Need to separate implant from tooth-to-implant splinted crowns: recommendations?

How long have these restorations been in place?

If you are planning on saving the crown on # 13. Section distal to # 13 first with the smallest burr available. Options: 1) Try to access the abutment screw via the occlusal table and untighten the screw completely and remove the crown with the abutment as one piece. You have the option of adding ceramic to the mesial of the existing crown after you separate abutment and crown. Screw the abutment back and cement the crown. Now you have a screw retained crown. 2) Just section the crown, remove it, bring a new screw and tighten your abutment back. Take an impression of the abutment ( As if you are doing an impression for a regular crown) and send to the lab for crown fabrication Try to research the exact type of implant, the older ones might have an external hex so maybe you can use a hexed abutment in the future

What concerns me is the implant also abutted to tooth #15? Based on information given the implant site was narrow and a large wide crown was placed and pier abutted to two natural teeth. This can cause loss of the natural teeth and significant bone loss around the implant which seems to be apparent on the film. It may be possible that only the natural tooth is loose due to the trauma from the implant. It would be wise to section the connection to #13 and see if the implant is mobile. I would also section #15 to preserve that natural tooth. The implant body can be put to sleep and a bridge made #11-15. This was a poor prosthetic treatment plan and the result is evident in the compromise of natural teeth and alveolar bone. Alas the patient did not get lucky on this one so good fixed bridgework would be my treatment of choice. My initial treatment would have been grafting of the site and placement of an appropriate sized implant in the molar region not bonded to natural teeth. If that could not be obtained then bridgework. Too many chances were taken resulting in this outcome. Trying to salvage this implant would not be the way I would choose to go.

Thanks for the comments so far. The splinted crowns #13-14 were placed sometime in the late 80's/early 90's by a small town dentist after one of the top oral surgeons in Columbus, Ohio placed the implant. That was a long time ago and Drs. were just following protocols (little experience or planning for future complications). I don't think anyone places non-engaging implants any more. I typically request engaging type abutments even for bridges unless it is a very large prosthesis, so that if they need to be individual units in the future, that is possible. However this was placed in the early stages of implants in this country so I cut the surgeon a little slack for placing a non-engaging implant. #15 is not connected to the prosthesis, the radiograph is deceptive. I understant the abutment is not a "screw-through" but is a "screw-on" type (no separate screw). Therefore, I have a plan to offer the patient (who is a dentist) to resect the connector and place a screw-retained crown that will require tightening periodically or place a cover screw, allow tissue to grow over, remove the implant. If sinus membrane is not torn, do a sinus lift and simultaneous placement of larger implant. However, was looking for feedback on the former "escape" plan. Anyone handled such a case before? Thanks

Looks like #15 is involved. Even so, why was this done this way? I agree separate the units.

Thanks for the feedback. I tend to agree with CRS and consider that at the patient's age, he might be OK with making a new screw retained crown and retightening periodically. As with all such problems there may be some unknowns that alter my plan once I've removed the crown. Dr. Hughes, I agree it appears to be part of the unit and so I checked it when he was in a while back. Actually it probably wouldn't have failed if #15 had been involved because then we'd have a bridge with a redundant implant that might provide additional support. I'll try to keep you all posted.

Hi Geoff this probably done in late 80s or early 90 s . Abutment attachment was in its early days and there were a lot more issues ( I used a system where the hex abutments were cemented in...... never worked well for me ) so this type of splinting was used to reduce issues . THis IMplant is great for its design and era , bone is perfect so just follow CRS advice. Peter

Dr. Fairbairn. Thanks for your help. I can't see a slide or X-ray. I'm new to this listing. Is there a method to view your photos? The dentist has tentatively decided to do the scrwe-retained crown with re-tightening periodically so your suggestion might be helpful. Thanks Again, Geoff

The Steri-oss non-hexed implant discontinued around '91 for obvious reasons. Unfortunately they were occasionally placed in single tooth applications by misunderstanding or confusion on the part of the surgeon. When the unfortunate event was discovered, after integration of course (remember the era, place and leave alone), the only choice for restoration was splinting to an adjacent structure or removing the implant. Your options today are the same, splint to the tooth (thumbs down), replace the implant (best choice) or bypass it with a bridge. I strongly recommend against trying to restore as a single unit, it will rotate loose. By the way, I have the original catalog if you need part #s.

Possibility of popping out #13, placing an implant then splinting the two implants together?

Something to consider, Screw retained crown with stress braker between #14-13 Thank you for sharing!

Thanks for more suggestions. I've spoken with the dentist and his first choice is to have the screw retained crown understanding that it will require tightening every so often. Second is a bridge. He just doesn't want to involve the sinus on this one. He's very busy with his practice and doesn't have the "down time". The one comment about physiologic differences between implant integration and PDL is true, though several articles have reported long-term success with teeth splinted to implants. The key is mobility. How mobile is the tooth. I appreciate your sentiment but you are preaching to the choir. It may have helped some who were reading the thread. At the risk appearing to defend a course of treatment that I would not have taken, the original dentist may have found that the neighboring teeth were immobile (which #15 is not even a half degree of mobility by Modified Millers so I presume that between the implant and #15 the splinting effect may have shielded #13 such that it may have had little to no mobility. Still not a treatment I would have planned. In my 24 years of implant therapy, I have never splinted to teeth but would not take someone to court who did so judiciously. In this case, if the teeth were immobile and were going to be prepared anyway why not just do the bridge? However, I'm looking in at this so many years past the "pioneering stage" of implantology in this country. Even in those years I wouldn't have done it, but I'm cutting them some slack. I thought about the keyway and will give it further thought. My concern was the current mobility of #13. Maybe with 15? I'll think about it. Thanks. I considered removal of #13 and placing an implant. However, CBCT shows the apex is up on the palatal side of the sinus leaving only 6 mm of vertical bone which is not very thick. Therefore, if an implant is planned, then sinus grafting is probably going to be necessary. Thanks for all the comments, Geoff