Poorly aligned implant?

Poorly angled implant in too small an edentulous space

Sometimes a patient shows up for the restoration of their implant and everything is easy. The implant is placed just where I would hope it could go and the the stars seem aligned for me to fabricate a screw retained implant restoration... sometimes not so much.

For a lab to fabricate a screw retained implant the implant must be placed so that the eventual screw hole will exit through the occlusal the implant crown. It can't end up coming from the mesial, buccal or lingual. Now some implants allow the fabrication of angled screw channels that can facilitate using implants that are up to 30 degrees from ideal alignment. Still some implants can not be restored as a screw on implant crown, but instead are best restored using a custom angled abutment and a crown that is cemented onto this abutment.

Dentists contemplating restoring implants also must be aware of the proximal guide planes of adjacent teeth as well, since these dictate the possible path of insertion of the implant restoration and if these guide planes are in conflict with the path of insertion of the implant internal component, then a custom abutment usually works better than a screw retained implant crown.

Just this week a patient came in with an implant placed in a space that seemed too small for an implant restoration. When I showed my periodontist the radiograph he commented that the adjacent teeth may have drifted since the implant placement since the patient had waited a good long while after the uncovering to come in for my restoration. Whatever was the case I was able to trim both adjacent teeth a little bit in order to provide the space and the proximal alignment needed to fabricate my restoration using an angled abutment and a cement-able crown.

Implant #21 after adjusting the proximal contour of #20





from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2018/11/poorly-aligned-implant.html - http://lspindelnycdds.blogspot.com/

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