Opening of contacts on Implant crowns: Anyone else seeing these?
I am wondering if other doctors are seeing contacts opening up on implant crowns after about 2 years of loading. I am not seeing a lot, but for some of my patients, the distal or mesial contacts, which were nice at the time of screw-retained crown inserts, subsequently became totally open contacts. I have 3 cases where this has happened. Case 1) Implant was placed in #29 site and pt had #30 and #28 in place and after about 2 years, I noticed contact between #29 and #28 has opened up. Case2) Implant in #13 and #14 site, with #15 in place. Contact opened between #14 and #15 and #15 seems to have drifted distally. Case 3) Implant crown in #3 site, #4 is crowned tooth, now after 2 years, wide open contact between #3 and #4.
I have noticed this about 1 year ago. I started looking for literature, but very sparse for now. No thoughts on remedy, other than remove the crown and add porcelain have been found. Additionally, I haven’t found any literature that can nail down the cause of this happening. I had heard about this issue and noted it on a couple of patients that came to me from other practitioners with similar issues, and I was at a loss to explain. I always ask for a wide, broad contact from my lab. Additionally, I will do slight enameloplasty on mesial or distal tooth/crown in order to get a good path of insertion and have a broad contact before scanning.
I know that some people say that our jaws are growing all the time, etc. However contact opening up on the distal of an implant is my first case.
Also, I have an implant in my own mouth in #31 location with both #30 and #32 present. I had not issue with the crown for about 4 years, then I noticed, while flossing, contact became really light between #31 and #32.
Any ideas/suggestions from more experienced doctors on this site?
16 Comments on Opening of contacts on Implant crowns: Anyone else seeing these?
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Ben
4/11/2019
There is literature that sights the rate of open contacts on posterior single tooth implant restorations as high as 50% at 2 years, so your findings are right on the mark! (I'll look for the citation if I get the chance, read it about 4 or 5 years ago now).
When I've had this happen if it's at the distal of the crown, sometimes I can resolve this with selective grinding (enamelplasty) of the tooth distal to have occlusion that promotes mesial drive of the distal tooth to close the contact. I've been more careful to assess the new occlusal scheme on the teeth around the implant crown at the time of delivery to avoid a distalizing occlusion on a terminal molar (typically upper second molars)
I see open contacts more on the mesial contacts though. I chalk this up to mesial drift of teeth overtime and the lack of movement from implants. When it's a screw retained restoration, I can remove the crown easily and add to the contact (gold or porcelain-- even onto Zr).
If I'm correcting this, I typically discuss with the pt to make some form of retention (retainer or ridgid occlusal guard) to prevent reoccurance.
For new cases, it is part of informed consent. Sorry about typos...sending this from my phone!
John Manuel, DDS
4/11/2019
‘Distal Walking” is my seat of the pants term for the observed tendency of posterior teeth to move, or tip Distally, leaving open contacts. Of course, teeth adjacent to extraction sites tip into the void a bit.
While one might question whether any implant body movement is directly at the bone/implant interface or in the dynamic mass of surrounding bone, my observations concur with yours regarding some contact opening over time.
The natural teeth create contact pressure in youth due to their striving to return over their points of origin, but this activity weakens with age, leaving older people with open contacts (of course wear plays a role also).
The majority of contact weakening/opening have been related to Angled Facets in the occlusion with a slide from initial contact to centric stop, which tends to drive one tooth away from another, or both apart.
By flattening the facets, and even reversing the slide direction, many molars, and some bicuspids, have moved to regain tighter contact.
As such, maybe the problem of opening implant/tooth contacts can be reduced by creating Neutral Centric Stops.
Dr. Gerald Rudick
4/11/2019
It is not fair to seek advice from collegues when no radiographs ( xrays) have been submitted...please repost with xrays and if possible photos as well... we would love to help you.
KPM
4/13/2019
Eleven nice, friendly and supportive comments........and yours.
GEESH.
Marcelo Bercovici
4/11/2019
43% of contacts open. Koori et al. Int J Prosthodont 2010
Dok
4/11/2019
Adjacent natural teeth which are not rigidly fixed to bone have the ability to move in unison as force is applied to them. Rigidly fixed implant teeth that lie adjacent to natural teeth do no move in unison with those teeth so spaces can be created. Next time you are on the street corner, stand against a cemented pole and close your eyes. You will eventually move, the pole will not.........
Gary Greenstein
4/11/2019
it happen 34 to 66% of the time
see reference
Greenstein G, Carpentieri J, Cavallaro J. Open Contacts Adjacent to Dental Implant Restorations: Etiology, Incidence, Consequences and Correction. J Am Dent Assoc. 2016;147(1):28-34
Dr Dale Gerke, BDS, BScDe
4/11/2019
Good observation and discussion.
Perhaps this is yet another reason to use screw retained implant crowns rather than cemented? Makes alteration to a crown much easier - if required or desirable.
Greg Kammeyer, DDS, MS, D
4/11/2019
Note that the typical single or partially edentulous implant case leaves the implants in slight infraocclusion.. This then allows the adjacent teeth to bear the initial pressures of occlusal contact. I have seen less drifting of these proximal teeth (my population is in 70's and 80's) yet I do see a fair number of endo teeth break adjacent to the restored implant. I believe we all are agreeing that it is the occlusion that is the cause.
Dr Ho Ho Ho
4/11/2019
Easy fix with flowable composite if you can retreive the implant crown
Dr Howard Marshall
4/11/2019
I had the same thing happen in my mouth with an implant in 31 position, and a fully erupted 32. The space opened between a pontic 30 and the implant 31. However, I also had an upper 13 crown that was placed with tight contact to 12 and 14 also open up. My training in occlusion indicates that forces from the lower crowns somehow wedged open the marginal ridge zones between the 2nd bicuspid and the adjacent teeth. Unfortunately the only solution I know is to replace the crown on 13 again and recheck the lower buccal cusps against the upper fossae and marginal ridges.
Yossi
4/11/2019
there was a recent JADA article on the subject .
Ed
4/11/2019
Natural teeth will move and implant supported crowns do not. Drifting of teeth distal to an implant supported crown will always have occlusal contacts on mesial surfaces of cusp inclinations that drive the tooth distally. When second molars move distally there is always a cuspal interference on a mesial slope of at least one cusp on that natural tooth. I personally have never observed a mesial proximal contact on an implant supported crown "open" after the implant was restored .
Brian
4/16/2019
They talked about this at a seminar in Chicago just lately. They said it is being seen now for example on lower 1st molars, which were said to be the most replaced tooth in the mouth. It is one more reason to do screw retained implants in such area in spite of some evidence that screw retained have somewhat more occurrence of screw loosening. The point is one needs retrieval potential, to later have lab add to contact when and if necessary.
Brian
4/16/2019
More importantly, it was said at the same seminar (as in my above comment) that there is Bone growth even in adults, and this the reason for contact separation . I thought this to be very important for practitioners to be mindful of , if it proves to be the case over time, as research compiles.
Dr. Moe
4/21/2019
Thank you all for your replies. I have used some of these theories to explain to patients why there is space where there was none when prosthesis was made. One of the other issue being, if Pt had perio disease then obvious reason for contacts "moving". I think missing any other explanation, bone growth seems to apply the best for now. Thanks for your "Distal walking" explanation Dr. Manuel and other things that you pointed out. I will check it on both my existing and new implant patients regarding those types of interference. Those are excellent points, and thank you for extending my knowledge in that.
So, I guess, this discussion posits another question; since Implants are ankylosed, Do ankylosed teeth have similar issues in patients' oral cavity? Do anklyosed teeth stay in place while others move with the remodeled bone, having issues like open contacts etc? I have never looked for these issues, but I guess a patient with ankylosed tooth now becomes something to look forward to in my practice. =)
Thanks again.
