Doctor L. 911! Dental implant crown seating issue

Our Master Clinicians are hard at work and are passionate for our course graduates success.                                                                                                                   “Clinical excellence through truth and knowledge.”                                                   Case submission: Crown was cemented using the minimal, chairside die technique.

Clinical presentation: Contacts were explained to be very tight. Upon radiographic examination dentist determined that incomplete seating had occurred.

911 Question: Should the crown be removed? In removing the crown will it damage the implant and abutment complex?

Recommendation: At times with tight fitting prosthetic contacts and the draw of either the natural tooth prep and or the implant abutment; hydrostatic pressure or physical contact pressure can prevent the cemented prosthesis from seating. In general, it would be recommended that the crown be removed or at least monitored closely and the patient advised that the crown has a high chance of dislodging. Over time saliva will hydrolyze the cement interface causing crown loosening. Preemptively removing the crown chairside will prevent an unexpected crown displacement  in which the patient inadvertently swallows the implant crown or worse- aspirates the crown into the lungs while asleep.

To remove the semi-cemented implant crown. The clinician can use a pair of “porcelain safe” crown removal hemostats such as from Paradise Dental Technology , or the thermo-plastic Richwil crown remover “jelly-beans”.

The  Richwil crown remover  thermo-plastic cubes are heated in warm water, softened and placed on the dried crown. The patient then can bite into the material. Once the Richwil crown remover hardens the patient is instructed to open and the crown is removed. Careful evaluation is needed to ensure there is no opposing crown or filling on the opposing dentition; as a risk may occur with those being dislodged as well. If there are opposing restorations, once the material is hardened the dentist can grab the material with  a pair of hemostats and dislodge the crown without damaging the restoration. Crown and bridge “tapping” removal devises should be used with extreme caution as the force applied may fracture porcelain restorations or under excessive force can possibly damage the screw-abutment interface.

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If you found this information to be helpful in your daily practice. Please leave your comments below.

2 Replies to “Doctor L. 911! Dental implant crown seating issue”

  1. Hello Dr. “DoING Implants in Houston” Thank you for using our online clinical assistance service. In the future please post any new clinical questions here:

    Our Master Clinicians have reviewed your question and created your own custom answer and thread. Please view it here:

    Thanks again, and as Dr. L always says, “Please continue to let other doctors know of our training programs.”
    Have a great week!

  2. Helllo. Dr. L. Wht the max height of crestal sinus lift.? What is the cardinal rule of graft volume and lift height? Where can we buy citric acid and the other drug to clean the implant surface in perii-implantitis treatment? Thanks.

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