Securing Loose Implant Crown - Dental Minute with Steven T. Cutbirth, DDS

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In this Dental Minute video, Dr. Cutbirth discusses how to control gingival bleeding.
Dr. Cutbirth is the Founding Director of the Center for Aesthetic Restorative Dentistry (CARD) (www.CenterforARD.com) and maintains a full-time restorative and cosmetic practice (www.WacoSedationDentist.com).
Edited by Casey Balda.

[@tarapoostchi4070]

God bless the real educators who are putting content for others

[@centerforard]

Thank you. Glad the videos are helpful. President Harry Truman said, "Imperfect action is better than perfect inaction." I do not have all the answers and am not an expert in all areas of dentistry, but I have a lot of fabulous training from excellent mentors and 40+ years of experience in dentistry restoring complex cases. My objective with my online teaching center is to give back to the profession, as well as to patients, even though I am not a world expert in everything. I feel I am educated and "very good" at a lot of procedures and excellent at some procedures. If you wait until you are the "best" at everything, as President Truman said, you never give back. You have "perfect inaction." Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513 .

[@LearnBasicSpanishFree]

Thank you so much for your unselfish contribution. I'm not a dentist, just some guy living in LA. I have an upper implant which feels loose and feels sensitive to chew on. I can't figure out if it's the implant itself, or the abutment, or crown, or what. Just watching this video earlier today got me motivated to call my dentist and make an appointment to see him tomorrow. Thanks again sir!

[@centerforard]

I find that normally the problem is a loose screw. I cannot ever remember having a loose implant. Certainly possible, but loose screw is the most common cause of a "loose implant" I see, and that rarely happens.

[@veronicahancock3245]

Hope you took care of your implant. Had the same happen to me. Needed more support with another implant and bridge. Also informed that the implants should be checked every year. I was never told that from prior mouth makeover. Yesterday had the abutment placed. Healing today and watching the tube to stay calm. Stay healthy!

[@judithvipond8717]

How much wud a dentist charge for this ..this has happened to mine ..its actually come off and the imbutment is still solid no movement at all ..

[@davinnewport3691]

A true professional helping the less experienced!!!!! Go team USA!!!

[@centerforard]

Thank you. I hope you are subscribed to DentistryMasterClasses.com for the best videos, plus many complete comprehensive cases.

[@dr.mukarramkhan9605]

Thank you Dr. Cuthbert. I find your vids very informative and applicable to situations i face in my dentistry. Keep 'em coming. Can i make a request on socket preservation, grafting and materials. Thanks!

[@centerforard]

Those comprehensive videos will be in DentistryMastersClasses.com, along with a "library" of all the Dental Minute and DMC.com videos.

[@Saxophonelady]

Hello I am a patient with a loose crown on implant tooth #30. My dentist did not place the crown and there are no records available as to the brand or any other characteristics about the implant or crown. My question: what are the chances of success for him to deal with this loose crown without any info and having to go into this blind? Details please :) And how can he replace the screw or other parts if he doesn’t know the brand ? etc. if needed. The X-ray shows the implant in the bone is fine.

[@centerforard]

Go to "Whatimplantisthat.com" on Google. This company can identify the implant system.

[@g51582]

Thanks for this; neat to see it from the dentist's perspective! I had a 13-year-old first molar implant start wiggling last year and my dentist used this same approach (after he found the right hex tool; he didn't install the implant). This week it happened to my other first molar implant but I couldn't get in to see my dentist for a few days. The wiggling and clicking was so annoying (and my bite was all uneven), so I just kept wiggling it until it unscrewed itself. Pretty cool to see the hardware up close. Keeping it in a safe place ($$$) until I can get it re-screwed.

[@centerforard]

I have researched this issue of implant screws coming loose and have added 2 important steps for preventing it from happening. The articles and video are in DentistryMasterClasses.com.

[@joshuatanase3718]

Dr Cutbirth, Great video! You make me want to become a dentist. Forgive me if I'm ignorant, but could leaving a void in the tooth with cotton allow for bacteria to grow in the remaining space? There might be a micro gap around the filling.

[@centerforard]

No, the void in the crown is filled with composite, so it is well sealed. Now we normally use plumber's tape instead of a small cotton ball, along with the composite to fill and seal the hole. I love the practice of dentistry! It is a fascinating and very creative profession.

[@MrMohsinkhan31]

This was surprisingly a very interesting video.

[@centerforard]

Glad the video was helpful.

[@LaidBackAssassin]

I have a molar implant and the screw has come loose 6 times. They were replacing the screw each time instead of using the same screw. This allowed each new screw to stretch and loosen whereas reusing the screw which is already stretched hopefully won’t loosen again.

[@centerforard]

Sorry. I have videos on tightening loose implant screws.

[@carolynkelly-mueller244]

It was an interesting case that was inherited Severe bruiser . # 14. Heavy lateral focuses due to a plunging cusp designs. The case was 2 years old . The access to the screw was distorted. The Zirconium portion of the crown was removed with so sweat that decreased the length of the screw access. To my surprise the screw was not damaged. The abutment was then wedged into the hex after the intact screw was removed. The abutment was not able to be remove through rotation but was able to removed by a lateral movement. The abutment did not have a high titanium %. In the future, I wondered if there is a way to verify materials in a lab cases? I suspect the abutment was less than quality and with improper heavy lateral occlusion isolated the abutment's poor quality.. I am assuming if the abutment would have a higher Titanium it wound not have distorted. Your thoughts?

[@centerforard]

Use a laboratory technician you trust.

[@Ed-kw7vw]

Dear Dr Cutbirth, Thanks a lot for sharing. I have two questions: 1. You mentioned in the other video not to use the same screw came together with the abutement crown. In this video, would it be more prudent to replace the existing screw and use a new one to avoid any chipped or worn threads which may be a part of loosening source? 2. In mechanical world, the ideal anti-vibration loosening of the screw is to put a split spring loaded washer under the screw. Is that possible in this abutement crown application? If not, as a second best approach, will wrapping the new screw with teflon tape further prevent micro clinching loosening (just like plumbing pipe installation)?

[@centerforard]

Since I have been tightening screws twice with 35ncm torque, 15 minutes apart and squirting Nobel Grip on the screws, knock on wood, I have had no abutment/crown screws loosen. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@mikehascats26]

Ed, plumbing tape on threads is not to prevent loosening. it is to prevent leakage of water

[@CousinHubertRetrogaming]

Nice video. Usually litterature tells us to replace the screw with a new one in case of a badly milled screw. Also many times abutments are not straight which makes the discovery of the screw way funnier (not)

[@centerforard]

I agree. If I could not have achieved 35ncm torque, I would have replaced the screw. I wiggled the loosened crown and abutment to be sure the abutment was completely seated, then confirmed the seating with a pa radiograph.

[@mikemajestic66]

So if I just got an implant recently , and the screw Keeps loosing. Who’s responsible ? Dentist or Patient? And this is obviously the procedure that needs to be done. How do I explain that to the Dentist ? Is this a common procedure ? This is the second time it loosened I guess show him the video. This is going to be fun 😮

[@centerforard]

Normally, the cause of the implant abutment screw loosening is the patient clinching excessively on the implant crown. The microtrauma causes the implant screw to loosen. I have a video on implant abutment/crown placement that pretty much eliminates screw loosening. At least in my practice I have not had an implant abutment screw loosen in 5 years using this method. It could be something else that caused the loosening, but that is all I know about the cause.

[@mikemajestic66]

@@centerforard Thank you for getting back to me on this. As of now my dentist is up in the air about what is going to happen. I have an appointment with them Wednesday as I was there Sunday and they tighten the screw and it was loose again within 2 hours. As soon as I ate something it came loose. They did mention about replacing the crown. Would this solve the problem ? I see this procedure you do , my question is. Is this a well known procedure ? If so they didn’t mention it. What is the actually name of the procedure. So I can mention it to them. Thanks again.

[@maychen9915]

Hi, Dr. I have a loose implant. Where is you office located? I need to make appointments with you.

[@centerforard]

In Waco, Texas, but I feel there is someone close to you who could perform the tightening procedure.

[@swampwiz]

So what do you do if the screw keeps coming loose, like only a few weeks after being tightened?

[@centerforard]

Read the article on loose implant abutment screws in DentistryMasterClasses.com. It's a procedure. You initially tighten the screw to 35Ncm, you then wait 10-15 minutes and tighten it again to 35Ncm. I now place CEKA bond, a liquid in a spurt bottle, on the screw that goes into the implant to help prevent loosening. Since I have been following this procedure, I have had no screws loosen. Also, be sure there are no eccentric contacts on the crown and the patient has a nightguard.

[@swampwiz]

Thanks. However, it turns out that the top of the insert is damaged, so I need to get a new insert put in. I'll have to tell my dentist to this next time.

[@harrybrooks7750]

Great video. Have you ever seen a case where the head of the screw was partially or entirely covered in compound? How would you proceed in this case?

[@centerforard]

I do not know, I have never faced that problem. Somehow you would have to remove the compound. Possibly squirt hot water into the screw hole.

[@MrShailendrasingh507]

Sir, i wish every dentist in the world would have watched your video. I too have a implant. As mentioned by you abutment got lose. However in my case an inexperienced dentist filled silver amalgam compound all over the crown and into the abutment screw covering its head and what not. And when I went to the dentist who implanted it she is unable to remove the compound from it. Then she tried to remove abutmant and crown somehow but still the screw is stuck inside the implant. They tried to make groove in it in order to open it but couldn't succeed. I have appointment on next friday, mam will give it a last try. Any solutions Sir? Will I be left with useless implant placed in my jaw bon? I am stressed...I would be grateful if u kindly suggest some solution.

[@Loudes012]

Great video.My crown fell off while chewing. It was loose and didn't think it would fall off. It did.I went to the dentist and the dentist said a piece of the abutment was broken inside of the implant.A periodontist removed it.I have yet to return to have the crown replaced. My question is, could I still use the same crown.I know you mentioned a new screw would be imperative. Thank you and would appreciate your reply!

[@centerforard]

Glad the video helped.

[@catherinebirch2399]

I had the same thing happen to me after I had my implant for several years. I eating and it was making a funny creaking noise. The next moment it came right off. When I saw the dentist he simply glued it back onto the abutment. It was high on the bite so I had to go back and have the implant and an upper tooth filed down.

[@ismaeelshanshal8248]

Thank you Dr. Cuthbert for your informative vids. I have a patient with exact same problem of tooth #18 is loose. I did exactly the same what you recommend in this video but the patient keeps coming back with the same problem loose screw. Should I just order a new abutment screw or is it the internal implant hex ?? Thank you in advance.

[@centerforard]

I think the patient is probably a big clincher/bruxer. Be sure there are no lateral contacts on the implant crown and only a very light CRO contact. A nightguard is a must to prevent bruxism damage. I always replace the screw. Be sure it is tightened to 35ncm.

[@decentdentist]

Useful info thx for sharing. Kindly share managment of loosened nonscrewed cemented crown...

[@centerforard]

That's what this is, a cemented crown. The loose screw is in the implant abutment. I am drilling through the cemented crown to get to the loose screw in the abutment.

[@mysticalcrystallover1409]

Here in the U.K. where this I’m pretty sure has happened to me. The implant crown came off, my usual dentist re glued with permanent cement , and now is lose. Went back to him and he says nope, it’s not the crown it’s the probably the screw. He’s not an inplantologist so has referred me. Assuming they don’t have to replace the whole crown which I dearly hope not, as it’s mega bucks, do you know approximately how much this usually costs to do this procedure in the video? I don’t want to get ripped off!

[@centerforard]

Sorry, I cannot diagnose your condition without examining you.

[@Karl.no1]

thank you Doctor. It is very informative. thank you again

[@centerforard]

You are welcome. Subscribe to DentistryMasterClasses.com. Many, many great videos in an organized library.

[@ritujashah5418]

How do you manage the case for an upper anterior screw retained zirconia implant crown, if the implant angulation requires the abutment screw to enter from the Buccal surface of the crown instead of palatal? This is case for upper central and lateral incisors with all crowns having holes in them on the buccal surface for the abutment crown to enter. I am finding this very challenging since I’m worried about the esthetics.

[@centerforard]

I have never had that happen, so I cannot give you an answer.

[@jeffwndy]

Thank you for the videos. I am a DMD practicing for 33 years. If loose abutment situation occurs and you did not place the abutment and it becomes loose, how do you know correct torque and when if ever do you replace with a new screw VS just tightening. Thank you...I have a case coming in similar to this in two days!

[@centerforard]

I normally replace the screw if I can find out which implant system was used, but replacing the screw is probably not essential if you can retighten it to 35ncm. I have only had to treat the situation 4 times. Two of the times involved implants, abutments and crowns I had placed, so I knew the screws were originally tightened to 35ncm. All 4 of the patients were big clinchers and bruxers. My 2 patients had night guards. Even if the abutment screw was originally tightened to 35ncm, the occasional patient will loosen a screw. I believe the loosening is caused from teeth clinching, so I feel it is important the patient have a nightguard and wear the nightguard and that eccentric occlusal contacts are removed from the crown so the opposing teeth only contact the implant crown when the patient bites straight down. This can be a problem if the implant is a cuspid tooth and the patient has cuspid protected working side contact. Also, I encourage the patient to practice hummming while they are awake. Humming puts the lips together and the teeth apart. I instruct the patient that the only time opposing teeth should contact is when they swallow, and then just very lightly. The teeth normally do not contact when we chew food and should not be in clinching contact any time, awake or asleep. The hard acrylic, flat, centric relation occlusion nightguard takes care of the situation while the patient is asleep.

[@jeffwndy]

Thank you again for the additional information....very helpful!

[@Appi_13]

@@centerforard I really need your advise urgently please. I am currently on a 10 days isolation due to Covid positive and can’t go see my dentist. I have a quite large bridge in my mouth (front) which became loose. My dentist is in process of implants in my lower jaw in order to support the upper bridge as I have some missing tooth. My next appointment by end January 22. The bridge is currently loose. Can you please advise the best thing to do so the bridge doesn’t come off please?

[@carolynkelly-mueller244]

The abutment was a crown hex with screw retention. The crown abutment interfacing was broken and the screw intact.The abutment portion is bent and the screw was not accessible. Once the zirconium crown portion was removed, the screw was accessible and successfully removed. The abutment is not moving with finger rotation using a hemostat or needle holder. Any experience removing the bent abutment without damaging the female portion of the hex portion of the implant?

[@centerforard]

In this case nothing was bent, the abutment screw was just loose, I suppose from clinching or bruxism. I always change the screw when an implant abutment is loose. When an implant crown is loose, in my experience the reason has always been a loose abutment screw. I have never had to deal with a bent abutment.

[@bethanytree3490]

Superb sir,

[@centerforard]

Thank you. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@ClaudiaRodriguez-hb4zl]

Great information!!!! just happened to me last week!!

[@centerforard]

Thank you. Subscribe to DentistryMasterClasses.com.

[@Ivegotthe411]

any pain?

[@Dr_No]

I have slight movement on my front tooth implant and will be having it 'tightened'. Is this a long procedure or done under anaesthetic? More to the point, will it hurt? Thank you for your video!

[@centerforard]

No anesthesia, no pain and it normally takes under an hour.

[@Dr_No]

@@centerforard Such a relief --- I wasn't loooking forward to this but , now? Eh! :-) Thank you for your thoughtful and most helpful reply!

[@wem-c9f]

Doctor, do you ever numb patients up when you place the crown onto the implant? Thanks.

[@centerforard]

Normally not, but if the emergence profile of the gingival tissue around the abutment is tight, it might be a bit uncomfortable for the patient and you might want to use local aneesthesia. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@wem-c9f]

@@centerforard Thank you so much, Dr. xo

[@RomanasKudriasovas]

Thank you for the video. I’ve had my molar implant abutment screw loosening four times within a period of three years. After taking the steps you discuss, it was decided to replace the whole implant as well as the crown. The crown would always wiggle sideways. It has been a year now with my new implant and crown, and I’ve noticed it slightly move upwards while flossing (no movement sideways). Does that indicate loosening in the crown itself? And how is it fixed? Thank you.

[@centerforard]

Be sure there are no eccentric (side) occlusal contacts on the implant crown. Also, wear a proper nightguard while you are sleeping to ensure you are not clinching sideways on the crown. Read the research article on implant abutments and crowns loosening in the library of DentistryMasterClasses.com. There is a technique of "double tightening" the implant abutment and crown 10-15 minutes apart. Additionally, the dentist can place "Ceka Bond" on the implant screw to help lock the screw in place.

[@gloriacarina1]

I think the crown on mine is loose. I told my dentist and he filed it down (I don't think he believed me) now I'm getting this foul odor and constant tooth brushing only helps temporarily.

[@centerforard]

Maybe have another dentist look at it.

[@nickvictor7832]

Facanating and informative.

[@centerforard]

Glad the video was helpful. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@HB-fo6ic]

I have an anterior implant bridge which wiggles anteriorly and posteriorly, can I get input on what could it possibly be? I also smoke occasionally

[@centerforard]

Sorry, I cannot diagnose your condition without examining you.

[@SamCon29]

I just had my crown placed a week ago and after the day he put the crown it looses. It's on the upper front tooth and now it looses a lot but I can't removed it myself. I can twist it 180 degree. I told my dentist about it but he said that there was just a problem with the cement. It's really irritating that he didn't do it the right and now I am suffering. He told me to visit his clinic twice but didn't do anything, he just said that I'll let it come off? He said, if he forces to remove the crown, there's a possibility that the crown might get broken. Do you have any alternative suggestion Dr.?

[@centerforard]

Sorry, I cannot diagnose the problem without examining you and seeing what is wrong.

[@osamaelleithi5404]

Thank you so much

[@centerforard]

You are welcome. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@sagarsuresh3473]

What if cement retained crowns are there??

[@centerforard]

Same procedure. The abutment screw is loose, so you just go through the crown to get to the abutment screw.

[@girlwnojob5704]

I just had my crown cemented but it feels weird when I chew and sometimes hurts. Why do my lips feel tingly and weird? Are those bad signs

[@centerforard]

Have your dentist check the crown, including the occlusion (bite).

[@marymctigue8238]

Looks like I'm facing something like this. My perio and the dentist who did the implant don't know what to do or where to send me I'm East Coast 07042. But thanks for the information.

[@centerforard]

This works and is all I know to do.

[@danielraymond38]

My whole implant fell out with screw or abutment attached to it. It was glued back in by dentist, lasted about a year. Fell out today. What do I do. I'm broke. Ugh

[@centerforard]

You should go see a dentist with a good reputation and find out what the problem is.

[@MegaVictorias]

dentists are good people considering what they could do if they were cruel.

[@centerforard]

I agree.

[@sohishirazi1565]

Is it possible to replace upper front implant crown with other? Because my current implant crowns do not seem natural and there is not enough space between them for forming gum. I'm really grateful if you can help me.

[@centerforard]

Sometimes it is possible, but much depends on how the implant was placed. I suggest you see a good periodontist, oral surgeon or restorative dentist with experience with implants and restoration.

[@sohishirazi1565]

@@centerforard And should implant crowns be attached together without any space in upper part? or the space between them can be filled with gum? Because one of which is a little bit diagonal, rather than completely vertical. Thanks

[@centerforard]

Normally the implant crowns are not connected together because they are harder to maintain that way, i.e., flossing.

[@monicalewinsky1234]

Do you use CBCT imaging for implants?

[@centerforard]

Sometimes. Standard of care in Texas is pano and lateral ceph. or cone beam. If there is plenty of vertical/horizontal bone I often also take a pa of a pilot drill in the bone with endo stop to measure the depth of the bone. I drill the tip of the pilot drill to a safe depth several mm short of the inferior alveolar nerve, then take a pa and measure the distance between the tip of the drill and the nerve with my digital measurement tool. I stay at least 2mm from the inferior alveolar nerve. The lower second bicuspid area is the most difficult location to place an implant because of the mental foramen and nerve. I try not to place an implant in that location but, if it is essential the implant be placed there, I use a cone beam radiograph to assist with placement.

[@MurtyCZ]

I wonder why do you use rubber dam if a big part of gingiva shows through? Shouldnt it seal the tooth completely?

[@centerforard]

It depends on the situation and the reason one is using the rubber dam in the first place. My objective is to encourage dentists to use the rubber dam more often, for most procedures, by making placement easy and quick. Normally, depending on the procedure, the assistant is aspirating as the procedure is being performed. There is minimum, if any saliva leaking through the rubber dam into the operating field. In this situation, the objective was to contain the screw so, if it slipped off the screw driver, it would be captured in the rubber dam. Complete isolation was not the objective in this situation.

[@MurtyCZ]

Dental Minute with Steven T. Cutbirth, DDS I was curious about this, because I watch a lot of these videos to learn, and it was the same even for endodontics and other vids. I know here it doesnt have to be complete seal here, but I thought for endo it has to be a completely sealed off.

[@centerforard]

No.

[@Wolk-o3o]

95% of dentist do not even use rubber dam in this case for a reason of saving chair time, saving material, not knowing how to place or simply being lazy. Or there are way more dentists who do not use rubber dam even in endodontics. So his effort putting the rubber dam by managing implant could be appreciated, regardless of partially visible gingiva.

[@mikethegodson4250]

I'm not sure what I have... But It just came out... It's like a thin, metal, threaded rod and the "tooth" is on it, like a lollipop... There is tooth left in my mouth which surrounded the "lollipop". I got this work done when I was in maybe middle school lol I'm 30 now!

[@centerforard]

Go see a good dentist.

[@scottprice2967]

Thank ya

[@centerforard]

You are welcome. Subscribe to DentistryMasterClasses.com for the very best videos.

[@Pj192130]

What would you fill a screw retained gold crown with? Could you use gold foil?

[@centerforard]

You do not want to fill an implant screw hole with a material that cannot be removed with a handpiece in case the screw ever becomes loose again. I would only fill the hole with plumber's tape and composite.

[@Pj192130]

Dental Minute with Steven T. Cutbirth, DDS Thank you very much Sir, I had a bridge for 25 years ago, lost them due to decay. Do you think screw retained crowns are reliable? I want to replace all molars with full cast gold. Do opposing amalgam and gold metals cause galvanized shock?

[@hippocampus1806]

😭💔

[@centerforard]

I hope the video was helpful.