This patient presented with their cement retained crown loose. These can be tricky to figure out b/c you need to figure out not only where the screw channel is, but what type of driver you need. As well, you have to make sure the implant is still functioning well before you reuse etiher implant, crown or both.
There’s such more things central the place where we’re passionate about sharing those unwritten hints in tips of dentistry well if you’ve ever needed to get into or remove a cement retain implant crown well this is one way to do it so we’re going to walk you through this case you can see we’re accessing right before you let’s go ahead and get started so cement
Retained crown and this patient presented just past week with this crown being loose and we reviewed the chart and we took a look and this is an old brandmark so this is a regular platform uh it was 3.75 at that time and this is actually this is the porcelain and here is the the poor pfm crown and actually if you look close enough there’s the junction between
There’s a crown margin so this abutment is actually a gold abutment and this crown is actually cemented but this whole unit is loose so what we’re going to try to do is we’re going to try to get into we’re going to try to cut through the crown and find where the access hole is into the abutment because you know you could as a friend of mine said suggested you
Could try to bang this off you know because it’s it’s looted on there but that’s pretty tough so what we’re doing is we’re making it let me go back here we’re trying to do an access into the tooth and try to i’m just guessing roughly where that channel screw channel is going to be and of course i do endle all the time so i actually please don’t judge me i started
Doing an endo access on this too so this is tooth number two six and you know we’re about two millimeters i would say two millimeters from the start of the porcelain down to the metal we’ve finally found where the screw channel is now again this is cement retained so this is one way you can get this off of here another one is you could potentially try to to you
Could try to kind of use one of those crown removers and try to pop it off but i think you might have more problems and solutions so if you don’t know what a a screw retain versus cement retain restoration is this is just a quick this is a model these i found in a old cabinet somewhere this is a screw retain so you can see this is what we would normally see we’ve
Got our our channel here let’s see if we get this clear there we go so this is a nobel so we’ve got our normal screw channel and we put composite we put teflon and then composite or polyvinyl siloxane into the screw channel just to prevent any of our restoration to go in to our screw channel you can put amalgam you put composite doesn’t really matter and this is
Old school because this is an external external hex versus an internal hex which is today so this is another case so this is another case here that looks at this is just a case that’s about to be delivered and it’s screw retained restoration so if we look at i don’t have a cement retain but if you imagine this would be a cement retain so imagine this debutment
There’s a screw channel down here and this gets screwed into the implant and then you take your cement put it in the inside of your crown and cement it down now what are the indications for that well there’s a whole bunch of different ones maybe where you go to where you’ve been trained what not but really what we try to we want a minute the problem with cemented
Restorations most of the time is that it’s the resin that gets around underneath the crown you can’t clean it out so whenever you can the recommendation is what i was trained is to use a screw retain but for some reason i have no idea why we were this was a cement routine so what we need to do is we need to create that channel to get down into where the implant
Abutment screw is now what’s really interesting is my perial buddy who sent me this case was saying oh now you’ve created you’ve turned this into a screw retain restoration i never thought of that that’s exactly what happened so what we’re doing here is i’m just removing some of the there’s like this material i actually don’t even know what it is maybe you can
Put in the comments below it’s kind of like a i don’t know it’s an old polyvinyl it just this crown is 12 years old and it might be just some sort of material that is in there i’m not sure whether it’s old polyvinyl that’s just gotten really old and kind of crumbled because when i take it out it’s definitely not teflon um and it kind of it’s not a cotton pellet
You can see here with a spoon excavator so what i’ve done here is now we’ve created more of a channel there’s where i started i was kind of like i said humbly i’m i started an endo access and i realized like well i’m not doing an endo so we’re going to move our axis over here um and i’m showing this not to show you i don’t know what i was doing wrong but kind of
If you’re in this situation you need to access this what we’re looking for is to kind of the center of the tooth really that’s what you’re doing center the tooth to kind of look for the screw channel so you can get this off of here without damaging the crown because that’s really what we’re trying to do is trying to remove this restoration the intent was to check
The screw actually the intent was to replace the screw check the restoration look if it’s good which it looked like it was good on the x-ray radiograph we’ll take a look at your orally and then check and then replace it because the patient wants to reuse it because it’s totally fine the real question i ask myself is why did this why did this become loose after i
Think it was like 10 years in service so we’ll take a look and see if you agree with me so here’s the screw you can see we’re using a microscope so it’s really helpful so what i need to do is we need to get this screw out of here but i don’t need to have this so there’s a little bit of metal that’s in the way so this metal is actually not the abutment it’s actually
The crown that’s in the way so i’m going to take this out of the mouth i can take my driver place it in here undo this and then i’ll clean up the use my high speed and make that channel fully capable you’ll see it but it kind of gets out of the the out of the image so and then we’ll make we’ll take my high speed make that a full clean circle so that driver so that
Screw can come out of there so this is what we normally see underneath an implant restoration you know it smells bad i don’t know why i talked to the perio and it’s always that way it always smells bad there’s plaque and whatnot getting under there so our implant looks good tissue looks decent a little bit a little red here but it looks good and as you can tell i did
This under rubber dam and it makes it so much easier to to use a rubber damp week my dental assistant cut this so we can then cedar crown down you’ll see it after but rubber dam keeps all the medical particles out of the patient’s mouth i did numb the patient up on the seven just on the gingiva so here unfortunately is you can’t see it for some reason it was out of
The shot i’m taking the high speed and i’m making that channel complete so my screw will be able to come all the way out of there i could have done that intro early but i’d rather do it extra orally it’s easier to do it extra orally and then we’ll do is we’ll pop the pop the screw out of there you can see i’m using my explorer there we go so look at all this bit
Of junk plaque in there so i’m going to use my probe punch to screw pop the screw out of there out it comes and then we’re going to do is we’re going to take a look underneath the microscope at the threads here no i’m not irrigating with hypochlorite i’m irrigating with so with uh not a certain amplicore with chlorhexidine we’re just cleaning up you usually use
A monogac syringe we don’t have any in the operatory we just have these um these syringes that i don’t use for endo i take that we take the tips off we’re just irrigating with some chlorhexane just to clean up the area so let’s take a look at the screws we’re trying to see what i was trained i’m just looking to see if the threads if anything are stripped or any
Are kind of like flattened to look like it’s stripped or they’re completely gone it looks fine but you know what let’s put a fresh one in there so we’re going to take a look at the interface so it looks good everything looks good here with the hex again this is an external hex which you don’t see a lot today and then there’s our screw channel there so what i did
Now let’s compare before so what i’ve done extra orally is i just took my burr and i made the screw channel completely circle a large enough so the screw will come out just making sure everything looks good i think this is the interface between the abutment you see this line here there’s the crown the metal from the crown the type 4 gold and then this is the the
Abutment gold here so the crown actually let’s take a look here one more time the interface looks good and what’s interesting you can’t see any so there’s no cement nothing like that around and it looks good all right so we’re going to reseat that so what i did was i’m going to place my screw back in the challenge it’s just like seeding a regular regular implant
Now let me just zoom out of here so i can bring this up a bit there we go because it’s coming out of the shot so let’s go ahead and we’re going to receded the crown so what i did was i put the screw in here so you can see the screw it’s out of focus because it’s out of the the focus of the the microscope and then we’re going to just seat it down you can take you
Should take you can or you should take a radiograph after you’ve had it seated i’m not concerned because this has been in service for 12 years and we’re fully good to go i’m not too concerned about that because it seats perfectly and then what we’re going to do is we’re going to take we’re going to torque it down to 35 newton centimeters intraorally then we’ll
Take a rubber dam off and then we’re going to do is we’re going to check and i think what happened was the reason why this tooth you can see let’s take a look at the articulating paper now these implant crowns i was trained to keep them out of occlusion so it looks like perhaps we had some passive eruption of the mandibular teeth the opposing teeth so what we’re
Going to do is we’re going to remove that with diamonds let’s get this out of the way so you can see what’s going on here i’m just packing some teflon tape into our screw access channel and now we have created from a cement retained into a screw retain restoration now again the patient wants to preserve it so we’re doing our best to do that i’m going to go old
School i’m an old school dentist so i’m going to place some amalgam in the access i know please don’t you know judge me on that it’s just really simple to place i’m happy with it and but definitely you can place uh composite a composite restoration you know hydrofluoric acid silane and bond your restoration in there so you see this contact here we’re going to remove
That actually so let’s go ahead we’re going to take a take a diamond burr and so we placed our amalgam sorry we placed our amalgam we’re going to take a diamond bur and we’re going to remove that rest we’re going to remove that contact a little bit more there there’s that contact right there now you’re starting to see the opaquer come through uh certainly the
Portion is thinned out so i mean there’s always a possibility and we mentioned that to the patient that the porcer may fracture down the road but i’d rather have obviously i’d rather have it out of contact so that prevents future loosening if that was the main reason you know that’s the reason why you know that’s the thing with dentistry is you’re always trying
To figure out you’re like an investigator trying to figure out why something either failed or came loose or what not so we’re just using our dilate polishers real quick and we’ll finish up with the final so we get a nice polish right there let’s slow that down there we go there and then we’ll burnish our amalgam so go ahead and let me know if you’ve done this
Before hopefully this is helpful um if you you know hopefully this is helpful in the minute that you need to use it a little burnish your amalgam and then that’s it so now we have converted like i said a cement retain restoration into a screw retain but it was more kind of for entertainment but also if you’re in a pinch you need to get one of these off without
Fracturing it good luck and that was actually the last thing i want to say is that when we did this we certainly went through the risks and benefits with the patient that we may have to replace the crown we may actually damage the implant we tried our best not to and i think we were successful but it’s always you know like my like dr yard had said many years ago
Tell the patient in advance so it doesn’t look like an excuse when something bad happens anyways thanks for joining we’ll talk to you soon cheers
Transcribed from video
How to Remove a Cement Retained Implant Crown (Crown is Loose) By All Things Dentistry
