Loosened Abutment Screw on Dental Implant

There can be elastic deformation of the screw. Try replacing it with a new one first and see if that solves the problem.

I would recomend to get a new crown done, over a new abutment with a new screw. A procera abutment may solve your soft tisuue problem or at least partially, since it can be coloured to simulate tooth structure or even gum tissue. Good luck

It sounds like you need to take off your mind from the implant itself and turn to a functional dentist who would understand Cranio-Mandibular space management, Lower Jaw and tongue posture and finally occlusion guidance. Once all of the above is coordinated you will get the environment under control for bone and soft tissue recovery.

To provide any real advice, we would need to know a bit more about the type of implant and the amount of bone loss over what period of time. However, based on the limited information you have provided, it is likely that this may be a "bite relationship" or occlusal problem, that may be improved by evaluating and modifying how the lower front teeth occlude with the implant crown.

You state that the screw has been tightened and yet, your restoration continues to loosen. Do you know if a torque wrench has been used in the past when tightening the abutment screw? Has the abutment screw been changed? Do you have any para-functional habits ie: grinding your teeth etc.? Has your occlusion (bite) been checked? Has anything changed in the last 4 years seeing as the implant and restoration were stable for 10 years? You also indicate that there is bone loss surrounding the implant fixture -how much? -where?

Just to give some more precisions. The implant placed is a Branemark-type clone (virtually unknown brand). 4 years ago, I had a new crown placed for aestetic reasons. I had not had any problems with loosenings of the abutment screw. When the new crown was placed, a new abutment and screw were also placed (The latter is tightened with a torque wrench). The occlusion, however, was not properly checked. Consequently, the screw loosened. The dentist I went to at the time did not seemed worried about it. Only a year or so after, the crown was removed, and a new abutment was placed with a new screw, which was subsequently sealed (with a fibre-glass type of solution I think). A temporary crown was fixed. This temporary crown was not well-modelled and I developed an infection which led to some bone loss and soft tissue retraction (about 3 mm or more). I went to the dentist who created the implant line. He re-modelled a new crown and paid special attention to the occlusion. The abutment and sealed screw were not replaced, as they seemed fine. Now, 1 year after, it seems that the screw has loosened again. Hence the treatments I mentioned earlier. A couple more points. (1) The bone loss in length must be about 2-3mm and some of the bone was lost already at the tooth extraction (in width), which tend to make the gum look convex in that area. (2) I don't have any para-functional habits that I know of. I only have a very deep occlusion. Many thanks for all your comments and responses.

If the screw is loose, you need to get it tightened right away, as it will irritate the surrounding tissues, as you know. A deep bite coupled with any bruxism could contribute to screw loosening. A bite plate could help. Not a surgeon, not sure what the best way to go with replacement vs just a graft.

There can be only two reasons, usually a combination of both for this happening: 1. The screw needs to be replaced with a gold screw which is then tightened using a torque wrench. 2. The bite needs to be properly adjusted, to all excursions, meaning not just when you bite down, but when you slide forward, and side to side. It has also been shown that using Tekscan (see my website) you can fine tune the occlusion so that the crown on the implant doesn't load until after the teeth are about 60 per cent loaded. Because teeth have ligaments, they have some "give" as you bite down. As the teeth "give" the implant absorbs too much of the initial load. Email me off list, and I can get you the name of someone in your area who owns a Tekscan.