Bridge stuck over implant: recommendations?

You may have to make an access opening through the crown on one or both of the abutments and back out the screw(s) to retrieve the bridge.

As the fixation screws were not torque high enough tapping the bridge off may cause fracture of those screws and alter the threaded channel in the implants. Leaving it on as is without cement will allow the screws to loosen and cause issues as most likely not both will loosen. The best option may be to drill an access hole in the occlusal and remove the entire bridge with abutments converting it to screw retained then lute the abutments in to the bridge and reinsert it torquing to 30 Ncm or higher depending on manufacturers recommendations. In the future never try a bridge in if the abutments are not fully torque down.

Leave it if it fits If not start cutting it off. This isn’t rocket science here

Just wondering. Was it difficult to seat the bridge in order to adjust the occlusion? Were these custom abutments that were supposed to be parellel , or stock abutments?

If the abutments aren't parallel the bridge shouldn't be on them.... remove it asap as the stress may lead to bone loss or worse . Section the bridge as much as necessary and remove it....replace the abutments prior to fabricating a new prosthesis. There are (2) ways to accomplish this ; (1) take fixture level impression and have the lab fabricate custom abutments and a new fpd or (2) if your abutments are stock take an impression of them ... remove and seat implant analogs pour in stone and adjust them with the aid of a surveyor (yea the gizmo from dental school).... replace them orally and impress as crown an bridge....

Since implants are not parallel, it may be difficult to convert to screw retained. Why did lab not parallel abutments in first place? Are they solid abutments? The safest approach might be to cut bridge off and have lab parallel abuts or reprep in the case of solid abutments. Any attempt to bang bridge off is dangerous!

First, an X-ray would be really helpful to provide the most useful advice here. Could you post an X-ray? I think the best option here it to try to create access holes and retrieve the bridge and abutments this way; even if the bridge becomes loose, it will not just fall off the way a bridge would fall of on abutment teeth; the abutments need to be unscrewed out and all you will get is a mobile bridge, loose abutments, and ultimately incorrect loading stresses and bacteria infiltration of the implants and bone loss around the implants. If you cannot create access holes, I suggest cutting off the bridge. It's ok that the implants were not parallel, but not sure why the abutments were not created parallel by the lab... unless the angulation was so far off that the lab could not create parallelism?

What I would do is to pull the entire bridge with the bridge remover, if it went in it can come out, if it turns too hard then drill a hole on one of the abutments and screw off the entire abutment. Next time don't force the insertion of a bridge/ crown, push a little and use Thompson sticks or crown oclusal marker to obtain passive adjusment. Good Luck!

I guest the implants are not parallel but the abutments are. The lab may have made them too much parallel, so the draw is too tight. Waiy a few days and try again Why not loop a wire under the bridge and very gently tap it off ? Or ask patient to eat caramel ? Or do a triple tray impression with rigid material to pull it out ? Of course drilling it off is another way...

Agree With Rich and Dr AG. Common sense approach

Don't cut it off! Loop a wire and impact it off or drill thru one of the retainers to access abutment screw.

With the screws only in at 15 Ncm if you try to tap it off the force will be on the screws not the crown abutment interface

If you are fortunate enough to remove the units intact, I would reprep the abutments lightly to give the bridge a better draw.

I agree with you Dr K! Guess I am talking about LIGHT force on the bridge. Dr did not say how he attempted to remove the bridge.

There is a green jujube sold for removing crowns. Excellent: heat, bite, cool and retain with a metal bladed instrument as the patient is instructed to "open and remain open". Kavo also make a pneumatic impact crown and bridge remover which is excellent in simplicity, physics and application albeit expensive.

Before you start cutting try this. I assume the bridge is not made from the same alloy as the abutments so there will be different coefficients of expansion. Get about six sticks of green compound and heat them with a flame. Stick all six on to the abutment crowns both bucal and lingual. As soon as they solidify pop them off and try tapping the bridge. The expansion of the crowns may allow you to get the thing off. If it fails the first time try again but at the end have the patient rinse with ice water then tap. If this all fails cut an access hole above each screw, torque them fully, and seal the holes. Adjust the occlusion and you’re done!

Since you speak of making a bridge...I assume the two crowns are soldered together, and there is a joint........ a spring loaded crown and bridge remover, with a fine tip placed under the joint.... will delivered enough of a light shock to lift off the two crowns.... all it takes is a light shock... you will not damage the threads of the implants......let the spring of the device deliver the shock.

Air driven chairside pneumatic tapping first ( if you don't have one of these devices, get one ). If no movement then just cut it off. Remake abutments as custom abutments ( perfectly parallel ) and remake the bridge.

Oh, those passive fitting bridges on 8 implants!

Leave it in function for a few weeks and see how it goes, let the occlusion be your friend temporarily. Failing that, crown cutter on one of the crowns and that'll do, pity though:( Maybe spray fit checker on next time and grind exposed material till passive . It is surprising that the lab did not let you know re lack of parallellism

If the bridge fitted easily on the model, but tight in the mouth, then two thoughts strike me; 1. That a verification jig was not used to confirm that the implant alignment in the impression was accurate before proceeding. 2. If a jig was used, and confirmed to be good, then maybe one of the abutments was not located correctly in the mouth before trying the bridge! Sounds daft, but I have seen it many times. 3, If No1. above was not confirmed, all further action is wasted! 4. If alignment was confirmed, then get your lab to provide transfer jigs for abutment location before attempting to try-in bridge. 5. First cut your losses, AND then cut off the bridge and start again, following No1 above and No4! Of all the action suggested, No1 is the most important, David Broughton. Implant technician