How does having crowns affect your ability to chew?

An implant is a multicomponent system consisting of an intraosseous element and an abutment, an adapter between an artificial root and a prosthesis. The implant/abutment connection is precisely calibrated, without micro-gaps, with well-designed abutment positioning. These are important factors on which the correct distribution of the chewing load on the implant and the durability of the orthopedic system depend.

When a crown on an implant is loose, there is always a reason for it. If the implant itself remains motionless, most likely the fixing screw has been loosened or the crown has become uncemented (if it is cemented).

What to do? Go to an appointment with an orthopedist, who will determine the cause of the looseness and effectively solve the problem - replace the fixing component or reinstall the crown. The main thing is to accurately install a loose implant or crown. Indeed, in the first situation, reimplantation may be required, and the second option involves a simple adjustment of the coronal part; the implant itself does not need to be changed.

Reasons for crown mobility

In most cases, the mobility of the prosthesis has nothing to do with the qualifications of the implantologist. Among the main reasons are:

• Loosening of the screw connection between the abutment and the prosthesis
  . This is possible if products from different brands were used. For example, the implant is Nobel Biocare, and the superstructure is Osstem. It is important to use original products of the same brand, which are developed as a whole, otherwise the likelihood of failure of all components is too high.
• Loss of properties of the cement composition
  . As a rule, this occurs due to high chewing load on the tooth, adherence to too hot or cold foods. The prosthetic system is fixed to the abutment with a soft cement composition; under unfavorable conditions, it begins to collapse, is gradually washed out, and the crown becomes loose.

The crown can be reattached in the clinic where the implantation was performed. The orthopedist will tighten the screw with an implantation key and secure the prosthesis. With the cement method of fastening, the crown will be cleaned of the remnants of the old composition and “set” on the cement again. Things are different if not only the crown, but the implant along with it is loose. It is very difficult to independently determine whether the implant crown is loose or the fixation of the intraosseous element is weakened. This requires a medical assessment of the clinical picture and a diagnostic examination.

Dentist advice: how to determine if you have a crown installed incorrectly

05/30/2019, 09:00 EST
Discomfort, taste in mouth and unpleasant odor. After installing a crown, various unpleasant symptoms may appear. Which of them are completely natural, and which require immediate treatment, says general dentist Tigran Grigoryan.

Photo: Depositphotosdent

Even if installing a crown costs you a fortune, this does not guarantee that you will be able to forget about your tooth problems for a long time, writes AiF. Sometimes unpleasant symptoms may appear immediately after the procedure. Is it worth it to immediately run to the doctor or will everything go away on its own over time, explains general dentist Tigran Grigoryan.

• Are you worried: the feeling that the crown is in the way

Tigran Grigoryan: The feeling of discomfort after installing crowns is absolutely normal. It is quite rare to encounter a situation where nothing bothers the patient after such a procedure. Even a new small filling is constantly felt in the mouth at first, because for our body this is a certain innovation that we need to get used to. A crown is a more serious intervention in the usual course of things; naturally, it always feels stronger, a little disturbing and causes discomfort at first.

• Are you concerned about: discomfort when chewing

This is a completely normal symptom. Again, the body needs to get used to the changes. It is normal to feel discomfort when chewing for 1-2 weeks after crown placement.

• Are you concerned about: unpleasant odor from under the crown?

But here you need to be vigilant. Bad breath in this case is associated with infection of the gums, which can eventually become inflamed. Installing a crown leads to trauma to the gums. Therefore, the dentist must warn the person who has undergone prosthetics to be more careful when brushing their teeth in order to avoid such unpleasant symptoms. The patient must very carefully clean the gingival part of the tooth with a brush, get rid of food debris and bacteria and not be afraid of the appearance of blood. Its presence while brushing your teeth indicates that the body is fighting infection. For faster gum restoration, patients after dental prosthetics are recommended to use an irrigator daily. If, after thoroughly brushing your teeth and using an irrigator, the smell from under the crown remains, you should immediately consult a dentist. Perhaps the reason lies in the incomplete fit of the crown to the cervical part of the tooth, which is also fraught with inflammation of the gums due to the constant entry of food debris there.

Photo: Depositphotos

• Are you worried: food has started to get stuck between the crown and adjacent teeth?

This is a good reason to see a dentist. If food gets stuck between adjacent teeth and the crown, this is a reason to replace the latter. But first it is necessary to establish the reason why this began to happen.

• You are concerned about: a black border near the gums that appeared after the installation of metal-ceramics

A black border can form when work on installing a crown is carried out in violation of the regulations (or when the gums are compressed). Several years ago, it was customary to grind teeth for a crown without a ledge, because of this it turned out that the crown fell on the gum, which led to its compression and the appearance of a black border. Today, teeth grinding is done with a ledge and does not provoke such negative consequences.

• Are you worried about: swollen gums

Gums can swell for several reasons. One of them is associated with poor oral hygiene: the patient did not clean out food debris from the gingival part of the tooth, which led to infection and inflammation. Another reason is incorrect installation of the crown (with a violation of the “equator”): when biting or chewing, food directly hits the gum, it is thus injured. In this case, the anatomical shape of the tooth was disrupted during prosthetics. This is a good reason to redo the crown.

• You are concerned: the gums next to the crown are bleeding

The reason for this phenomenon may be insufficient oral hygiene, which led to an inflammatory process. Due to the nature of my work, I often have to deal with the fact that patients simply do not know how to brush their teeth. And these are not children, but adults. It seems to them that they need to brush only that part of the tooth that rises above the gum, but in fact they need to brush not only over the surface of the teeth, but also where the gum meets the tooth. In this place there are “pockets” (the circular ligament of the tooth), into which food debris often gets clogged: they lead to infection and bleeding. Another reason is severe trauma to the gums when installing a crown, into which food debris also gets caught, and much more of it remains there. Good oral hygiene and the mandatory use of an irrigator will help to cope with the situation. After installing the crowns, the dentist may prescribe rinsing the mouth with special solutions or herbs; this should not be neglected: they will help the gums recover faster. I repeat once again that there is no need to be afraid of the sight of blood when brushing your teeth: there is nothing to worry about in this situation; on the contrary, an infection comes out with the blood.

• Are you concerned about: bitter taste in your mouth after having a crown installed?

This happens rarely, but it does happen. Mainly when the patient had metal-ceramics installed. In this case, the bitter taste is a sign of oxidation of the metal, which is a good reason to replace the crown.

Photo: Depositphotos

• You are concerned: the tooth under the crown reacts to hot and cold

This happens when the crown does not fit tightly enough. In such a situation, you should immediately contact your dentist so that he can reduce the sensitivity of the tooth using special materials.

• Are you worried: the tooth located next to the crown hurts

A crown cannot affect the adjacent tooth in any way! If a neighboring tooth hurts, you need to see a dentist to determine the cause.

• Are you concerned about: aching pain under the crown?

Most likely, here we are dealing with gum inflammation. Another reason is that the crown was installed without removing the nerve. When it comes to metal ceramics or gold, removal is mandatory. Zirconia crowns and porcelain veneers can be installed without removing the nerve. Most often, dentists decide to remove them so that neither they nor their patients will have problems later. But sometimes the doctor meets the client halfway and still leaves a nerve. And here no one will give you a guarantee that the tooth will not hurt later under the crown, so it is best to remove the nerves before installing the crown in any case.

Implant mobility due to patient negligence

The main reason why the intraosseous structural element began to wobble is ignoring the recommendations regarding the care of implants and the orthopedic system fixed to them. If the surgeon performed the implantation without violating the protocol, 90% of the responsibility for rehabilitation lies with the patient. The following can lead to loosening of the structure:

• Refusal of medications prescribed by the surgeon for the speedy restoration of injured tissue, prevention of the inflammatory process, etc.
• Regular consumption of alcohol and smoking slow down the rate of engraftment of the artificial root, increases the risk of peri-implantitis, and impairs blood circulation in the tissues. Clinical studies have shown that implant failure in patients with bad habits is 3 times higher than in those who do not have them.
• Overload of the artificial root when chewing hard foods. Premature chewing load on the implant. Typically, the doctor recommends following a soft diet for 2-3 weeks after the intervention. Ignoring the recommendation leads to displacement of the implant in its bed, disruption of osseointegration and, as a consequence, rejection of the intraosseous element.

The survival rate of a titanium structure is also affected by systemic diseases accompanied by impaired regenerative processes. These include diabetes mellitus, immunodeficiency states, oncological processes, some pathologies of the central nervous system, and chronic processes in the oral cavity.

What treatment methods are used

Treatment for mobility of the structure depends on the cause of the problem. If the implant crown is loose and the intraosseous element itself is motionless, it is again secured with a screw or cement. When the entire structure is wobbly, including the artificial root, treatment tactics are selected according to the clinical picture. The most favorable option is that the implant wobbles slightly, there is no inflammation around it, and the gums do not hurt.

In the second scenario, loosening of the artificial root occurs against the background of inflammation and pain in the jaw. Treatment includes:

• Cleaning the implant and nearby tissues - opening abscesses (if any), ultrasonic cleaning of plaque in the subgingival area.
• Osteoplasty using osteoplastic material and barrier membranes (according to indications).
• Antibacterial, antihistamine, anti-inflammatory agents.
• Treatment of the oral cavity with antiseptic compounds.
• X-ray control at each stage of treatment.

After the inflammation is eliminated, the prosthesis is again fixed to the implant. If the intraosseous element is rejected, it is removed from the socket, necrotic tissue is removed, and bone grafting is performed. Re-implantation is possible only after 6-8 months, when the bone mass has taken root and the tissue has recovered to its parameters.

Where to find a good dentist in Zvenigorod

You can get high-quality metal-ceramic crowns in Zvenigorod from a professional in the dentistry department of the Istok Health Clinic. Our doctors carry out diagnostics and retreatment using optics (dental microscope or binoculars), which increases the efficiency and quality of work and often makes it possible to treat a tooth under a crown even in the most hopeless cases. Contact us for a consultation today and receive well-deserved high-quality service at affordable prices!

Rejection symptoms

Rejection of the intraosseous element is a serious complication leading to the loss of the metal pin. Usually, implant rejection is accompanied by quite eloquent symptoms:

• Swelling of the gums, which does not decrease within 5 days after the intervention, but, on the contrary, increases.
• Reddened mucous membrane around the artificial root.
• Severe pain that intensifies with any load on the structure.
• Bleeding of the gums around the implant for more than 4-5 days after implantation.
• Purulent discharge from a wound.
• The appearance of a putrid odor from the implantation area.
• Excessive mobility of the artificial root, exposure of its neck, subsidence of the gums.
• Deterioration in general health, increase in temperature.

A loose implant crown is a reason to urgently go to the dentist. Rejection is rarely treated. With such symptoms, the best option is to remove the implant from the bone with further drug therapy aimed at restoring the body and regenerating bone tissue.

The implant fell out, what should I do?

In rare cases, the implant becomes unscrewed from the bone and may fall out. This occurs when the size of the socket and the intraosseous element do not match, as well as due to the weakness of the jaw bone. Such situations, when the implant loses its fixation and falls out, but there is no inflammation or other signs of rejection, can occur against the background of systemic diseases in which tissue regeneration is impaired (osteoporosis, diabetes mellitus). The problem is solved by reinstalling the structure using regenerative membranes (enriched with growth factors) that accelerate osseointegration, and prescribing a course of vitamin therapy.

If your tongue is knotted and your mouth feels dry

Dry and sticky mouth is a sign of insufficient saliva production. It becomes a consequence of stress, and regular discomfort indicates illness.

Possible reasons

• Side effects of medications. More than 400 species negatively affect the oral mucosa. These are antihistamines, painkillers, decongestants.
• HIV, AIDS, diabetes mellitus, Parkinson's disease, vitamin deficiency, Hodgkin's disease.
• Impact of radiation and chemotherapy.
• Menopause. Hormonal levels affect the functioning of the salivary glands.
• Smoking, drug addiction.
• Consuming a lot of salt.
• Allergic reaction, liver and kidney diseases, seborrhea.

Prevention

The best treatment is prevention. The positive outcome of the operation is influenced by:

• Professional approach
  – you need to take the choice of a clinic and an implantologist seriously, since the success of treatment depends 90% on the professionalism of the doctor.
• Quality of diagnosis and preparation
  - you need to prepare seriously for the operation, eliminating all contraindications. To do this, you need to undergo tests and not hide health problems from the surgeon - the more the doctor knows about the patient’s health condition, the more accurately he will select the implantation protocol, and the better the implantation of the artificial root will be.
• Oral hygiene
  – at the preparation stage, all dental problems should be eliminated and the quality of hygiene procedures performed should be improved.

After implantation, be sure to follow medical recommendations regarding care, nutrition, and physical activity. Do not skip control and preventative examinations.