Loose Implant Restorations

As we know in the world of dentistry today implants are becoming increasingly prevalent. And while they are a great option for tooth replacement, they bring us new issues that we must deal with such as loose restorations. While with the advent of internal connections the incidence of loose implant restorations has greatly decreased, the simple fact is that even with these improved connections we can still have things come loose – and of course there are a lot of older, more problematic connections still in service.

This brings us to the following questions: Have you come across a loose implant restoration in your practice yet? If you have, did you do anything about it? If not, should you have? If you have not come across one yet, do you know what you will do when you do?

I will start off by clarifying that what I am referring to in this article is a loose implant-to-restorative complex. Meaning that the restorative component has come loose at its juncture with the implant. With this being clear, I will add that I find it hard to imagine a situation, (although I will concede it might exist in really rare situations), in which I would not want to properly re-tighten a loose implant-restorative interface. The reasons for this are simple. First, when this connection is loose, it means you have a screw moving around inside the implant fixture that is at a higher risk of breaking since it is in reality the only thing holding the restoration in place. You now have basically zero help from the implant connection.

If you are thinking it might be easier to deal with this situation after the screw breaks and the restoration comes off on its own, I will tell you that anyone who has had to retrieve a broken screw inside an implant would disagree. Think about it. If you wait, and the inside of the implant gets damaged because of the loose screw stripping the threads of the implant, or you damaged the implant while trying to retrieve a broken screw, how is that a good thing?

The other big reason to get these connections retightened is the fact that if they are loose there is going to be gross leakage around them and debris is going to collect where it can't be cleaned out. It's a simple fact.



So if we know that the success of our implants relies on periodontal health, how can this be a good thing? Take for example this image from a case in which I removed a loose implant restoration on a patient of mine.



As you can see, there is gross contamination present and the tissue was far from healthy. Another unfortunate aspect of this case is the fact that the only long-term solution for this patient will be a new restoration, as the previous restoring dentist designed the restoration with completely non-engaging interfaces. It appears that the internal hexes and anything to create a positive seat were completely removed from the abutments, leaving nothing at all to engage the top of the implants.



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