Rocking Implant: how can I determine what is loose?

It would be helpful to post a radiograph, if the implant was integrated one month ago it will not be mobile that quickly, the abutment screw could be fractured or if the crown is screwed in it could be loose. A cemented crown would fall out if it were loose. Usually the abutment screw is the culprit on such a short timeframe. What kind of implant? And a radiograph would be very helpful in solving this. Think you have to take it in steps, remove the crown then the abutment and you should be able to tell. I doubt it is the implant, the patient would probably have some pain or symptoms. Good luck.

The key to Dental Implantology is deling with problems ( albeit rare ) sadly. Hopefully just a loose screw with a hex type abutment or a indexed taper that has not been located correctly. Generally youi can feel when it is merely the screw as it has a "metallic " rattle when you move it hwereas if the implant is the issue when you move it it a more "solid" movement which can be associated with pain. The only way is to remove the crown ( hopefully you used a retrievable cement ) and torque it down. Peter

I was lucky once and made an endo access hole in the crown, found the abutment and the screw and retighten the abutment down and refilled the access.

possible a controversial post and i maybe need to duck when i say this one. But surely this is another example of when it is better to try and have screw retained restorations as opposed to cement? As i said, DUCK!

Hi . I suggest to proceed with these steps : 1.Take an X-ray ( check to any space between fixture and abutment ) 2.Remove//unscrew crown ( if it's a screwed crown ) 3.Check the abutment screw and the fixture stability . 4.resolve the problem. Good luck !! Dan

If the xray looks good and there's no pain it's probably a loose screw. A loose implant tends to be symptomatic and has radiographic and clinical evidence of pathology. Remove crown, tighten screw and figure out why the screw loosened so soon. Did you torque the screw to the proper torque with a torque driver? Isn't implant dentistry fun!!!

Much probably is the screw and obviously the abutment, so remove the crown. Good news, much probably the implant is ok. Bad news, I think you have to cut the crown to remove it, because is very difficult to remove the crown with a loosen abutment, you can brake the screw, even with a temporary cement. And if the patient accept, as some Doctors wrote, do an acces on the oclusal surface, only if it is a metal-porcelain crown. Good luck.

This one appears to be easy to solve! If the crown (cemented or screwed-in?) went in four weeks ago, then I guess the abutment screw is loose due to loading. Or rarely, the prosthetic screw needs tightening, which if its a cemented crown, you may want to try an access hole through the middle as Dr West suggested above. When re-tightening screws down on a well-integrated implant, try tightening once to recommended torque, then open again, then tighten back to full torque a second time using the correct torque wrench. Learned it from a plumber!

1. Try an abutment screw access hole through the crown. It may be difficult as it's a canine, to predict where you are going. 2. You may have to cut the crown and remove it. 3. Always ensure that the torque prescribed by manufacturer is achieved during abutment tightening. 4. We all know that screw retained is superior to cement retained. The only thing may be the cost and the available lab with such expertise. And occasionally, for some systems, it may not be possible. 5. Labs can easily make an access hole in the crown during the fabrication process itself. It will help in accessing in case of failure.

Key is not to panic..! most of the time it is the abutment screw.... if it is screw retained- -sure you can access as an endo case.. if it is cement reatined- going to be little tricky...use two wooden wedges....most of the time the crown falls out [hope u used ZOE based cement]... all the best

Take the crown off and see.

Hopefully you still have the models. If so, you can place an implant guide pin and get a more accurate idea where the access hole is. This is assuming you didn't use a solid abutment.

first hold the crown and press it down and check mobility ,if it become fixed then it is loos abutment screw ( most common especially because some doctors they do not tightening the screw to maximum recommend torque ) or loos crown cement. second raise the crown up and see if the margin of crown move separate then it is cement , or abutment and screw move as one part and you may reach to see the fixture implant junction depending in it,s position. to fix loose screw go through an access cavity with copious irrigation do right torquing, put temporary filling and most important is to check the occlusion( another main cause of loosing screw) recheck the patient after few days if every thing is ok tightening the abutment screw again and do composite covering

What usually happens for a large single crown fixed to a fixture by a single screw is that it got unscrewed during function. This will not happen in the case of two implants splinted together by a bridge. If this is a screw retained crown, just expose the screw and replace the screw. Since it is probably a cemented crown here, use your high speed to remove the porcelain mesially and distally. This will enable you to unscrew the whole crown together with the screw. Then screw in a new abutment with a new screw and put on a new crown. Screw retained or cemented have their pros and cons. Screw retained will have a microgap which will be colonised with microbes, a possible cause of peri-implantitis. Cementation is a problem like here where you have to remove the crown. I still go with cemented because screw loosening happens usually only with single crowns. Work out a protocol where all excess cement is removed in order to pre-empt peri-implantitis, and it will be a much better option than screw retained crowns and bridges. Cementation eliminates the microgaps, which is also a cause of peri-implantitis. Take your pick.