Loose Implant Crown

[toothtrouble]

Hello,

I am a healthy, non-smoking, 23 y.o. female. Several years following a fall, I developed a complete fracture in the root of my front tooth. As advised by multiple dentists, the tooth was extracted by a very experienced periodontist and an implant was put in place. I wore a temporary flipper while it healed. My periodontist gave me the ok to load the implant after 3 months, but for insurance purposes I waited 6 months. I was assured that the implant was completely healed and ready.

After lots of waiting and minor setbacks while the crown (as well as a veneer for my other front tooth for cosmetic purposes) were made, it was finally ready to go. My dentist (who is young but reputable and specializes in cosmetic dentistry) and the dental assistant attached the final abutment, crown, and veneer. I was pretty satisfied with the cosmetic result.

It has now been 1 month. Two days ago, after flossing I noticed that the crown was loose. I was able to move it about 1mm front and back as well as side to side. I immediately called my dentist and went in the next day. After taking an x-ray and looking at it, she told me that it was either that the abutment screw was loose (most likely) or that the implant itself is loose. She is referring my to a local periodontist and says that he will need to drill into the back of my crown to access the screw and see if it is in fact loose.

I am very upset. I can't even begin to imagine starting this process again. Not to mention that I am completely broke from this whole process. I am worried about the possibility of damaging the crown from drilling this hole and about the costs of all of this. It seems to me that the most likely issue is a loose screw caused by improper tightening or torque before loading. I do not understand how the screw could become loose on its own in such a short amount of time otherwise. Am I correct in thinking this? Do I need to be worried about making sure this dental office is accountable for their work? Does it seem like it may have been their error? Should I be making sure they pay for additional charges incurred?

Thank you for taking the time to ready this and give me feedback!

 

[Belinda]

Hello,

I am a healthy, non-smoking, 23 y.o. female. Several years following a fall, I developed a complete fracture in the root of my front tooth. As advised by multiple dentists, the tooth was extracted by a very experienced periodontist and an implant was put in place. I wore a temporary flipper while it healed. My periodontist gave me the ok to load the implant after 3 months, but for insurance purposes I waited 6 months. I was assured that the implant was completely healed and ready.

After lots of waiting and minor setbacks while the crown (as well as a veneer for my other front tooth for cosmetic purposes) were made, it was finally ready to go. My dentist (who is young but reputable and specializes in cosmetic dentistry) and the dental assistant attached the final abutment, crown, and veneer. I was pretty satisfied with the cosmetic result.

It has now been 1 month. Two days ago, after flossing I noticed that the crown was loose. I was able to move it about 1mm front and back as well as side to side. I immediately called my dentist and went in the next day. After taking an x-ray and looking at it, she told me that it was either that the abutment screw was loose (most likely) or that the implant itself is loose. She is referring my to a local periodontist and says that he will need to drill into the back of my crown to access the screw and see if it is in fact loose.

I am very upset. I can't even begin to imagine starting this process again. Not to mention that I am completely broke from this whole process. I am worried about the possibility of damaging the crown from drilling this hole and about the costs of all of this. It seems to me that the most likely issue is a loose screw caused by improper tightening or torque before loading. I do not understand how the screw could become loose on its own in such a short amount of time otherwise. Am I correct in thinking this? Do I need to be worried about making sure this dental office is accountable for their work? Does it seem like it may have been their error? Should I be making sure they pay for additional charges incurred?

Thank you for taking the time to ready this and give me feedback!

I am sorry you have this problem.
There are two options:
1. The abutment screw is loose. This can happen if it is undertightened when the abutment is fitted. Your dentist should have used a torque wrench or torque driver to tighten it to the recommended value. Alternatively the implant may have been overloaded. This can happen if the implant tooth or the implant itself is placed 'out of harmony' with your bite relationship. If the crown has been cemented over the implant abutment, there is no way to access the screw without cutting through the back of the crown. This will unfortunately render the crown weak and liable to fail at some later date. Your dentist should do all this remedial work at no cost - including making a new crown. You are protected by the Sale Goods and Services Act which states that any item bought must be fit for purpose and of reasonable quality. Don't be persuaded otherwise.
2. The implant may have failed although this is less likely given the amount of time that has passed. An Xray will generally indicate a failed implant and removing the crown will confirm it.
There is little redress if the implant has failed as this is a recognised risk and you gave informed consent. Were you fully informed verbally and in writing? Did you sign a consent form? If not, you will have grounds for full redress and/or a complaint to the GDC.
I would advise you to talk to your dentist and allow him to rectify the situation. If it happens again, ask for your money back and find a better dentist.