette the socket fill with graft material place resorbable membrane close and let heal for 3-4 months then place new implant and allow to heal

R W

3/22/2013

How long has the final tooth been placed before this x-ray was taken? Is it four weeks? If it is, the bone has not had time to shrink due to overload from the 'large' tooth. Looking at the position of the main nerve I think a second implant would be difficult. I also think grafting might not be as succesful/easy as some of the contributors above have suggested. See someone who does a lot of implant dentistry (hundereds of implants a year) for advice.

[email protected]

3/23/2013

Thank-you for your comments and recommendations. I appreciate it. I will talk with my Periodontist about this issue. If I don't need a second implant, I can live without it. Perhaps two implants can be done if the implants are of a smaller size? I will need an opinion whether or not I need a replacement implant. after this implant is removed.

Dental Implant Crown is Wobbling: what do I need to do?

9 Comments on Dental Implant Crown is Wobbling: what do I need to do?

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