[Prosthetics]  Ailing implant with suppuration

The #46 NobelActive implant was placed in 2009 by another dentist. When I saw the patient, there was suppuration coming from the gingival margin. PA shows bone loss to the 2nd thread in some areas. There is also open contact on both mesial and distal areas with food impaction. The crown was cement retain and there is evidence of excess cement at the implant level from the PA


The treatment plan is to remove the implant crown, clean out the cement, place a healing abutment for 4 weeks and then remake a new crown to close the interproximal contacts and to improve the emergence profile on the mesial to minimize collection of plaque and food debris. 


So the patient came in today to proceed with treatment. I was successful in locating the screw channel and removed the screw but I could not remove the implant crown. It wouldn't even budge. No amount of finger force would budge the crown. Unfortunately, i do not have any padded forceps so all I had was my fingers.


Can anyone suggest a good way to remove the crown? could there be anything else holding crown down?



by Mike Zhou at Fri, Mar 11, 2016 1:31 AM

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Mike Zhou Replied at Wed, Mar 30, 2016 4:14 AM

Thank you everyone for your suggestions. I brought the patient back and used the crown removal tool suggested by Ho-Young and it worked like a charm! After two tugs and the implant crown dislodged. Interestingly it was a plastic abutment althought the crown is porcelain. As visualized on the PA, there was retained cement. It was removed and a 6x5mm being abutment was placed. I will take impressions to make a new crown in 4 weeks. Thanks for everyone's help!

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Ho-Young Chung Replied at Mon, Mar 14, 2016 2:40 AM

Glenn, You are right. I got myself confused with cemented crowns. Crowns cemented with resin cements are sometimes hard to remove with padded crown removers even with powder. Ho-Young

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Ho-Young Chung Replied at Mon, Mar 14, 2016 2:19 AM

You can use gauze but if forceps slips you will scratch the crown guaranteed. Ask me how I know

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Glenn van As Replied at Sun, Mar 13, 2016 1:59 AM

Borrow a CoronaFlex from Kavo and get at the lingual margin if you can, it will pop straight up. Its like a mini jackhammer. Ho-Young the key with the forceps with yellow pads is to have the crown dry and to grab it below the center of the bulge of the tooth. They work great with the powder in my hands. PS You can put gauze on the tooth and grab at it when its dry as well..... Glenn

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Ho-Young Chung Replied at Fri, Mar 11, 2016 3:02 AM

Hi there, If the screw came off completely, then this is a case of cold welding. You could either try using a crown and bridge remover (has a hook and an end that you tap) sold by Sinclair or Surgical Smart has an electric one that is less "invsasive" for patient that attaches to an electric motor. You could also try a padded crown remover but I find that they slip easily even if you use their recommended powder. I have had several cases like this and took a lot of pulling before the crown or abutment came off. Ho-Young Chung