What to do if I want to have new tooth restorations designed for my long-existing implants?

Today a slew of different brands and types of dental implants are available on the market. The implants differ in terms of their surface finish (outer surface), their connection to the abutment (inner surface), their use indicated for different surgical procedures and their price. Different manufacturers specify different devices for the fabrication of crowns to their respective implants (which may vary even with respect to a single manufacturer). The diameter of the implant and the way it connects to the abutment may differ. To fabricate a new crown or bridge “compatible” with the implant the dentist is required to select an appropriate impression coping and abutment.

The assembly of a Straumann implant and its abutment

Photo credit: Straumann.com

On average 2 or 3 different brands of implants are installed at a dental clinic, that is, a given dental clinic is “equipped” with machinery exclusively for such products. If the implant was installed at a different clinic or country even a simple crown replacement may prove difficult since with such requests a clinic has to conduct an inquiry into the specifications of the implant and thorough preparation is required. Following an implant surgery carried out at our clinic the patient is given a booklet called an “Implant Passport” to keep on hand, with the help of which they can have their damaged bridge replaced in the event of an accident, breakage of the crown, or dislocation of the bridge anywhere in the world.

Recommendation: in case you have an old implant and never received your Implant Passport and no follow-up panoramic radiograph was made following surgery, contact the surgeon without delay and request all information relating to the implants. You have a right to do so and can never know just where and when this information will be needful!


Photo credit: straumann.de

In everyday routine it may occur that an implant and a crown are not installed at the same clinic. This can be due to number of reasons such as:

  • The oral surgeon only undertakes the surgical part, namely the implant surgery.
  • The patient loses confidence in the clinic where their surgery was performed and would like to continue their treatment at a different clinic.
  • Financial reasons: with implants installed abroad the patient may choose to have the crowns done in another country due to lower prices (dental tourism)
  • The patient desires to continue their treatment at a clinic closer by because they have moved places.

Overall, it is safe to say that implants installed at another clinic or country can be fitted with an abutment or crown provided the dentist receives all necessary information as to the implant.

At the beginning of the implant surgery the surgeon fills out an implant passport which contains all data relevant to the implant installed. This has to be kept by the patient since whenever a crown or tooth restoration needs to be replaced the data therein will be required.

When a tooth restoration is designed for an implant installed at another clinic you are advised to participate at a personal consultation in order for us to assess the condition of the implants and discuss the possible mode(s) of tooth restoration. At this encounter no treatment will be performed, only a panoramic radiograph recorded and your teeth assessed. A treatment plan will be drawn up and handed over with a quote included. The possible tooth restoration methods and any other instructions prior to the treatment will be talked over and the initiation and schedule of the treatment determined.

What to take along to the personal consultation?

The following items may come in handy at the consultation:

  • Previous panoramic radiographs.
  • Implant Passport.
  • Any items in the patient’s possession that contribute to the treatment and the construction of the abutment since we need to decide what to order, source or borrow from the manufacturer for the date of the treatment session
  • If an inflammation is visible around the old implants or clinical and radiological symptoms indicate periimplantitis (bleeding or inflamed gums, soreness, bone resorption, purulent discharge around the implants) the doctor may immediately order a 3 dimensional CBCT scan. Sadly, more often than not, not only the crown needs to be replaced but the whole implant needs to be removed due to infection caused by untreated periimplantitis.

The last upper right implant was beyond repair due to the inflammation and bone loss having formed around it

The bone around the so-called blade implant has completely resorbed .It had to be removed without delay as it was purulent and painful.

Due the omission of regular check-ups all implants had to be removed as they had developed periimplantitis.

Periimplantitis in an intraoral radiograph

What happens during a treatment involving the replacement of an implant crown or bridge?
  1. Option no. 1: the most ideal, most expensive and longest lasting solution is the replacement of all parts and fabricating the new bridge using all-new implant parts. The dentist removes the old implant crown or bridge in topical anaesthesia, unscrews the old abutment and the whole restoration right to the implant and starts it all over. To this end, he needs the following items during the treatment:
    • gingiva formers (healing abutment)
    • impression coping
    • implant analogue (implant replica)
    • screw driver
    • ratchet key (torque wrench)

Side view of the two Straumann implants’ precision impression with the closed-tray impression copings

In the course of the treatment the old crown or bridge is removed, precision impressions are taken and the technician can order the custom-tailored implant abutments supporting the new crown or bridge once the master cast is ready. Our clinic can only assume warranty on the new tooth restoration if everything is fabricated onto new abutments.

The wide spectrum of Straumann abutments
Photo credit: straumann.com

Upper left cement-retained implant abutments on the master cast

Upper view of the implant crown with a screwdriver on the master cast

It is indispensable to know the brand, type and size of the implant. It is based on these data that we can check whether the old implant has a distributor in Hungary from where we can source the items required for the fabrication of the tooth restoration. All data and tools should be on hand prior to the treatment lest something should turn out to have been omitted, or incompatible, as this would leave the patient without teeth for days or weeks before the missing items can be acquired.
Option no. 2: all abutments are preserved and only the old crown is cut off. This is the fastest, least cost-intensive and simplest crown replacement. Following removal of the crown, the best case scenario is that the abutment is in a good condition and can be salvaged if the previous doctor did a fine job. In such cases direct impression is taken of the abutment itself as if to fabricate a bridge for a tooth preparation without actually unscrewing the abutment. No additional items are required, save for a ratchet key with which to verify the stability of the screw securing the abutment. It is advisable to tighten the screw to 35 Ncm of torque to ensure that vibrations while cutting or prying the old bridge off did not loosen the abutment. If the abutment is stable and well-placed and has appropriate gum height, an aesthetic crown can be fabricated by performing gingival retraction at the abutment and taking an impression thereof, by means of which the dental technician can finish the crown or bridge. This method is advantageous for its fast turnaround, cost-intensiveness and simplicity, but it has the downside that Suba Dentál can assume no warranty on this restoration, since the implant was not installed at our clinic; the abutment was not ordered by us or filed by our technician. This procedure is similar to overhauling a used car… it may look nice and be operable for years, but in this case we cannot provide the warranty terms applying to a new dental restoration.

What if I have previously purchased the items required for the abutment? Can they be used again?

There is a good likelihood that they can. Usually these are devices made of metal which can be used again in the fabrication of a new dental restoration. Obviously this can only be ascertained following a personal consultation and X-ray examinations.

In case the implant installed is not distributed in Hungary and I live abroad where it is available, can I acquire the necessary items?

Of course, if you can source the required devices (e.g. screw driver, torque wrench, impression copings, healing abutments, implant analogues, permanent abutment) the dental restoration can be performed without an issue. In such cases the dentist has to contact the manufacturer to draw up a complete “shopping list” to make sure nothing is omitted.

Keywords: implant passport, dental implant, dental implant surgery, periimplantitis, panoramic radiograph, healing abutment, impression coping, implant analogue, replica, screw driver, torque wrench, replacement of old implant crown