crown won't stay on abutment

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terri1731

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Good morning! Not a tech - a Mom here. Have son who was missing I teeth as a kid. At 18 I had implants made for him. Best I know they have procelain abutments (white). Now he's 24 and one of them will not stay cemented on. Daughter in law is a hygenist - her dentist (son saw sis n law's dentist when I was out of town) re-cemented and said replace everything. The re-cementing only lasted a few hours. We went back to original dentist yesterday she re-cemented...and alas it only held a few hours also. Question - Is there a 'plan B' that does not require replacing the six year old crown and abutment? Can the abutment be etched to provide better adhesion? It is a very snall tooth with a very small abutment. Looks great - just won't stay on! Any advice would be greatlt appreciated. Would like a little info prior to meeting with his dentist this morning to dtermine Plan B. Thanks - :confused: The MOM
 
rkm rdt

rkm rdt

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If it is a white abutment then it is probably made of zirconia.

Zirconia cannot be etched .However ,if the abutment could be unscrewed ,then the lab could fire a thin wash of ceramic over the surface area.
This would give better retention for the crown to adhere to but be prepared for a new crown in case the old crown doesn't re-seat properly.
 
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terri1731

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Thank you RKM - would that be your first option or might we be better off planning a new crown and abutment? Might there be a better appliaction for this front tooth?
 
Mike2

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Sound fishy to me as crowns are cemented to Zr all the time. May be that there is no retention to the abutment, ie if it is shaped conical and is very small there needs to be something to counter-act the forces being applied. Which tooth is it? The abutment should not have a perfectly round mg. as there needs to be some way for the crown to lock into place. Either way, my opinion is the Dr. that placed it should not be recharging for something that isn't working. If one of my clients sent it back to the lab we would remake or modify the abutment and crown for no fee or just the fee for a new abutment. my two cents
 
rkm rdt

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If the abutment can be removed(unscrewed) safely then it probably can be reused.I would inspect it's condition under microscope at the lab prior to applying the ceramic bake.

It would be a shame to replace the abutment with the same thing.

Having said that, I would ask the dentist/lab if it is possible to make a screw retained porcelain fused to zirconia one piece abutment and crown

Here is a molar to give you an idea.This is a one piece. You can see the screw hole.The Dr will fill the hole with tooth coloured resin once it is seated.

A front tooth could be made this way if the screw hole is in the right place.

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terri1731

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Thanks all - we have a 1PM back with our dentist who we have used for years and we really like her. She has done all my crowns and veneers with no issues and was the son's dentist all through braces etc also. With that said the tooth would be the 'eye' tooth on his right side (10?). It has been in place for 6 years. It is a small tooth and a very tiny abutment.
 
PDC

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Before redoing everything, I would have the dentist remove the abutment, cut some undercuts or notches in it, screw it back in place and bond the crown in. If the crown is Emax, it needs to be blasted, cleaned, & re-etched...if it is zirconia it may not work as well.
 
JohnWilson

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If I am reading this right the restorations have been in the mouth for 5+ years and only now they are coming uncemented?

If they have always had an issue then a remake would most likely have been done by now. If its only recently he is having issue perhaps now that he is older his adjacent teeth/opposing are in a different function meaning they are hitting the tooth harder when he chews/functions.

I am all for screw retained where applicable but most likely if these were congenitally missing canines the angle will be facial and only a cemented restoration will work.

As the other techs have mentioned even the shortest abutment when mating with a properly prepared crown will have retention. The cuspid guidance on this case must be checked very carefully as this is what I suspect is the biggest issue.

Good luck
 
rkm rdt

rkm rdt

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let me repeat for John

"A front tooth could be made this way if the screw hole is in the right place."
 
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terri1731

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Thank you gentlemen. You are correct - the implant was over 5 yo - and his 10 is/was conjentially missing. The tooth actually came loose in October when he had it recemented back in by dif dentist. Came out within a few hours. Its is a small tooth with a very small and oddly angles abutment. When I saw him at Christmas I decided time for him to seee his family dentist who had placed the tooth after the implants were done (He was 18 when implants were done and is 24 now). She recemented today AFTER totaly reasdjusting the bite. It appears that with it being off for a couple of months that it was hit by other teeth but he didn't say anything yesterday. Back in...no charge...and hopefully it will 'stick' (pun intended) this time. Thanks for the insight. I like at least partially understanding what professionals are telling me.
 
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