Yes. I’m still a dentist. I just need patients to come back!
Last week, a patient was referred to me by a periodontist. Her implant crown had come off, and she was referred to the periodontist by her dentist up north. By the patient’s recollection, the implant crown was placed about 1-1/2 years ago.
Clinically, it looked like what you see below. It would appear to be a custom abutment, but it had diamond bur marks on it. The soft tissue is clearly not happy. Also, note that the implant is lingually oriented.
The patient brought the crown with her. It still had cement inside. Removing the cement revealed that it was a very thick layer. I had to use a bur, initially. Then I switched to a sandblaster to get the rest. When I tried the crown on intraorally, a very poor fit was evident. The crown rocked loosely on the abutment. I can’t recement the crown.
I removed the abutment and tried the crown on the abutment extraorally to re-examine the fit. The arrows show the abutment margin and crown margin, respectively. Hoo-boy! This crown fits like the proverbial “socks on a rooster!” I also believe that the patient may have complained about the crown crowding her tongue, and the previous dentist recontoured the lingual – through to the metal. See photo below.
Here’s another shot that I intentionally over-exposed in photoshop to illustrate the marginal discrepancy, which was 360-degrees… or all the way around. No wonder the tissues weren’t happy.
My guess is that the custom abutment was made and then re-prepped intraorally. Then a direct impression of the abutment was made. The patient recalled that several impressions had to be made.
Here’s a view, straight down, so you can see the overhanging margin, all the way around.
I made a new fixture-level impression for a new crown. Then I made a screw-retained provisional out of Luxatemp and the old abutment. The screw-retained provisional assured that I could create a smooth margin for the tissues to heal.
Hopefully, we can accommodate a screw-retained restoration with the lingual orientation of the implant.Copyright protected by Digiprove © 2020 The Dental Warrior®
Well done Mike, it was lucky that you had the right impression coping. Lucky for the patient you were open too!
Yeah… I happened to have the right impression coping. She was the only patient I saw that day. 🙂
Nice job Mike. Good save Always good to have a nice stock of impression posts .See I agree with you on most things dental. 🙂
Got lucky. It seems more often than not, I get the odd-ball implant salvage cases and have to become an investigator to determine which kind they have. I pretty much cannot charge enough for those cases, given the time it takes to sort it all out.
I get a sense that you love investigating these implants like Barry Allen does in Flash. I love your enthusiasm.
Good save though. I hope people start coming back soon.
Great work Mike! Keep up your work!
Great work, Mike! I’m beginning to feel like I should fly over to Florida for non-routine dental work like this, if I need it. OMG! Good save! Great that you have the patience and professional commitment to resolve the problem for the patient!
Hi Sheryll! You’re a long way from Florida! haha!
Thanks for your comments! Hope you are well.
Thanks for sharing such a informative blog.