Holey Moley?

 IRM in the First bicuspid implant crown
Pardon my tittle, but this is a post about what we dentists stick inside the screw holes in implant restorations. Not a great deal of thought has gone into this subject by dentists. Most just shove some cotton  or teflon tape over the screw and seal the hole with composite. Unfortunately this allows space for anaerobic bacteria to multiply in and this bacterial stew can  pump out of the base of the implant restoration when the implant is in function. Possibly this may play a role in the subsequent development of peri implantitis. At the very least its gross to think about.

I have been restoring implants for over twenty years and although most are successful, some do better than others at least as far as the amount of bone loss that occurs adjacent to the implant. This observation got me thinking about what I could do on my end to possibly help increase the odds of implant restorations succeeding.

Several years ago I was fortunate enough to have dinner with Fredrik Engman who was a senior product engineer fro Noble Biocare before helping to develop the Neos implant system. He pointed out the importance of using genuine manufacturer parts when restoring implants since these parts fit better and manufacturer screws may provide a more firm attachment with less micro movement. Micro movement of implant restorations are thought to contribute to the pumping of bacteria out of the base of implant restorations. In particular the Nobel Screws are specially coated to allow a more firm attachment. 

After this dinner, I bit the bullet and stopped sending my implant impressions to Atlantis to fabricate my cad cam abutments and started using systems that were manufacturer approved and made to their exact specifications. I figured it couldn't hurt and possibly might actually might help improve implant longevity.

Another change was that I started placing a small amount of teflon tape over the screw head  instead of a cotton pledget since teflon tape is not moisture absorbent and may not promote future bacteria growth. On top of the tape I placed some IRM, which is a potent anti microbial cement . I reasoned that this step should keep the area around my implant screw relatively bacteria free or at least not promote bacterial growth. 

I realize that there is little research evidence to back up my newer clinical protocols, but I thought it couldn't hurt and may help. It is a little inconvenient using the IRM, because I usually do not place my composite immediately over the setting IRM. Instead I wait for a subsequent visit to place an occlusal composite on  screw retained crowns. 

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2019/11/holey-moley.html - http://lspindelnycdds.blogspot.com/

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