Odor from Dental Implants

Dear Jane, unfortunately it comes to a bad smell if you remove the screws from dental implants. But there is a way to remedy this odor. There is a material in Germany available called Tectusil what seals all internal connections of dental implants. Your doctor can oder it at zl-microdent.de. Good luck, Dr. Best

Dear Jane, This happens when blood is held inside the implant, usually in the surgery, you should have no mayor concern. Dr. Pinto

Dear Jane The odour is the normal result of blood and oral bacteria accumulating inside the screw hole of the implant during the surgical placement or uncovering of the implant, or may result from leakage where abutment parts have loosened. The trapped blood/bacteria deteriorate over time to produce the odour. If your dentist flushes the screw hole of the implant (eg.during the restorative phase)with an antiseptic liquid (chlorhexidine), and prevents further contamination, the odour will not recur. We usually leave the screw hole filled with the antiseptic solution between visits.

Dear Jane, In response to your question regarding an odor or stench when your dentist removes the fixation screws from your implants, I believe it has to do with an inferior design of the implant system. Bacteria start to form between 5-7 microns. If the abutment and implant connection (called the micro gap) are greater than 5-7 microns, you will always have a host bed for bacteria and odor. The Astra Tech Implant System has a connection (micro gap) of less than two microns. I have gotten comments from many of the doctors I have restored Astra Tech with in the past that they never have any odor, blood, or irritation when dealing with their patient's Astra Tech Implants.

You can prevent this by flushing the implant with sterile saline following insertion and applying neosporin to the threads of the sx screw or healing collar...I havent seen anything in the literature that says its a problem...thats what I was taught..and it works for me...I dont get the odor... Bill

Regarding the microgap, I concur. As far as I know, Bicon has the smallest microgap: less that 0.5 microns! They have some good research proving their connection is a bacterial seal.

The odor is from the periodontal pathogens within the micro-gap. These bacteria are .8-1 micron in size. Placing an antibotic in the gap may subject the patient to problems later if the antibotic is used to control a systemic infection. Although the pathogens may cause a local problem with the implant(bone loss), the major problem is the systemic exposure of the pathogens and their toxins. The epitheliun becomes ulcerated and this offers ample opportunity for connective tissue invasion by bacteria and/or their endotoxins, leading to bacteremia and endotoxemia. Bacteremia and endotoxemia have been implicated in a variety of systemic responses, such as altered platelet function and increased intravascular clotting, and synthesis of prostaglandins. The localized inflammatory event of periodontal disease is also implicated in the systemic inflammatory response, leading to the production of acute-phase proteins by the liver, i.e., C-reactive protein, serum amyloid-A, haptoglobin, and fibrinogen. All of these systemic responses, in turn, may have varying degrees of impact on systemic diseases, including cardiovascular disease, ischemic stroke, diabetes, adverse pregnancy outcomes, and possibly dementia and Alzheimer’s disease. Why implant a device that harbors periodontal pathogens within the microgap of the implant.THERE IS A BETTER WAY!!

Bicon does not have a seal, no implant does. The micro-gap should be evaluated after the implant has been in function and not before it is placed into function. The true test of microgap size is after the the implant is place and in function, and then using sound biological principles.

Even with a higher medical degree it's difficult to follow what Don Callan has written above, but ulceration of epithelium is incredibly unlikely to cause a bacteraemia and 'endotoxaemia'. The rest of what he describes as a consequence of dental implant use is just pure unscientific extrapolation, exaggeration and nonsense!

Please look this up on PubMed or IJOMI, and tell me what you think:In vitro evaluation of the implant-abutment bacterial seal: the locking taper system. Dibart S, Warbington M, Su MF, Skobe Z. Department of Periodontology and Oral Biology, Boston University School of Dental Medicine, Boston, MA 02118, USA. [email protected] PURPOSE: To test in vitro whether the seal provided by the locking taper used in the implant-abutment connection was capable of preventing the invasion of oral microorganisms. MATERIALS AND METHODS: Twenty-five wide-body implants (5 x 11 mm) and 25 abutments were divided into 2 groups for a 2-phase experiment. The first phase tested the ability of the seal to shield the implant well from outside bacteria; the second phase tested the ability of the seal to prevent bacteria present in the implant well from seeping out. For phase 1, 10 implant-abutment units were immersed in a bacterial broth for 24 hours. The abutments were then separated from the implants and bacterial presence was evaluated using scanning electron microscopy. In phase 2, the tested abutments were inoculated with a droplet of soft agar bacterial gel and assembled with the implant. These units were incubated in a sterile nutrient broth for 72 hours, sampled, and plated to assess bacterial presence. RESULTS: In phase 1, no bacteria were detected in any of the implant wells. In phase 2, no bacteria were detected in the nutrient broth or on the agar plates at 72 hours. DISCUSSION: In implants where a microgap is present, microbial leakage could lead to inflammation and bone loss; thus, it is important to minimize bacterial presence in and around the the implant-abutment junction. CONCLUSION: The seal provided by the locking taper design has been demonstrated to be hermetic with regard to bacterial invasion in vitro.

MS, Sorry for your reaction to my posting but, the lit is very clear on this subject. You relly need to read the latest information from the medical sources. Note: You should refrain from ad hominem attacks, and comments. Thank You for your understanding.

What Don Callan has said just flies in the face of basic biology, let alone pathology. The next thing we'll hear is that patients will pick up radio Moscow via their implants! There is no quality research to back up his statements, just anecdotes and pseudo-scientific studies.

The DENTSPLY ANKYLOS Implant with a Morse Taper connection has the smallest microgap of any Implant, smaller then the size of bacteria. It is known for the "abutments with no odor". This connection helps eliminate micro movement and the microgap between the Implant and abutment. In doing so there is no bone loss and the bone is able to grow over the connection giving you long term success. PT

Art, First, Russia is too far away to get radio Moscow . Again ,sorry for you not wanting to have an open mind. The implant seal may be present in vitro. The junction should be evaluated in function and in humans. Please see the following publications. Callan, DP. Dental Implants and Coronal Bone Loss. An Evaluation of 350 Implants/202 Patients - Dentistry Today, 1997.28. Callan DP, O’Mahony, A and Cobb, CM. Loss of Crestal Bone Around Dental Implants: A Retrospective Study. Implant Dent, 7:258-266, 1998. Callan, DP. Maintaining Cosmetics and Marginal Bone with a Dental Implant. Implant Dent 2000; 9:154-161. Callan, DP. Cosmetic Implant Dentistry. Dental Economics. P40-43. May 2002. Callan, DP. Eliminating Microgaps: Dental Implantology Update 2002. Vol.13 (11): 81-86. Callan, DP, Cobb, CM and Williams KB. DNA Probe Identification of Bacteria Colonizing Internal Surfaces of the Implant-Abutment Interface: A Preliminary Study; J Periodontol, Jan. 2005. Callan, DP. Superior Esthetics Without Micro-leakage of Bacteria and Bone Loss. Implant News & Views, May/June 2006, Vol. 8 No. 3 (6-11). Callan, DP. Achieving Optimal Esthetics Results with Dental Implants. Contemporary Esthetics October, 2006, Vol 10 No.10 (24-31) THANK YOU

Actually the Bicon implant-abutment connection has the smallest microgap of any implant, and some would say that the microgap is so small as to be non-existent. Dr. Callan, does any of your research address the Bicon implant system and the claimed (and seemingly proved) elimination of the microgap? Thank you.

MS Yes it does. The implant seal may be present in vitro but, junction should be evaluated in function and in humans. Bicon did show a gap after being in function.

Mr Callan, was there ANY implant on the market that did NOT show the gap in all of your studies?

Dear Jane, I represent the Bicon Dental Implant System. I believe that Dr. Callan is not aware of a study published in the International Journal of Oral and and Maxillofacial Implants in 2005. The study was performed by a periodontist at Boston University School of Dental Medicine and instructors at The Forsyth Institute in Boston. The reference is seen below. The study showed that the smallest bacterium known in dentistry was unable to penetrate the implant-abutment interface of the Bicon Dental Implant System. This particular study supported earlier work done in 1996 by professors at Tufts University School of Dental Medicine and Suffolk University. The FDA also has granted Bicon the right to promote the implant-abutment interface of Bicon as a "sealed connection". At this point in time, Bicon is the only system known to have this right. Moreover, experienced Bicon clinicians will tell you that after the removal of a Bicon abutment post from a Bicon Implant, one does not have the odor associated with screw type systems. I hope that this information is helpful. Sincerely, Craig Bicon REFERENCE ON THE SEAL OF THE LOCKING TAPER SYSTEM Dibart, S., Warbington, M., Su, M.F., Skobe, Z, In-Vitro Evaluation of the Implant-Abutment Bacterial Seal: The Locking Taper System, The International Journal of Oral & Maxillofacial Implants, Vol. 20, No. 5, p. 732-737, September 2005.

CM: I looked in PubMed at the study that you posted and it was an in vitro study. However, Dr. Callan posted a little above your post that he has noticed the bacterial issue even with the BICON system when he has done in vivo studies. Are you aware of Dr Callan's in vivo studies on your Bicon system? Dr. Callan: could you please confirm that you found bacteria issues around the microgap in the BICON system in your studies. You seem to be saying that above, but given CM's post, I am a little unclear what is really going on with the BICON system in regards to bacterial issues around the microgap.

Bicon says they do have a "small" microgap therfore, there will be micromovement of the abutment/implant junction and bacterial involment. Oral bacteria are .8-1 micron in size and the microgap after being in function is 10-15 microns in size and are now open to the periodontal pathogens. Today's studies show it is the inflammation that is the problem associated with systemic concerns. DPC

Wait a second! From the research I've read, Bicon's microgap is less than 0.5 microns. That's what the published resaerch that I've read states. Dr. Callan: Where is the research that states that Bicon's microgap is 10-15 microns in size after being in function? That's something I've yet to hear. I could not find any of your research regarding Bicon's connection. Is it posted on your "perioseal.com" website? If so, please post the URL. Thanks in advance.

So Bicon has a microgap that seems to get worse under load [in vivo] according to some here, and from what I have read on other places on this site, the Astra and the Ankylos implant systems also have a microgap bacterial issue too. Does any implant maker claim that their implant is microgap free? And better yet, has this proven to be true in vivo?

Has Bicon done any IN VIVO [not in vitro] research to really prove that their microgap is really less than 0.5 microns?

The only person I know of that is saying that Bicon has a microgap issue is Dr. Callan, whom I believe is offering a competing implant system called Perioseal.

Does the PerioSeal really solve the microgap bacterial issue? Anyone?

Dear JN.: is this a screw retained reposition? If it is, the smell is coming from the material you used to cover the screw, before inserting the crown. Remove it and use a non organic pellet.If it is a cemented restoration, x-ray the joint.You may have a problem there.

I do belive that we are walking far from the problem of the patient. I also think that this is getting personal , but we all know from regular crow and bridge if we have an open margin we will have filtration of bacteria , I belive that this issue have something to do with the micro gap of the system used in the patient particular case. Cast UCLA ( even in gold ) have an open margin, the gold standard is to test a prefabricated titanium component , we all know that this has also someting to do with the screw loosening and torque of the screw. Second we also know if we have a conical conection ( Morse Taper ) of the any above mentioned systems we have a better seal of the implant abutment junction , and will depend where the gap is located at bone level , supracrestal or infracrestal, also we know that there is a bone remodeling phenomenon called saucerisation where there is a 1.5 to 2 mm "bone loss " that occure in almost all of the systems , even with the Astra , Bicon and Ankylos , but with this system is less than with a but joint system. The issue of the odor could be related to any of the above mentioned reasosns , to the patient I sugest to go with you dentist and ask him to solve the problem sealing the entrance of the implant and to properly torque the retaining screw. To all of the respected colleagues I think this is not the place to flame anybody and not to have a comertial bias saying that this or other implant system does not work or mine is best, all of them are in the market with FDA , CE , And ISO seals , so they have pass a quallity test, we have to look at the literature and try to healp each other to solve problems , at least this is my humble opinion and sorry if I misjudge someone Best Regards and hope the patient solve her problem.

The question of microleakage and the micro-gap at the abutment/implant junction has been highlighted by companies promoting dental implant systems like Ankylos that have been developed specifically for placement at or below bone level. This should have no bearing on one stage implants such as Swiss-Plus!!!

What are the main drawbacks for a 1 stage implant? Are they just as successful as 2 stage ones in the molar areas, given the high stress rate there?

if any colleague is working with maxi osteocare non-surgical implants for the region of upper posterior please come to chat about our experiences.

As far as the drawbacks of the single stage implant... They are limited on the restorative aspect.. One piece implants are great solutions to certain situations...It should not be looked at as the best option for all "molar areas"

I use ankylos & i dont get any odour when and if I have to remove the abutments.I cant say the same for zimmer or 3i.I feel that all morse tapered connection will have this advantage

Has anyone read the " In Vitro Evaluation of the Implant Abutment Connection Sealing Capability of Different Implant Systems" from Tufts Dental School? I heard that Ankylos was part of the trial and backed out when the results showed that their results were the worst.

This article was published by our research group in the Journal of Oral Rehabilitation in 2008. There were four implant systems tested: Ankylos, Strauman, Replace Select and Intra-Lock International. When the microleakage study was completed, the Ankylos values were so high that one of the authors requested that the implant system be removed from the study. When Ankylos in Germany was questioned, they stated that they were aware of other studies with the same results. With regard to the remaining three implants, the Replace Select had the highest microleakage, followed by Strauman. To our surprise, the Intra-Lock system had dramatically lower microleakage. This is the result of the ferrule design on the abutment with both an inside and outside retention design. Lowering micromotion of the abutment on the implant body can have significant effects on peri-implant tissue. We are planning another study comparing this abutment design against other systems. RJM

This thread is unfortunate, particularly Dr. Miller's anecdotal references (which I shall address and counter)as frankly, the mis and disinformation through the 34 postings in addition to the dismissive tone of some is disheartening in a profession forum that is read by so many. I'm far from being an expert, but I as an endodontist who realized early on that, that implants and endodontics are in truth a discipline that for all intents and purposes must be seen as foundational dentistry in a new construct and nexus format. Tectusil is a silicone based material, that will wash away as will Polysporin et al..think O rings and their "effectiveness"...the problem with any geometrical fit is "rotational slop"...all hexes can be overtorqued and thus the intimacy of fit or lack thereof will lead to gapping, lobes or no lobes as the microphlange simply will not exert sufficient frictional fit to resist torque stress during function. I refer you to the papers on the Mechanics of the taper integrated screwed-in abutments in dental implants, TIS, by Bozkaya and Muftu - in Journal of Biomechanics February 5th, 2004 and the one on Efficiency considerations for the purely tapered interference fit TIF abutments used in dental implants...same authors, October 2003 - you can find these articles in tdsonline - under the implant section - articles under DESIGN. I believe in both cases, the design parameters of friction fit are demonstrated to be far superior in terms of mathematical modelling which is the essence of engineering design. While Bicon demonstrates a reasonable design concept, the design of the fixture body does not allow for sufficient osseous presence at the collar/platform area. Bone supports tissue and creates biologic width, in the natural site and in the biomimetic site. Astra Tech is a double conical hex and is a most difficult fixture to restore as you are trying to dial in 12 geometrical steps not six.......without a jig, impossible to tell if you are at 11 or 1...The conical shape is far too cyclindrical to truly represent a native bio-emergent profile. All internal hex implants micro-gap and micro-pump.....that is a harsh reality.......suggest to an engineer that you wish to connect two structures that will be subject to high stress and torque during function and there isn't a snow balls chance in hell he or she would advocate anything but a friction fit, a TRUE MORSE TAPER - no the one used by Straumann....the only morse taper design using a screw to ensure "cold welding of the abutment and fixture" is ANKYLOS. New to N. America, it's been around since 1987 and the long term studies showing bone retention around the collar decimate the generally accepted view that you can live with .5 to 1mm of saucerization in the first year and .1 over the course of the next ten.....reasonable in full reconstruction cases, but potentionally disastrous in single tooth replacement which is pushing 50/50 in terms of implant usage for rehabilitative dentistry. As to the leakage studies discussed, I refer you to Dr. Lundgren's in J Periodontol Dec 2009 and I strongly suggest that you GOOGLE using scholar.google.com and input the keywords bacterial leakage dental implant abutment interface - endodontic leakage studies have long considered "IN VITRO" as soft and irrelevant science.......suffice it to say, that a properly designed interface leakage study would either use 3D computer modelling or would at the very least match up the systems side by side and subject them to 50, 100, 200 Ncm force consistent with the oral ecosystem and then determine leakage per se. Dr. Miller's comment re; ANKYLOS and Tuft's is somewhat libelous in my opinion....Coelho and Sudack et al did not subject the test units to functional stresses....again, in vitro and irrelevant. The "smell" is no different that a transitional with cement washout or one that has been in place far too long and has sorbed saliva and microflora....nor is the absence of smell a defining parameter. The key to this entire discussion is that ANKYLOS built in platform switching from its inception 25 years ago, can demonstrate crestal bone retention which by default suggests an absence of microgapping and the resultant inflammatory contaminant and it's impact on the biologic width and the resultant emergence profile is consistent with "an ovate pontic"....it's restorative components are nowhere near as complicated as UCLA customized et al as the friction fit directs forces along the long axis of the fixture and not into the cervical bone. If you really want to see the impact of microgaps, I suggest Dr. Miller lead an investigation into computer modelling and/or photo-elastic stress testing fixture abutment interfacing and then determine whether in vitro testing is a valid parameter of anything. Read the literature, ANKYLOS is new.....the design is far more desirable than most, it will improve with time as it has now entered the N. American market - C/X just launched.......the bottom line is the science on hexes and gaps and platform switching is getting dated, the existing systems need to redesign, not add laser etching or encourage intermixing of parts.........without a ferrule, you can't retain a crown and biologic width is paramount.....without retained crestal bone, you can't retain tissue in an aesthetic position.......think biologic width....as to leakage...focus on what doesn't gap under function....and the only structure that won't do that is a friction fit......... Thanks for your attention.

Dr. Serota, Good points made about the platform designs. I too think Bicon is an excellent implant. However, I have had issues with single Bicon Implants in the anterior (abutments become lose with function).

I have 1 year BIO-Horizon 6 top mouth Inplants /removeble denture/ every time when I du cleaning /7x or more time d./ with wotter-pic I feel that come from the inpl. terrible smell, I du cleanink with "Closys" eaven I dont eat and du again the cleanink after 1 houer still come from the membrane the bad smell. I tolk with dentist and he sad it is normal ,it is from saliva. I dont belived! Please could you help me with some advise ? Thank you Vlasta Snider from AZ Sun City

I read all your comments, it seems to be confusing and distractive to me. The question now is: does an invitro study to evaluate microgap and microleakage at abutment /implant interface is reliable OR invivo studies after being in function is mandatory for a reliable and true results?

screwd connections and morse ones have usually 40-50nm tolerance. bacteria are less than 5nm. no screwd connection can be bacteria free, rather they r a bacterial tank. there's a solution: cemented connections. there's an article on "journal of periodontal" about an experiment at chieti university. They dipped "ankylos" (conical-morse), "branemark" (screwd connection), and "bone system" (cemented abutment and frictioned collar) in a liquid solution with bacterias. only bonesystem implants had no bacteria contamination, whilst all the other ones shows bacterial leakage. Bicon says to respect 5nm tolerance: it's impossible to respect this tolerance with current machines. the real world shows tha no screwd connection can be less than 30nm: ask for a cemented implant and no bacteria, no unscrewd problems, no bad breath

1.5 months(Jan 2018) ago had a 10 year old non-capped implant removed at the right upper eyetooth and was replaced with one that will accept over-dentures(dentures will clip on to it) and same type implant installed at left upper eye tooth. Also the tooth next to the right eyetooth(closer to front center) was pulled- it had previous been impacted but not currently infected and all other upper teeth were pulled years ago. PROBLEM: smell a strong dental compound (have smelled similar odor tothis many times in past 60 years during dental work- has a slight burn smell and slight menthol like odor. though that has decreased quite a bit)every breath since that day implant was installed. Smell is a bit nauseous at times and I worry that this is dangerous and that dentist should do something but he seems un-concerned. Having work done thru Medicare so in couple more months, Dr. will pull 4 remaining bottom teeth, install two implants and says at end of summer can get dentures.