Open proximal contacts after implant: causes?
I delivered a crown on an implant between natural teeth. At the time of delivery it had tight proximal contacts with the natural teeth, but now the proximal contacts are open. What could be causing this? What do you recommend I do? Periodontal health of implants and natural teeth was good.
17 Comments on Open proximal contacts after implant: causes?
New comments are currently closed for this post.
Merlin Ohmer, DDS, MAGD
6/26/2017
It happens. Natural teeth move. Implants don't, or at least they shouldn't.
Mark Simpson
6/26/2017
It happens. One reason is often the patient has gone some period of time without that tooth then the contacts on the adjacent teeth change as the adjacent teeth move . You try the implant crown in and the contacts are tight . Then ,due to the tight contacts with the implant crown the adjacent teeth move back. Try cementing the crown with temporary cement then check the contacts in 2 weeks. Often the contacts will have changed and you may need to add a contact.
Dr. Elnadi
6/26/2017
It also happens when you have rough porcelain in the contact area which is very appraise it wears down the natural teeth and you will endure with open contact. Or the crown was not seated all the way when you checked the contact. It happens.
THOMAS PAVELKA
6/26/2017
Only time I had the problem you are describing is when the implant crown was loosening...
Montana
6/26/2017
Happens frequently, recent studies suggest about 52% of mesial contacts open; mesial drift (and perhaps cranial growth).
Try to restore as screw-retained to allow correction by addition to the tooth or implant crown. If the problem repeats, consider opening the contact to allow debris to evacuate as caries risk goes up if entrapment occurs..
Spence Bloom
6/26/2017
JADA Jan 2016, p28-34
"Open contacts adjacent to dental implant restorations"
... Mentions that it is a common enough occurrence that it should be included in the informed consent... It can lead to need for repair or replacement of implant crowns or rehab of adjacent teeth. Continuity of the arch should be checked periodically and open contacts monitored for signs or symptoms of pathosis so prosthetic repair of the gap can get be initiated, if needed.
Dr. D
6/26/2017
Montana is right; there is a mesial drift of teeth. Implants don't drift they have no PDL. Teeth wear becoming narrower mesiodistally, and crowd up because of the orbicularis orus flexing 2,000 times per day. The teeth move to fill the space created.
Eric B Fisher DDS
6/26/2017
So everyone has the experience of implants being ankylosis and teeth move Very basic knowledge of a complication of especially single implant placements Soas well stated inform your patient if the very real possibility and advise them with all restorations maintenance and follow up procedures may and most of the time will be necessary for the reasons stated Now we are not stuck with a bill redoing a crown, apologizing for an unsuccessful result but instead we have prepared our patients with information that allows us to continue to treat them effectively, charge for our services with patient acceptance
Dr. Larkin
6/26/2017
Bruxing. Secondly, mild ortho movement do to non passive crown insertion. More passive is screwmentable.
Keith
6/26/2017
If its a screw retained implant crown, drill the composite filling out, unscrew it & sent it to the lab & have a prox cantact added
LCM
6/26/2017
Adding prox contacts to porcelain after being in moist environment is easier said then done.
If cemented, may degrade that bond. If lab don't know what they are doing, will become worse problem than when started. Easier to just etch and bond with flowable to adjacent tooth if natural tooth. Just my 2 cents LCM
Josh Perlman
6/26/2017
Did you check contacts with crown/abutment fully torqued? If not then things can change when it is seated more apically!
Dr Bob
6/27/2017
How were the contacts in the rest of that quadrant before cementing this crown? If the other contacts were not tight the tight contacts on the implant crown would act as an orthodontic application of force to move the adjacent teeth toward the loose spaces. Even if the implant crown is removed and adjusted to make tight contacts this problem may recur if the other contacts remain loose. A missing tooth in the quadrant might also provide for space for tooth movement.
TK
6/27/2017
let make my question more clear, contact between the rest of the teeth are good, after a years there is no significant contact wear, I wonder the contact still open around 0.25mm as the perio conditions are good, sometimes even happen between implant supported crown.
Dr. Gerald Rudick
6/27/2017
This happens very frequently......all the replies above are correct...... this is something that is unpredictable...... this is the reason that implant crowns must always be retrievable, whether they are cemented or screw retained
Marc Lipkin
6/29/2017
Glad to see that others experience this issue also. It happens more that I care to discuss. I think that natural wear and bracing play a great roll. I make sure my crowns fit the teeth and implant fixtures well and make sure the contacts are light beteeen a natural tooth and an implant. The implant crown and tooth born crown are always cemented with a retrievable cement like temrex do if this happens I can tap the tooth out and add the contact in my office as I gave a glazing oven. If done right this rarely damages the porcelain. I have done this to crowns more that once! Again, not sure why it happens but I NEVER cement two crowns next to each other without one being a retrievable cement.
OsseoNews
6/30/2017
Editors Note: Readers may find this article from Implant News and Views from Gerald Rudick DDS interesting, as it pertains to the problem. The article was can be downloaded here (PDF file). It starts on Page 6-8 of the PDF.
