tissue regeneration over implant?

[mike716]

Hi, fellow medhelpers. I've got a thorny dental problem I need some urgent help with.

If for some reason a crown can't be placed immediately over an implant, will the tissue that was removed from around the head of the implant while preparing it for the crown grow back to protect the implant?

This may sound like a strange question, but I'm in a dangerous situation. I go to a dental clinic, and the dentist who put in the implant, and with whom I had a good understanding, has been replaced by another with whom I have a very bad relationship. Basically, the new dentist does not understand that the crown must not touch the opposing molar because I am a heavy bruxer (grinder) and have already lost one implant in the same position after two years of painful infection in my jaw. And she won't talk to me or even look at the x-ray history.

Only after this new dentist took impressions and had the crown made did I find out that she intends to include it in my occlusion, just as if I didn't grind my teeth, which will end up causing the same awful result as previously. I want to suspend the procedure but I'm worried about the safety of the implant, which has already been prepared for the crown by having the gum cut away around it..

I hope someone here can help me. Just to know that the gum will grow back around the head of the implant will relieve me of a lot of anxiety.

Thanks.

Mike

[mike716]

The previous implant became loose and the bone infected, but the crown never became loose from the implant.  So, while your theory may make sense, in my case it did not work out that way in practice.

By the way, are you a dentist? An implantologist?

Thanks.

Mike

[scottma]

If your bruxism can not be controlled , implant crown may be cemented with temporary cement . If excessive occlusal load exerting on implant prosthesis, the weakest interface of implant system will be broken down, which is the interface between crown and implant abutment, crown tends to be loosened and may fall out. In that case, you will not jeopardize implant. The worst scenario is you need to re cementation of crown. However, meticulous adjustment of occlusion is required to prevent future crown loose. Without occlusal overloading, crown will not fall out.

[mike716]

I've been to a couple of TMJ specialists but they wanted me to wear appliances  that were much thicker than my usual night guard and that posed immediate threats to my implants.

I believe that bruxism can be decreased or even cured, but not after the bruxer has had his mouth filled with implants, as I have. I also have very bad occlusion, and it has been suggested that I have all teeth and implants removed and then full implant-supported bridges put in, maybe a nice idea but incredibly expensive.

I take an ansiolytic now for sleeping, and this has reduced bruxing somewhat. I believe that with a good night guard and correctl-made implant crowns (that barely touch opposing teeth) I can make it through the twenty years remaining to me.

Mike

[scottma]

Well made occlusal appliance may cure bruxism. Seeing a tmj specialist is advised.

[mike716]

Thank you very much. I feel relieved.

You know, there really ought to be a dental specialization for bruxer/grinders. The problems we have, especially regarding implants, are special and quite different from those of non-bruxers. It's very hard to find a dentist who really understands and has experience with the occlusal problems and the consequences of bad occlusion to the implants. I have lost six implants due to my bruxing, and I believe that all could have been avoided if sufficient care had been taken. For example, many dentists think that use of the night guard solves all problems. Not so. It protects the horizontal surface of the teeth and crowns from wear, but the forces of the jaw are still transmitted between upper and lower bite. Also, the night guards themselves require almost as much care in their construction as the teeth.

Anyway, thanks again for your kind help.

Cheers.

Michael

[scottma]

Implant without crown is never a problem. Instead, most complications occur after crown restoration.

[mike716]

Hi! Thanks for replying.

I forgot to say that this implant is a monoblock type: the abutment is part of the implant.

I figured that, with soft tissue cut away around the top of the implant (the bottom of the abutment), bacteria could seep down into the bone around the implant. Is that wrong?

I believe the implant is well integrated, but I know no way of being absolutely certain. X-rays taken last year about eight months after the implant was screwed in look good, and if I tap on the abutment with a probe it sounds solid.

So do you think I can go for a while without a crown on it?

Thanks again for your help.

Mike

[scottma]

If abutment is connected already, soft tissue will not grow back. If there is low closure screw, soft tissue may grow and cover up closure screw. However, no problem for prosthetic rehabilitation in the future al all. As long as the fixture is osseointegrated, no need to worry what the restorative dentist is doing.