Uncovering Trends in Implant Mechanical Rescue:
Implant dentistry has revolutionized patient care, significantly improving quality of life and delivering high treatment success rates. For many dental professionals, implants have become indispensable in treatment planning, offering crucial support in a wide range of cases.
When managing Implant Mechanical Rescue (IMR) patients, the initial focus often centers around recovering the case and restoring it to success. However, over time, I’ve come to realize that a deeper question needs to be addressed: “Why did it fail?” This insight has become key to achieving long-term case stability and should ideally be considered during the initial treatment planning phase.
After handling more than 1,300 cases, I’ve identified notable trends that can enhance stability and reduce failures. Examining the large number of fractured abutments I’ve retrieved has provided valuable insights into why these fractures occur. Over the years, I’ve meticulously logged details about the fracture zones and their locations, revealing intriguing patterns.
Many of you may be familiar with the post-treatment reports and redacted case studies we share on our website for educational purposes. I’ve now begun compiling these reports to gain a broader understanding of these trends. Although this report primarily focuses on Straumann bone level cases, I plan to extend it to other systems in future chapters.
I hope you find this report as insightful and engaging as I did while compiling it.
Yours Truly,
Dr. Charles A. Mastrovich
Mechanical Assessment of a Straumann RC BL Case Where Two Abutments had Failed in Two Years
Case History
The patient presented on referral for retrieval of a loose crown and abutment from a Straumann 4.8 BL RC implant in the #19 site. Our Referral Intake Problem Summary noted the implant crown on #19 had loosened during the extraction of #17 and #18. He was referred to our office when the attempt to locate the abutment screw to recover the crown was unsuccessful. However, the patient related to us the crown had felt loose prior to the extractions. The patient was probably correct and when the distal contact was lost with the extraction of #18, more mobility was noticed. This implant was placed along with another in the #20 site on 04.27.22. Both were restored with Tibase abutments as independent restorations following osseous integration.
On 06.10.2023 he presented back to his restoring dentist with an abutment fracture in #19. This fracture occurred after approximately 1 year in function. The mechanics of this fracture will be discussed in detail below.
Recovery
Recovery of the crown with microscope visualization revealed the access opening had to be modified to the lingual to accommodate lingual implant pillar angulation. This allowed the driver to engage into the SCS screw connection on the long access of the screw. Once the screw was retrieved, the abutment and crown were recovered. As suspected prior to the appointment, the crown looseness had been secondary to a fractured abutment. Following cleaning of the internal aspects of the implant, the implant was examined under 25x microscope magnification and found to be free of any structural defects visible at that level of inspection. He was referred back to his restoring dentist following routine placement of a healing abutment.
This case became significantly more “interesting” when I realized the vertical location where this abutment had fractured and the short duration in function to produce this failure. While the recovery phase of this case was straight forward, consideration as to how to restore for better long term stability is more complicated. The current issues then become, why did these abutments fail, the locations where the fractures occurred, and the short time span of just 1 year in function for each abutment. I believe we need to examine all these issues.
Read more about my Mechanical Assessment of a Straumann RC BL Case Where Two Abutments had Failed in Two Years.
Our team at Implant Mechanical Rescue, led by Dr. Mastrovich, is committed to providing quality dental care. Contact Dr. Mastrovich and the Mastrovich Dental Team for more information on our Implant Mechanical Rescue services.
