[Surgery]  Implant Question

I need your help please

it is a fairly straight forward case. I did CAS kit to lift up the sinus and placed 4.5x10 implant on 16. After 3 months, I restored it. patient started having discomfort in the area after the crown delivery. It sounds like gum inflammation around the implant. especially distal of the crown.
Probing is within normal range ISQ torque  everything is WNR. it was a screw retained crown     Due to discomfort I removed the crown and the pain went away on the same day. Currently  I placed healing abutment.

My thought is that I used small healing abutment 4x4 I believe for 16 because emergence profile is not good the gum is irritated. (I usually use 6 mm healing abutment for molar but that was bad mistake for using 4x4 healing abutment)  That's the only guess I have.

Attached gingivitis is not too bad ~ about 2mm. only other thought is failed implant for some reason. I see a radioluecency on the distal aspect of the implant but I think that is an artifact as it has been there from the beginning. I am really puzzled and confused. Do you have any thought or suggestions?  If I change the healing abutment size to 6x5, do you think it will help?? 

Once again thanks for your help


Ray Han

by Admin BITES at Thu, Jul 16, 2015 10:39 PM

1135 Views | 3 Replies

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Mark Kwon Replied at Sun, Jul 26, 2015 7:36 AM

Possible reason: Pressure around sub-gingival area by abutment - sometimes this happens due to encroaching the "biologic width" ; you can assess this by placing wider diameter Healing abutment such as 6x5mm . If pt still experience similar pain then we know that the pain is due to the pressure. If thats the case surgically carving out coronal surrounding bone especially the mesial wall will eliminate this. Another thing you should also check is interproximal contact. Heavy interprox contact of the crown can also cause painful sensation. I dont think the implant is failing by looking at the xrays. - mark

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Glenn van As Replied at Fri, Jul 17, 2015 3:24 AM me it looks like the crown might be not all the way in .... 1. Are you sure that your impression post was all the way down or could you have not seated the impression post all the way 2. Could tissue or even bone be stuck in there....this can be a problem ...high mag often shows that you are resting on bone or soft tissue...and its on the shoulder of the implant. 3. Ho-Young has a good idea...put in a larger Healing abutment and see if that helps get the tissue out. I always try to put at least a 5 mm in for a molar ( diameter) and if possible a 6 mm to get a better emergence profile. Good luck and let us know how it works out. Glenn

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Ho-Young Chung Replied at Fri, Jul 17, 2015 1:42 AM

Hi Ray, There's a chance that the prosthetic screw might have come loose and this lead to pain. I would also check the occlusion as it is free-end. I would use a 6 by 5 HA for a couple weeks prior to putting crown back on. Might need to anaesthetize patient or use good topical. Ho-Young