How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site. Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.
Ask Lara Coseo Your Own Question
Lara Coseo
Lara Coseo, Dentist (DDS or equivalent)
Category: Dental
Satisfied Customers: 205
Experience:  Awarded, licensed dentist with over 13 years experience
99431558
Type Your Dental Question Here...
Lara Coseo is online now
A new question is answered every 9 seconds

I got a dental implant and bone grafting done around 4-5

This answer was rated:

I got a dental implant and bone grafting done around 4-5 years ago. my crown seems wiggly and i have a lot of pressure around the tooth and gum where the implant is. i saw my dentist and he said we will keep an eye on it, it may be failing or have loose abutment. but the only way to know is remove the crown, which i paid a lot for its ceramic, and have to purchase another. This morning i woke up and have some swelling around the tooth. so i made an appointment of re-check tomorrow. Do you have any other opinions to why this could be happening or what would cause an implant to fail 4-5 years in?
JA: How long have you been dealing with this? Any other symptoms?
Customer: around 2 months now
JA: Anything else in your medical history you think the dentist should know?
Customer: I have been seeing many drs over the past 8 yrs with diagnosis of fibromyalgia, elevated inflammation in the body, now issues with my autonomic nervous system causing POTS, I'm actually going to be seen at mayo soon to figure out what is going on and causing the above details.

Good afternoon! I am sorry to hear you are having this problem. I hope it makes you feel better to know that I am not only a dentist, but I've actually had a dental implant, AND I've had the exact same problem with my implant crown in the past.

The crown being loose is most likely caused by the screw (which anchors the abutment into the implant body) loosening. I do not have an explanation for you as to why this happens. They are supposed to be tightened to a very strict measurement of force, and at that prescribed force, they should not be able to unwind. However, it happens. It happened to my implant crown about 3 months after the crown was cemented.

It is very likely that the tenderness of the gums is caused by bacteria and plaque being able to reach into areas that they have previously been protected from. The loose crown will allow buildup underneath the crown, between it and the implant. It is important to remedy the loose screw before the gum problem worsens.

The good news is that there is typically a relatively simple fix for the "loose screw". The screw must be accessed by a dentist or the surgeon who placed the implant. They can access it by drilling a small hole into the biting surface of the crown. They then tighten the screw, and fill the access hole with filling material. This is the exact procedure I had done when my screw became loose. I simply had a colleague of mine do it after work one day.

The good news is that it is painless as they are only drilling on foreign material, not your anatomical structures.

Does that answer your question?

Sincerely,

Dr. Lara

I'd like to clarify that a loose screw is the most likely culprit as long as your dentist has checked the implant with an x-ray to confirm that everything else looks normal. Have they already done that?

Dr. Lara

Customer: replied 30 days ago.
Unfortunately the dentist who did my implant over 4 years ago moved. And the dentist who replaced him said my crown would have to be completely removed to even adjust the screws (if thats the issue) So another question if its the problem you said above would that cause pressure around and inside the tooth and cause it to wiggle?

It would cause the crown itself to wiggle. Sometimes it is hard to tell which of the structures is wiggling. When you feel the wiggling movement, do you feel discomfort or pain in the jawbone around the implant?

Dr. Lara

Customer: replied 30 days ago.
in july i had an x ray and he said it was normal but he did say its possible my implant could be failing and that scared me because it is my front tooth and i don't think there are anymore options other than what i have to not be toothless? I'm sure he will X-ray it again tomorrow. And yes when it wiggles i feel a pressure in my tooth and into the gums/bone.
Customer: replied 30 days ago.
Did you get my last question? I sent it and its gone now, weird

Of course you were scared! That's a scary thing to happen.

Yes, it is possible for implants to fail. However, when one fails, that does not mean that you cannot have another one.

Does this dentist do implants?

Definitely get a new x-ray first. A failing implant will show bone loss on an x-ray. Also, the dentist should be able to get a sense when he "wiggles" it whether it is the crown or something more.

However, if this dentist does not do much with implants, you could ask him to refer you to a specialist. Since it's your front tooth, I highly recommend seeing a periodontist. A periodontist is a gum specialist who will work with your dentist to either remedy the problems on this implant, or work with you through a new one.

Because cutting off a crown is pretty invasive, unless your dentist is absolutely sure it's NOT the screw being loosened, you should start with having someone access the screw to tighten it. Once the screw is accessed, the periodontist will know for sure what the problem is.

Does that answer your question?

Dr. Lara

Customer: replied 30 days ago.
He dose do implants and is at the same office that my dentist who did my implant was at but I'm not sure on his experience with them. I only saw him the one time that was in july and his advice was to either remove crown to check to see whats going on or wait it out. He couldn't say what the problem was. I wasn't comfortable with that nor did I know how much this was going to cost me. I'm sure you know how expensive the implant process is and I didn't have insurance at the time so I paid a lot for this to get done "since i was told it was more of a permanent solution" little did know i would have issues 4 yrs later :( so this is a bit frustrating. Not to mention I'm terrified to have to go through it again because i had a lot of pain and swelling after the implant placement.
Customer: replied 30 days ago.
How can the screw be assessed if the crown is not removed?

Your concerns are completely valid. I don't know what he say in July that made him recommend removing the entire crown. If the x-ray was fine then, my first thought is a loose screw, which is pretty easy to figure out by accessing it. I've done that many times on patients, and I've had it done on my own implant crown. When you go tomorrow, I would specifically ask if he sees signs of failure of the implant itself on the x-ray or as he is "wiggling" it to evaluate it. If he says no, then request that he access the screw to confirm that it is tight. That is the most conservative way to begin. If he seems hesitant or uncomfortable doing that, I would request referral to a periodontist. Then you would go through the same questions with the periodontist. If they don't have enough evidence from an x-ray and a clinical evaluation to say the implant is failing, accessing the screw is the next step.

You will also want to request specific instructions, and possible a prescription mouthrinse, to address the gum inflammation in this area. I feel confident that the inflammation is caused by your loose crown for several months.

Does that answer your question?

Dr. Lara

Typically, the screw is accessed by drilling a small hole in the crown to get to where the screw is. On a front tooth, they would go through the back of the tooth. As I said, if your dentist seems hesitant to do this, don't pressure him to. Just ask for a referral to a specialist.

Does that answer your question?

Dr. Lara

Customer: replied 30 days ago.
Ok got it, thank you for all your advice! I wish you were located near me so I could have you take a look at it ;) Have a great day! -Rachael

No problem! Let me know how it goes tomorrow. In the meantime, do some good swishing to keep the area under the crown flushed out, and hopefully reduce some inflammation in the gums.

Let me know if you have any other questions.

Sincerely,

Dr. Lara

Customer: replied 30 days ago.
Maybe with salt water or just water? and how can i let you know tomorrow, sorry new to this site :)

Warm salt water is great. Any over-the-counter mouthwash will work if you already have some around the house. It's just the flushing motion that is important at this stage.

Once you accept the answer (meaning you're satisfied and don't have any further questions for me and are happy with my advice), the question can stay open for up to 7 days. You're able to return to it for follow-up advice during that period.

Hope that helps!

Dr. Lara

Lara Coseo and other Dental Specialists are ready to help you
Customer: replied 30 days ago.
Great thanks!
Customer: replied 23 days ago.
Hi Lara! Just following up. After my appointment my dentist sent me to a periodontists just as you expected, to have a CT on the tooth. Thank God he didn't seem to think the implant was failing and my bone looked fine! so I am going in tomorrow afternoon they are going to remove my crown and figure out what is going on hopefully it's just a matter of tightening the abutment or screw I think that's what they said? And they did say they do have to cut the crown to do this but I think they're going to make me a new one free of charge so I'm okay with that just not looking forward to being toothless too long considering it's my front tooth :-( I do have a question for you though I do take Ativan and Zantac regularly right now and my pharmacist said there shouldn't be any reactions between those and any local anesthestec, but I do not use the epinephrine they are going to use something else on me called mepivacaine HC I think? Is this true? Because I found online that avtivan dose interact?

Good evening! I'm so glad you were able to get into a periodontist so quickly! Yes, if you do not use epinephrine, mepivacaine is the most common local anesthetic of choice. There is a moderate drug interaction between any local anesthetic and ativan because they are both depressants of the central nervous system. If you notice anything at all (and you may not), you could have some drowsiness or feel mildly sedated. For this reason, you may want to have someone drive you to and from your appointment and make sure to not have any specific plans for the rest of that day. Because the mepivacaine is used locally and typically wears off relatively quickly, there should not be a strong effect at all.

Does that answer your question?

Sincerely,

Dr. Lara