Background: In 2005. right before Hurricane Katrina struck, for a lower #5 (I have the genetic condition that seems to be popular in that that permanent tooth never exists, and when I hit age 40 the baby tooth had to go) I got an oral surgeon to implant a Zimmer 4.7 Tapered Screw-Vent Implant with a 4.5mmd restorative platform. And as I had mentioned Hurricane Katrina, of course it is very pertinent to my situation as the oral surgeon's records were completely destroyed in that. I was living abroad in Ukraine after that and got the crown put in, and believe that the crown was from Israel. I would presume that it was a Zimmer abutment, but who knows?
So fast-forward to today and my crown now has a range of motion of a rotation of about 30 degrees or so, but it seems to not have any range up or down. My current dentist drilled at the top to get to the screw and when she tightened the screw, the crown ended up being rotated at one of the ends of that range, but unfortunately, that position has the tooth at about 20 degrees out of line. I had been told by my current, and another, dentist that the abutment is shot. Both the implant surgeon colleague of my current dentist and the original implanter said that they have never encountered a situation like this.
OK, so I need a new abutment from Zimmer. (BTW, it was like - pun semi-intended - pulling teeth to get someone from Zimmer to talk to me because I am just a stupid patient). I had an X-ray that shows the abutment that I had sent to Zimmer for them to tell me exactly what I had (they had addressed me as "Dr." and originally clammed up after I had informed them that I was the patient, although it seems that finally I have a manager who will speak to me!). After I relayed this to my dentist, she (actually the office manager of her dental practice, which is a large dental care organization) told me that she also needed the the reference # or the size of the healing abutment. When I had relayed this to the Zimmer representative that had identified by implant, she said that my dentist has all the information that she needed. So I figured that I needed to mediate between these 2 parties to continue on with my care.
Anyway, so I finally got to talk to someone at Zimmer that respected my concern as a patient and she said that there are many choices about what can be done. For the new healing abutment - which would be there while the crown gets manufactured - it seems that are 2 independent selections: the height and the flarity. AETM, the height must be determined by the dentist using a perioprobe, and the flarity - which can be either 4.5 (cylindrical) or 5.5 (conical frustrum) mm depends on the condition of my gum there. My question here is is that something can be determined without breaking the crown off? The whole idea of the healing abutment is that it be there when the crown is broken, so it there seems to be a chicken & egg dilemma; perhaps my dentist should order both and figure out which one is needed, and then send the unneeded one back?
And as for the permanent abutment, it seems that I have 4 choices:
[1] screw-retained crown with UCLA abutment, in which there is only 1 screw used
[2] screw-retained crown with a tapered abutment which itself is screwed into the implant insert, and thus there being 2 screws
[3] cementable crown with a hex-lock abutment
[4] cementable crown UCLA abutment
My first question about this is which of these sounds like what I have now. The second one is what are the pros & cons of each type, both in durability & $$$. I have been told that I have a strong bite, if that matters.
And of course, I would welcome any advice about my situation. Thanks
So fast-forward to today and my crown now has a range of motion of a rotation of about 30 degrees or so, but it seems to not have any range up or down. My current dentist drilled at the top to get to the screw and when she tightened the screw, the crown ended up being rotated at one of the ends of that range, but unfortunately, that position has the tooth at about 20 degrees out of line. I had been told by my current, and another, dentist that the abutment is shot. Both the implant surgeon colleague of my current dentist and the original implanter said that they have never encountered a situation like this.
OK, so I need a new abutment from Zimmer. (BTW, it was like - pun semi-intended - pulling teeth to get someone from Zimmer to talk to me because I am just a stupid patient). I had an X-ray that shows the abutment that I had sent to Zimmer for them to tell me exactly what I had (they had addressed me as "Dr." and originally clammed up after I had informed them that I was the patient, although it seems that finally I have a manager who will speak to me!). After I relayed this to my dentist, she (actually the office manager of her dental practice, which is a large dental care organization) told me that she also needed the the reference # or the size of the healing abutment. When I had relayed this to the Zimmer representative that had identified by implant, she said that my dentist has all the information that she needed. So I figured that I needed to mediate between these 2 parties to continue on with my care.
Anyway, so I finally got to talk to someone at Zimmer that respected my concern as a patient and she said that there are many choices about what can be done. For the new healing abutment - which would be there while the crown gets manufactured - it seems that are 2 independent selections: the height and the flarity. AETM, the height must be determined by the dentist using a perioprobe, and the flarity - which can be either 4.5 (cylindrical) or 5.5 (conical frustrum) mm depends on the condition of my gum there. My question here is is that something can be determined without breaking the crown off? The whole idea of the healing abutment is that it be there when the crown is broken, so it there seems to be a chicken & egg dilemma; perhaps my dentist should order both and figure out which one is needed, and then send the unneeded one back?
And as for the permanent abutment, it seems that I have 4 choices:
[1] screw-retained crown with UCLA abutment, in which there is only 1 screw used
[2] screw-retained crown with a tapered abutment which itself is screwed into the implant insert, and thus there being 2 screws
[3] cementable crown with a hex-lock abutment
[4] cementable crown UCLA abutment
My first question about this is which of these sounds like what I have now. The second one is what are the pros & cons of each type, both in durability & $$$. I have been told that I have a strong bite, if that matters.
And of course, I would welcome any advice about my situation. Thanks