Healing abutment loosened: precautions?

I would suggest that you take a look to see if there is hard or soft tissue interference, that might be preventing the Healing abutment from seating fully. Did you place the Implants? Are the sub osseous and if so did you use a bone mill to prep the site for full seating of the Healing abutment? Is the diameter of the healing abutment so wide that its prevented by soft tissue from fully seating? Generally Healing abutments, at least in my years of experience, dont need more than hand-tightening to keep them in place. You will probably get about 10Ncm maybe a bit higher and this should be able to hold them in place. You don't want to put to much torque on the healing abutment as that torque will transfer to the implant body and as we know, the BIC is weakest with shear forces.

There are several aspects to this. First, it is not possible to hand tighten to much more than 10Ncms, and this is often inadequate to hold for extended periods of time. Second, in immediate placement of implants and healing abutments an operator can be hesitant to over-tighten because this may turn the implant. These cases are the ones that have the greatest amounts of trouble because the healing abutments may be in place for three months or more. Healing abutments are generally single-screw devices, and these are bound to be less secure than two part components which engage the anti-rotation components inside the implant. It has surprised me that implant manufacturers do not make some two-part healing devices available. If we have a case where traditional healing abutments can be expected to come loose then we often trim down an impression post and use a standard screw to retain it. These work great. Hope this helps.

15ncms is what I have used for the last 20 years without it loosening. When I have hand tightened the healing screw comes off.

I place healing collars at three months for three weeks. (Hand tightened ) I tell the patient to check it daily with tongue or finger for mobility. If any, they return to my office or restorative dentist to tightened. This prevents breakage of the stem if pt. kept chewing on it. I never place the healing collar at implant placement as chewing on it (accidently) may prevent integration or lead to stem fracture over three months, and then implant failure and removal . Honestly, I have a 99.8 percent success rate this way. No miracle, just conservative treatment. Nice and easy wins the race.

Hard or soft tissue impingement or trapped soft tissue within the implant body is the most common cause of this problem. Hand tightening of a healing abutment should be more than adequate to secure any healing abutment for any reasonable length of time. .