Some days, I feel like I’m the dental version of a fireman. On Monday, I saw a new patient who had been referred to me by a colleague in Ohio (who knows me through the Dentaltown message boards). The patient is a “snow bird” who spends his winters in Florida. It happens a lot, as it seems there is a rule that most patients up North eventually end up in Florida. I share many patients with my northern colleagues.
The patient, a 75 y.o. male with a history of multiple myeloma, had a chief complaint of a loose bridge. It was implant-supported with abutments in the position of #9 and #13. Interestingly, rather than pontics, there were crowns on natural teeth in the positions of #10 and #11. There is a pontic #12. So, it was combining natural teeth and implants. Except, the natural teeth were no longer really part of the equation (as you’ll see below)
The patient was planning to return home to Ohio in a couple of weeks. Normally, I’d recommend replacing the screws with new screws (and I told him so). The old screws have been stressed cyclically and are prone to breakage. But, he wanted a quick fix, and I thought I’d just tighten the existing screws enough to get him home to Ohio. And, so that’s what I did. I recommended that he see his dentist ASAP when he gets home. I also mentioned that the entire bridge may need replacement.
Yesterday, the patient called to tell us the bridge came out completely. Rut-roh! I knew the screws did not likely loosen themselves all the way out in a couple of days. And, I was right. Both screws broke off in the implants. Oh, crap. I saw him this morning, and this is what I found.