There are a myriad of complications that may occur with either the surgical or prosthetic phase of implant dentistry. In this case report one uncommon complication is presented and the possible solutions examined.
A 41-year-old patient presented for an implant in the 26 area after a failed endodontic procedure. The patient was a smoker of more than five cigarettes per day which placed him in a higher risk category for implant failure. The tooth was removed using an atraumatic technique and the alveolus allowed to heal for 12 weeks. A dental implant was placed in conjunction with an indirect sinus lift using osteotomes. The bone quality was mostly cancellous and determined to be type IV. The implant was placed at approximately 32 Ncm with primary stability achieved. A transmucosal healing abutment was secured to the implant at 15 Ncm.
The patient had an unremarkable recovery. Eight weeks post-surgery the implant was tested for osseointegration and was found to be secure. The patient was referred to his general dentist for the fabrication of the implant supported crown. The dentist had previously encountered a situation where a patient’s healing abutment came loose after impressions were taken.
To avoid this inconvenience for the patient, the healing abutment was tightened to 35 Ncm after impressions were taken.
Upon the delivery of the implant supported crown, the dentist could not remove the healing abutment from the implant and the screwhole was stripped. At this point he informed the patient of the complication and decided to consult on possible approaches to remove the abutment before doing irreversible harm.
The following four options were considered to facilitate the removal of the abutment:
1. Cut a slot along the length of the abutment to allow the insertion of a flat instrument to function as a screwdriver.
2. Grasp the edges of the abutment with a rongeur or hemostat.
3. Drill a hole through the center of the abutment.
4. Trephine out the implant and place another fixture.
Given the poor quality of the bone and the smoking status of the patient, the methods to remove the abutment posed significant risk of implant failure and inconvenience to the patient.
Due to the excessive torque (35 vs 15 Ncm) used to tighten the healing abutment, the morse taper connection between the abutment
———
There are a myriad of complications that may occur with either the surgical or prosthetic phase of implant dentistry
