Interproximal open contacts

130 Rating(s).


Posted on By snjezana pohl In Failures

Left lateral incisor was extracted due to root fracture. Patient was 31 year old (2011). Flap less hard and soft tissue augmentation was performed to treat socket type 2. After uneventful healing an implant was inserted and restored in 2012. Patient received a night guard. He came in 2016 because of abutment fracture (Zirconium abutment, Richard, it`s your turn to quote Seiler`s paper).
Mesial and distal wide open interproximal contacts. Patient haven`t wore a night guard.
He received a provisional, therapy is in progress. Patient cannot afford orthodontic therapy and really doesn`t care about it.
How often do you experience interproximal contacts opening between single implants crowns and adjacent teeth?
Snjezana




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14 Comments

Teeth shifted to Right side of midline?? Not sure why but clearly happened. Implants will remain in place but teeth when not in stable bite or retained will drift over time. Dr. Salama


Reply

Mid line in 2012 & 16 looks almost same, IS canine tipping distally? regards, Ashok


Reply

Ashok, it looks like that. All first molars are missing and it seems that the teeth shifted distally and central incisors are more protruded.
Thank you for your comment
Snjezana


Reply

Snjezana, probably you will come to know many other hidden reasons for the tooth movement IF you mount the case in C.R and further evaluate the mounted models in all movements. Regards, Ashok.


Reply

Dr. Salama, you hit the point: the teeth were (and are) not in stabile bite.
I´ve seen inter proximal space opening but never to that extent.
Thank you for your comment
Snjezana


Reply

Snjezana; Interestingly, look at how the lateral incisor implant crown now looks rotated and out of alignment? I am SURE that is NOT how the final crown was fitted? I have seen tremendous shifting of natural tooth positions after implant placement making the implant look out of alignment when it is in fact the surrounding dentition that has shifted. This is a bigger issue than we have heard from our lectures and therefore EVERY implant patient receives a retainer or nightime appliance. Dr. Salama


Reply

Dr. Salama, the picture was taken as patient finally showed up - with abutment fracture. For this reason is the crown so rotated.
But the teeth shifted tremendous and this is the reason for posting this case. To remind all of us that the best result can be compromised if the patient doesn't`t receive night guard or receiver. Or doesn't` wear it. All patients in our clinic get it, but obviously we must be more convincing.
Best regards
Snjezana


Reply

Snjezana, here we see a right shift of midline. Brixism is the explanation. Any xr to see incisors bone level change in 4 yrs ?
Thanks for posting
Jorge


Reply

Jorge, I don`t think he is bruxer. His dentition is in-stabile, may be a tounge presser, too.
I just have initial OPG, X-ray and CBCT and X-ray from December, the next time we`ll take OPG.
Thank you for thinking with me!
Regards
Snjezana


Reply

Snjezana,

Interesting findings- I have seen this ( not as severe and not huge shift) in a few of my patients that I have been able to follow - it is usually within a 3-4 yr period and always the central lateral canine combination -Is it occlusion related ? Most likely and I remember was struck me as odd that it was only in female population - I think we can prob breakdown to a cellular level also- I remember reading a paper or 2 a few years back.

As far as Zirconia - I believe Irene's paper IJPRD vol 34 2014- but to my knowledge did not address movement maybe be other paper? I sure you with put the kids to work on this ....

I will look for my cases and follow up

Cheers,

Richard


Reply

Richard, when doing only surgery it is difficult to follow up the patient. This is my problem. They usually come only if there is a problem, like this patient.
Thank you for your time and don¨t forget reteiner/night guard.
Cheers
Snjezana


Reply

Snjezana, please look at the amount of wear on the distal of the lower left canine. It must be the occlusion. You can check incisal and canine guidance at next visit.
Did you check if abutment torqued properly?
Was it hexed or non-hexed abutment?
Did the crown come off and was re-cemented by another dentist?
Is there a facial bone loss? CBCT would help.
Do you plan CT graft on the facial?
Sorry about too many questions,
Always enjoy your posts.
Mike


Reply


Mike, there is nothing better than many questions:))
It was hexed abutment. Abutment was fractured for a few weeks and bluish looking gingiva was a reaction on irritation due to crown movements.
The facial tissue looked quite good after the new provisional crown was screwed.
The next time I`m going to take occlusal images and look after all that you proposed.
Thank you so much for your time and contribution!
Snjezana


Reply

Snjezana. I agree with Jorge. Occlusal forces can impact tooth migration in a healthy or diseased Periodontium. For better or worse cosmetics. Warmly. Chuck


Reply

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