Best Way Forward? Dentist Answers, Tips
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Best Way Forward?

All on 4 implants placed in maxilla (7 years) and prosthesis has fractured twice and cracked 3 times necessitating the construction of another one. Had new fixed bridge 3 years (reinforced with metal along back of teeth) which cracked along one side. Found fractured screw when taken off and unable to remove. Advised implant has to be removed and dental specialist says can replace removed implant with immediate placement of another. Says pioneering procedure and ? risks. Opinions please.

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fracture cracks prosthesis replacement screws
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5 Doctor Answers | Asked by Jess135
+2

Problems with all-on-4 implants

This is a great treatment modality for many people. However some people may be better served with a different treatment plan. I am assuming that your prosthesis is a screw retained one-piece appliance that has a metal framework with teeth and gums over it. If you do not have any excessive bite forces or clentching/grinding habits then it should not break so easily or so often. If you do have these issues then you may be better off with an overdenture that clips on the implants but is... more
+2

Your dental implant treatment..............................

Dear Jess, Hello I am Dr. Amit Goswami, from Delhi Dental Center in New Delhi India. the 1st thing is all-on-4 is all-on-4 till the time you have all 4 implants with your self -- if you loose any one on them then it become none-on-3.................... see the best thing you should do is instead of the replacement of your failed implant -- add some more implants to your bone -- see when we take out an implant too much of bone around it will also has to be sacrificed along with the... more
+1

All on 4 implants

I am not a fan of the all on 4 restorations for the upper, but it does seem to be popular since 4 implants are cheaper then 6. You are experiencing just what most of us dentists try to avoid - not enough implant support or restorative strength to withstand the forces in your mouth. As to the broken implant screw, they are usually easy to retrieve with the right instrument. Removing an implant does destroy a lot of bone around the implant so I would question an immediate replacement. With all... more

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+1

All-on-4

While this is a treatment choice successful in some, in many others, complications are evident. It is always best to stage the treatment and place more implants for adequate support of a prosthesis. I generally place at least 6 implants and a work closely with our prosthodontists to fabricate a balanced and precise prosthetics. I recommend, remove the poorly positioned or poorly healed implants, allow the site to heal or graft if bone is inadequate and place the new implants as second stage... more
+1

Best way forward?

I assume you still have natural teeth on the lower arch? If so, you must start with looking at your bite the way upper and lower teeth come together. If your upper has fractured that many times your bite must be off and that should be address before you start doing everything over again. Good Luck Kevin Coughlin DMD, MBA, MAGD CEO Baystate Dental PC
Doctors will not see your comments on their answers. If you'd like to follow up, please go here to ask another question.

Comments (3)

Jess135 19 Dec 2012
The screw removal kit was used and the specialist could not remove it with several of the tools. I have recently found a damaged tooth on my bottom dentition. This lies immediately below the lateral implant where the abutment screw broke. The abutment has always been visible as I feel that it was too long from the outset. The hole was never covered over the bridge because of this. When the bridge was replaced a second time the abutment was drilled as it was even more visible through the hole in the bridge, but still remained visible and not covered with composite. I believe that the tooth has been broken as a result of continual brushing against it whilst chewing. Could this have been a contributory factor also that the screw has broken?
Megan P (Community Manager) 19 Dec 2012

I wanted to give you a heads up that it is unlikely that the dentists will see your comment in this section, as it is a place where the community members are meant to discuss the question. If you need more info you are welcome to submit another Q&A.

Jess135 19 Dec 2012
Thanks for the info. I wondered why it appeared in another section. I thought i would follow on from my original question. I wasnt able type any more characters than I did and had to cut some of it out.

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