Zimmer 4.7 in Posterior: is this normal?

it would appear that the bone level has either been lost or the implant might not have been placed deep enough from the get go. i have seen this often when doctors use a punch approach versus a traditional flap. i don't think the size of the implant is a factor. the "space" between the implant and abutment I feel is not a factor and would credit it more to a slight defect in the cone angle of the xray.

At TSV 4,7 with 4,5 platform is great implant for molars restorations. on x-ray implant abutment interface always looks like you described. Everythink is ok. good luck.

I agree with Dr. Pituch. No worries. This is common and of no clinical consequence.

Thank you a lot dear colleagues for your comments, calmed me down. Regards

I'm curious why using a punch would produce this defect. Does anyone have insight into this occurrence

The implant appears to be installed to the correct depth. The bone loss is a circumferential defect which should be debrided and grafted with particulate bone and closed with a membrane covering the implant. Good luck

sometimes a junction can look slightly "off" due to thinner metal in the conical connection area. Since this area is superimposed over other thicker parts and connections, it doesn't look "wide open" but it IS different. Our gut reaction is to think something is wrong, but it is possible/likely that all is well. That may be the case here.

I would agree with the prior comments it appears that there was some bone loss after placement which should be addressed as it will only worsen over time. With regards the impression head it may be the angulation of the sensor in relation to the long axis of the implant so that there is some overlap and that appear to be a radiolucent fine line, if the bone were higher i would say the bone may be hampering seating of the head but in this case thats not it unless you trapped some soft tissue between the implant and part. with regards the cast final crown it appears that the plateform of the crown was not finished with a reamer after casting to ensure that the horizontal surface was smooth and no microbleps present. if you blow up the image you can see its contacting on the outer edge which is preventing full seating. Did the lab use a gold UCLA or a Plastic one to make the pattern and cast?

The UCLA (cast to gold abutment was used in that cases).

I apologize for the initials stating my fellow status in the ICOI. M Iphone 6 has made an embarrassing self correction

I have extensive experience with the TSV implants and find them to be outstanding in most cases. This site does exhibit 3-4mm of bone loss and ideally should have been addressed before restoration. Why do we see early, pre-restoration crestal bone loss around implants? Most commonly the crestal bone was not of ideal contour or density to begin with. (Never trust grafted crestal bone that is granular in nature to remain after implant placement.) There can be inflammatory disease even when the area appears to be healthy when the implant is placed. I have seen this when healing abutments are below the tissue height and cleaning is difficult. Also in cases that were the wound was closed primarily and then dehisced over a deep cover screw where a healing abutment was not immediately placed. As for the abutment not being seated, I would agree that it could be a problem with the casting not being properly cleaned. If it is not a Zimmer part, that could be the cause. **Only use factory parts when restoring any implant no matter what the lab or the clone part maker says. Many times the clone TSV parts are subtly different to avoid patent infringement and therefore may not fully engage with the friction component of the interface. I have also seen several TSV implants where the outer tapered portion fractured and seeing this abutment not fully seated on the flat portion of the platform may predispose it to premature failure. By the way, if you see a gap on a radiograph, it is really there. If you don’t see a gap, it may still be there. What to do now is the question. I would recommend removing the crown and attempting to graft to restore the crestal bone. This is very technique sensitive and less than predictable even in the hands of experienced specialists. Check with the lab and demand they include invoices with each implant case showing that factory parts were used including the lot numbers. At least you can get the implant and prosthetic parts replaced when failure occurs. Use your team of specialists to handle cases that are anything but ideal so you have high success rates with the cases you attempt yourself. The plaintiffs bar is looking at implant failure as their next cash cow so plan for success. Regards

Phantom gap in impression xray? As long as the sides of image shows no gap between impression coping and implant , then the "long football shaped" image is probably a phantom gap.