Loose screw retained implant crown

[aidihra]

I just got a call from the dentist about a case we did last October. It's a screw retained implant crown that suddenly got loose in the mouth about a month ago. The dentist said he torqued it in the mouth correctly & this shouldn't have happened. He's sending the case back to me so I can look for any discrepancies under the microscope. He may want a new screw to replace the older one. Any ideas why this happened?

 

[wilkscm]

Check on xray if seated correctly check occlusion checking it will do nothing

 

[aidihra]

Apparently, everything was fine. It was sitting correctly and the bite was good. I'm just going to look at it to make the dentist feel better.

 

[Jo Chen]

Make sure there is only one light contact point on the occlusal right over the implant. I know this is a challenge for a screw retained crown. No lateral interference. Keep the occlusal table narrower (2/3) of what the natural tooth would have been. And yes, a new screw. Should the screw come loose again in the future despite all the corrections instruct the dentist to wrap Teflon tape around the threads of the screw and torque to manufacturer specification

 

[zero_zero]

Tell him to wait 30 mins then torque again, apparently screw loosening happens in the first few minutes...

 

[aidihra]

Great tips! Thank you!

 

[DarrenS]

Tell him to wait 30 mins then torque again, apparently screw loosening happens in the first few minutes...

I'm with you on this one. My docs have made it regular practice now.

 

[aidihra]

Unbelievable! So, I get the case and realize that it was made by another lab. I called the dental office and tell receptionist this and she says that the doctor just wanted me to look at the screw and see if it can be reused. I'm upset now because I have to pay the courier for the pick up. This is a dentist that sends maybe 8 pfm units a year.

Anyway, I decide to deliver the case myself since I was going to be in the area. I tell the dentist that the screw looks fine, but Nobel Biocare recommends replacing it. He says ok and he'll have a new case for me in 20 minutes. So, now I'm having lunch at Chipotle.

 

[Hary]

I just got a call from the dentist about a case we did last October. It's a screw retained implant crown that suddenly got loose in the mouth about a month ago. The dentist said he torqued it in the mouth correctly & this shouldn't have happened. He's sending the case back to me so I can look for any discrepancies under the microscope. He may want a new screw to replace the older one. Any ideas why this happened?

There is another thing you can check, check if any porcelain particles are around the sited area, does't take much to unscrew the bridge we had the same thing once that was the cause...

 

[Marcusthegladiator CDT]

Tell the doc to use super glue after he torques it in.

 

[kmgold1234]

Unbelievable! So, I get the case and realize that it was made by another lab. I called the dental office and tell receptionist this and she says that the doctor just wanted me to look at the screw and see if it can be reused. I'm upset now because I have to pay the courier for the pick up. This is a dentist that sends maybe 8 pfm units a year.

Anyway, I decide to deliver the case myself since I was going to be in the area. I tell the dentist that the screw looks fine, but Nobel Biocare recommends replacing it. He says ok and he'll have a new case for me in 20 minutes. So, now I'm having lunch at Chipotle.

One other option in the future is a carbon coated screw specifically for Nobel Replace.
We offer them at our DESS USA website.
Also thanks for the tips regarding the 30 min rule- good to know.

 

[TheLabGuy]

Always send a virgin screw with your implant cases. We techs tend to stretch the threads taking an abutment on and off in the lab as much as we do. Hence, why so many implant companies have gone to try-in screws.

 

[rkm rdt]

Always send a virgin screw with your implant cases. We techs tend to stretch the threads taking an abutment on and off in the lab as much as we do. Hence, why so many implant companies have gone to try-in screws.

...good luck finding that virgin screw in your neck of the woods!

 

[TheLabGuy]

Nice one Stopping swimming over here and we wouldn't have that problem!!!!

 

[dmonwaxa]

Unbelievable! So, I get the case and realize that it was made by another lab. I called the dental office and tell receptionist this and she says that the doctor just wanted me to look at the screw and see if it can be reused. I'm upset now because I have to pay the courier for the pick up. This is a dentist that sends maybe 8 pfm units a year.

Anyway, I decide to deliver the case myself since I was going to be in the area. I tell the dentist that the screw looks fine, but Nobel Biocare recommends replacing it. He says ok and he'll have a new case for me in 20 minutes. So, now I'm having lunch at Chipotle.

Maybe an update is necessary,,,,, how was lunch?

 

[aidihra]

Haha! Lunch was good and I haven't heard anything new about that case. I actually started going out to get my lunch more often when I can. It's a nice little break.

 

[dmonwaxa]

Nice to hear,,,, keep us posted on what happened with that case. Also I hope the case you waited for was worth it. On another note, since it wasn't you case to begin with I hope you had a nice talk with the doc sending you someone else's work to fix...on the sly. I personally dislike that kind of trickery. And I guessing you charged accordingly (markup); for the screw and your time.

 

[aidihra]

The dentist ended up ordering a new screw. The new case they gave me was a single pfm AuPd. I made sure the metal weighed more than it normally would.

 

[dmonwaxa]

Yeah I hear ya,,,,sometimes those copings on a lower central can be pretty heavy!

 

[JamiennBenet]

Particularly during early stages of abutment screw loosening. There is a limit to how high the crown can be raised. The entire body of the implant fixture should be intact, eliminating the possibility of an implant fracture.