Screw coming loose repeatedly!! Whats wrong?

[AKDental]

Hey this is a question for anyone that has a thought on it. I welcome any comments.
So I'm working on an implant case[hiossen, screw retained previously, with a dess ti base] for tooth #3 and for some reason the screw keeps coming loose in the patients mouth after some time, which I believe is as soon as a few weeks, as well as longer too and I don't know how long. It's happened already 4 times that I know of. The implant is centered ok on the patients jaw, however it comes out at an angle diagonally(so mesially and buccally). The Dr has tried numerous things to fix like new screws reducing occlusion and flattening, making proximal contacts very light or tighter. Even tried( however not recommended) something to hold the threads in place better and prevent vibrations on the screw.
Anyone have any thoughts on this???
--i am definitely out of ideas but the Dr ordered a custom abutment this time and although I don't feel it will make a difference, who knows right??
I don't have a lot of experience when it comes to implants and especially not when it is is a problem case....

 

[Contraluz]

What is the crown to implant ratio? I have had a case where we had to reduce the width of the occlusion, also get rid of any lateral interferences, in order to reduce any occlusal forces.

Another problem, as soon as the crown gets loose, the abutment starts working against the implant and either the abutment or the implant is being abraded. So, over time, there is no flat intaglio surface any more, which accelerates the problem even more.

I have had my issues with loose screws only with one brand, but it isn’t Hiossen.

 

[ztech]

The angle diagonally is likely your problem. The torque imparted in the chewing will slowly loosen the screw. The only possible solution will be to remake and make sure not contacts, centric or working, occur more than 1mm from the screw hole.

 

[Affinity]

Maybe dont use an aftermarket abutment? I use dess also, but that seems like a good place to start. Dess might warranty it also.

 

[Sda36]

Hey this is a question for anyone that has a thought on it. I welcome any comments.
So I'm working on an implant case[hiossen, screw retained previously, with a dess ti base] for tooth #3 and for some reason the screw keeps coming loose in the patients mouth after some time, which I believe is as soon as a few weeks, as well as longer too and I don't know how long. It's happened already 4 times that I know of. The implant is centered ok on the patients jaw, however it comes out at an angle diagonally(so mesially and buccally). The Dr has tried numerous things to fix like new screws reducing occlusion and flattening, making proximal contacts very light or tighter. Even tried( however not recommended) something to hold the threads in place better and prevent vibrations on the screw.
Anyone have any thoughts on this???
--i am definitely out of ideas but the Dr ordered a custom abutment this time and although I don't feel it will make a difference, who knows right??
I don't have a lot of experience when it comes to implants and especially not when it is is a problem case....

Could well be an impingement with bone. Dess & others, collars are low unless you order a higher emergence which they offer. What happens is Dr. torques down, bone then escapes and screw is loose. This can easily happen with bone level implants if no Xray is supplied with the case. Make good use of heightened profiles when case is presented. Not sure if this is the issue but perhaps so.

 

[AKDental]

It is a hiossen standard internal hex

 

[AKDental]

Ok thanks for all the replies everyone. Let me add a few details that I left out that may or may not change some of your guys theories on wut is going on....(which BTW are all excellent and very likely possibilities). So yes it is a dess and it is regular gum height for hiossen. (Which is slightly higher than normal...or is that astratech?? But let me ask Dr about the bone imp. Cuz the angle could definitely cause that lip to dig in if too close.

Could well be an impingement with bone. Dess & others, collars are low unless you order a higher emergence which they offer. What happens is Dr. torques down, bone then escapes and screw is loose. This can easily happen with bone level implants if no Xray is supplied with the case. Make good use of heightened profiles when case is presented. Not sure if this is the issue but perhaps so.

Also wut do you mean "make good use.......is presented."? Sorry if I'm asking dumb question but I'm new to the implt game so I worry about everything, probably overly.


Oh and last detail or clarification is that Dr used loctite.( not the permanent red one. But the semi permnt blue one) in an effort to combat the loosening. I felt this would do the trick but Dr said no good. Can chewing really cause screw to come loose under these conditions?? Jeez...oh and this was the crown after lab adjustment to the occlusion to correct the cusps and crown contour bc crown was made to look like a normal tooth...(not by me tho, hehe. Although I won't lie. I have made more than one posterior impl crown that a normal person problee couldn't tell its a crown....but hey wut can u do??
Neways sorry I'm rambling on. So can someone answer this for me??
Will a custom abutment possibly help in any way??

 

[AKDental]

Oh and to answer the comment about design. Crown was reduced to make it narrower with flattened and open occlusion. IMO the placement of the implant makes it impossible to reduce lateral forces... impl starts in the center but comes out diagonally to a corner

 

[JMN]

I just have to ask since nobody else has: Was engaging or non-engaging used for the interface of the restoration? It's an easy foulup.

Engaging must be used unless there are more than one implant site on the restoration to keep it from micro-rotating and loosening the screw enough that it becomes obviously loose.

 

[HampeTC]

A few years ago i attended a lecture where they found that newer vibrating "sonic" tooth brushes could loosen the screws of larger implant bridges over time. Might me a shot in the dark but it could be a good idea to ask the patient what kind of tooth brush they are using.

 

[Pronto]

I just have to ask since nobody else has: Was engaging or non-engaging used for the interface of the restoration? It's an easy foulup.

Engaging must be used unless there are more than one implant site on the restoration to keep it from micro-rotating and loosening the screw enough that it becomes obviously loose.

It's an internal hex...

 

[Pronto]

My guess, lollipop on a stick syndrome. Implant too small, abutment/crown too big. Huge torque applied to the tiny head of the screw works it back and forth.

 

[Sda36]

Ok thanks for all the replies everyone. Let me add a few details that I left out that may or may not change some of your guys theories on wut is going on....(which BTW are all excellent and very likely possibilities). So yes it is a dess and it is regular gum height for hiossen. (Which is slightly higher than normal...or is that astratech?? But let me ask Dr about the bone imp. Cuz the angle could definitely cause that lip to dig in if too close.

Also wut do you mean "make good use.......is presented."? Sorry if I'm asking dumb question but I'm new to the implt game so I worry about everything, probably overly.


Oh and last detail or clarification is that Dr used loctite.( not the permanent red one. But the semi permnt blue one) in an effort to combat the loosening. I felt this would do the trick but Dr said no good. Can chewing really cause screw to come loose under these conditions?? Jeez...oh and this was the crown after lab adjustment to the occlusion to correct the cusps and crown contour bc crown was made to look like a normal tooth...(not by me tho, hehe. Although I won't lie. I have made more than one posterior impl crown that a normal person problee couldn't tell its a crown....but hey wut can u do??
Neways sorry I'm rambling on. So can someone answer this for me??
Will a custom abutment possibly help in any way??

Hi again, what I meant us there are new and improved emergence profile heights available now and should definitely be considered. If you use a standard Ti Base, they are typically 1.5 mm emergence height. If its a bone level implant with some crestal bone you are unaware of, you could easily have a bone impigement issue. Wheras if you escaped that area with a 2 or 3mm emergence height these worries are avoided. Hope this helps

 

[rkm rdt]

Hi again, what I meant us there are new and improved emergence profile heights available now and should definitely be considered. If you use a standard Ti Base, they are typically 1.5 mm emergence height. If its a bone level implant with some crestal bone you are unaware of, you could easily have a bone impigement issue. Wheras if you escaped that area with a 2 or 3mm emergence height these worries are avoided. Hope this helps

Your custom abutments suggestion helps as well.

 

[AKDental]

I just have to ask since nobody else has: Was engaging or non-engaging used for the interface of the restoration? It's an easy foulup.

Engaging must be used unless there are more than one implant site on the restoration to keep it from micro-rotating and loosening the screw enough that it becomes obviously loose.

Yes no problem thanks for asking. It is engaging. Wish it was something simpler like using a non engaging...and I appreciate and invite any comments. Thx

 

[AKDental]

A few years ago i attended a lecture where they found that newer vibrating "sonic" tooth brushes could loosen the screws of larger implant bridges over time. Might me a shot in the dark but it could be a good idea to ask the patient what kind of tooth brush they are using.

Hmmm...interesting. I never though of that but it definitely makes sense as I remember
The first time I used a Sonicare it was so strongly intense that I could barely hit that 2 minute mark.

 

[AKDental]

Hi again, what I meant us there are new and improved emergence profile heights available now and should definitely be considered. If you use a standard Ti Base, they are typically 1.5 mm emergence height. If its a bone level implant with some crestal bone you are unaware of, you could easily have a bone impigement issue. Wheras if you escaped that area with a 2 or 3mm emergence height these worries are avoided. Hope this helps

Yes thank you.

 

[Affinity]

Loctite on an implant?

 

[lcmlabforum]

I am not sure who is the newbie here, if the DDS use Loctite on the implant, that might be
a problem since this is not approved to be used in the mouth. I take it you did not recommend that.
As that creates a problem with retrievability and may affect future efforts.

Can't really suggest much without a PA/Xray possibly intra-oral photos on the arch to
see how much wear there is generally, and how many teeth are in occlusal contact besides
that implant. If that is the only posterior teeth in that quadrant in contact, good luck.
So many variables, so little information to go on for me.
LCM

 

[keith goldstein]

If you are in the USA can you send us xrays and the parts you used from us since we can have one our clinical advisors look at this and give their opinion if that would help. Our email is [email protected].