Custom abutment not seating

[Brett Hansen CDT]

I've been restoring a doctor's implant cases for over a decade. Never any issues seating the abutments. I've had three cases in the last month that she couldn't get seated. One of them was a screw retained Atlantis abutment case. She consulted with the periodontist and they think the abutment is hitting the bone. The perio also said he has started using shorter implants(all strauman bonelevel) recently. For this case, they think that bone on the mesial of the implant is holding up the abutment. Anyone have any ideas on what could be causing this issue? I've never run into in the molar region. I have seen this issue with doing screw retained bridges using straumann variobases in the anterior region of the mandible because the prosthesis is too thick under the tissue. It doesn't seem like the bone would be keeping the abutment from seating, but I am going to recontour the abutment on the mesial to relieve it more.

 

[grantoz]

on average implant are being placed deeper than they used to so they hit bone or the soft tissue is really solid so the abutments don't go down. i now ask for xrays of the site for certain dentists, they also seem to use smaller healing abutments so again the site is too tight.

 

[TheLabGuy]

That cortical bone looks like it grew right up there and is impeding the abutment. I've had this happen before, surgeon not using large enough healing caps...what a pain for the patient. Most times, the surgeon has to go back in and relieve the cortical bone that grew...sucks when you get too much osseointegration...lol

 

[doug]

So are they trying to figure out how this is your fault?

 

[Sda36]

I've been restoring a doctor's implant cases for over a decade. Never any issues seating the abutments. I've had three cases in the last month that she couldn't get seated. One of them was a screw retained Atlantis abutment case. She consulted with the periodontist and they think the abutment is hitting the bone. The perio also said he has started using shorter implants(all strauman bonelevel) recently. For this case, they think that bone on the mesial of the implant is holding up the abutment. Anyone have any ideas on what could be causing this issue? I've never run into in the molar region. I have seen this issue with doing screw retained bridges using straumann variobases in the anterior region of the mandible because the prosthesis is too thick under the tissue. It doesn't seem like the bone would be keeping the abutment from seating, but I am going to recontour the abutment on the mesial to relieve it more.

Ya a definite mesial bone lip, can you imagine how well this would have worked being 90° vertical axis instead of 75-80° to mesial??

 

[Sda36]

Ya a definite mesial bone lip, can you imagine how well this would have worked being 90° vertical axis instead of 75-80° to mesial??

Typically would like the max size of healing caps across the board as we're trying to reconstruct with actual tooth morphology. If an X-ray presents with that type of possible bone interference then periodic tightening of the healing cap will displace bone over time but really best to recognize it in the first place. Placement angulation has to be **MORE IMPORTANT** to the best final outcome for the Patient. To all concerned...

 

[GH23]

The shorter implants won't affect things, but the first radiograph is of a submerged healing case with a cover screw; maybe the "taller" healing cap after 2nd stage surgery isn't being given enough time for things to remodel. Has something else changed with how they take the impressions; for example, you could easily take a scan with a skinny scanbody but it's also nice to have a scan of the current emergence profile (or size of the healing cap in place)...

 

[Brett Hansen CDT]

So are they trying to figure out how this is your fault?

No. I think they are just trying to figure out why these issues all of a sudden popped up. I've restored around 1000 implant cases for this doctor and periodontist without this issue ever occurring before.

 

[Brett Hansen CDT]

I'm sharing some of these responses with my doctor so be nice

 

[TheLabGuy]

I'm sharing some of these responses with my doctor so be nice

What he/she say about the cortical bone and having a larger healing cap out of curiosity?

 

[Brett Hansen CDT]

What he/she say about the cortical bone and having a larger healing cap out of curiosity?

I will let you know. I passed on yours and SBA's responses so far.

 

[GG - J]

That cortical bone looks like it grew right up there and is impeding the abutment. I've had this happen before, surgeon not using large enough healing caps...what a pain for the patient. Most times, the surgeon has to go back in and relieve the cortical bone that grew...sucks when you get too much osseointegration...lol

great call on the healing cap/ yrs ago had a doc tell he you should always put in a larger diameter healing cap and i have told every single doc that has sent implant work the same thing
i believe about 40% actully listen

 

[sirmorty]

Healing Cap is nice and all but isn't the better option to make a temporary crown and really manage the healing of the tissue?

 

[TheLabGuy]

Healing Cap is nice and all but isn't the better option to make a temporary crown and really manage the healing of the tissue?

Temp implant crowns usually involve immediate loading which most Docs don't want to go down that road. Most use the cover and let heal approach to osseointegration. Now i've seen where some sandblast the healing cap, use composite to form the emergence profile and while using that composite on the healing cap are able to match the gingival zeniths and such, especially for anterior cases.