abutment doesnt fit?!

[chromecobalt]

Hey guys, I had one client call me to say the abutment doesnt fit. But Ive checked the gingiva and the insertion resistance and everything was smooth sail.
What are the possible reasons that it does not fit?

 

[swisstek]

I assume you are talking about an abutment from one of the known implant companies? If not can you explain! If this is an aftermarket product there can be a variety of factors in play. I need to know more in order to help you go down the variables line.

 

[chromecobalt]

Its nobel biocare 15 degrees replace RP 3mm on top of groovy RP trilobe. On the model it fitted perfectly but the doctor says that it doesnt fit in the mouth? Ive never heard of implant abutment not fitting

 

[ParkwayDental]

He needs to use a angled screwdriver he can get it next to the stripped paint at lowes. Lol no I don't know seems odd!

 

[JohnWilson]

Have him look at an X-ray to see if there is a ledge of bone not allowing it to seat. The impression coping is not angle corrected like your abutment, I would suggest that the angel correcting abutment is tilted back and contacting bone not allowing it to seat properly.

 

[swisstek]

Now that we know that it is an original nobel biocare 15 degrees replace RP 3mm. John made very good points as a 3mm collar angled has a different exit profile then the impression coping above the platform level. We also need to be sure that the replica is original. Some aftermarket products, abutments or replicas have slight tolerance problems. Next do we know that impression coping was seated properly? If that was the case you can not detect anything on your model, everything looks fine but its not in reality. The same situation as mentioned by John, not detectable on the model. Lets go to the next possible scenarios.

 

[chromecobalt]

The angle of the collar is straight, only the abutment surface is tilted 15 degrees. My original guess was the tissue has intruded into the platform. What are the chances of bone retaining the original walls of the socket. Could possibly be an immediate? Do they resorb after placing the implant?

 

[chromecobalt]

I will be receiving the case with a printed xray tomorrow ill post it here later on.

 

[CoolHandLuke]

might you ask for photos of his insertion process? could be there was a bit of dried blood on the abutment from the first "try-in" that made the final cementation go awry ?

stabbing in the dark.

 

[corona]

are you sure that it is the right TYPE of abutment . did the doctor include all the components that you used and the transfer assembly was correctly connected and replaced back in the imp. ?? sometimes the simplest things slip by us ....

 

[disturbed]

I agree with john, most likely. are you trying to displace much tissue? X-ray needed.

 

[chromecobalt]

http://img38.imageshack.us/img38/5416/21659961.jpg

I see no problems. The only problem I can think of is that the tissue has collapsed into the top of the platform?

 

[JohnWilson]

Thats a bad xray or perhaps the way you took a pic of it???, it almost looks like if the tri lobe is not down inside, did he get the screw to eng at all? If he did, was he able to put some force to it? Its way too open to be tissue entrapment

Did the patient have a healing abutment or healing cap present when they came to get the fixture restored? Did he take an xray of the impression coping seated?

 

[CoolHandLuke]

if so isnt that a fairly big OOPS ? shouldnt there have been a healing cap on that to prevent the tissue from forming on top of the interface layer ?

then again considering it is Nobel implants we're talking about, could it not be that this guy's impression had the lobes pointing in the wrong direction, and the subsequent model and abutment were made at the wrong lobal angulation ?

 

[JohnWilson]

if so isnt that a fairly big OOPS ? shouldnt there have been a healing cap on that to prevent the tissue from forming on top of the interface layer ?

then again considering it is Nobel implants we're talking about, could it not be that this guy's impression had the lobes pointing in the wrong direction, and the subsequent model and abutment were made at the wrong lobal angulation ?

I have seen where the patient presents to the GP with healing abutment in their hand saying it came out last week. then its a bitch for most guys to get the healing cap back in place as many are afraid to use a tissue punch and makes things worse with a scalpel or even dumber with an electro surge. Its amazing how fast unsupported tissue will collapse in.

A quick visual in the mouth of the lobe placement and a confirmation to the analog placement in the model is fast and easy.

 

[Scanner Man]

I agree with John's statement... "it almost looks like if the tri lobe is not down inside". and lobe angulation is wrong preventing it from seating.