Implant questions.
The questions practices ask most often about implant restorative work.
Can you identify the implant system from the impression?
Not reliably. The connection geometry is inside the implant and an impression coping records the position rather than identifying the manufacturer. Some inferences are possible from a radiograph, and they are inferences.
The fastest route is a photograph of the component packaging from the placement appointment, or the sticker from the implant record. Where the implant was placed elsewhere, request the record before the restorative appointment.
Ordering a component on a guess is expensive in both time and money, which is why we will always ask rather than assume.
What if the system genuinely cannot be established?
It happens — a patient who moved practices, an implant placed abroad, records that no longer exist. A periapical radiograph will often narrow it to a small number of candidates by thread pattern and connection profile.
From there the options are to try a candidate component clinically, or to refer for identification. Neither is quick, and both are better than fabricating on an assumption.
Tell the laboratory the situation rather than sending the case as though the system were known.
Do you need the healing abutment sent with the case?
Not usually, and a photograph of it in place before removal is genuinely useful. It records the emergence profile the tissue has adopted, which the restoration then has to work with or deliberately change.
What we do need is the emergence captured — scanned or impressed before the scan body goes in, because the sulcus starts collapsing within minutes.
Can third-party components be used?
They can, and the quality varies considerably. Some are excellent; others fit loosely enough that the connection is not fully engaged.
The consequences of a loose connection are not immediate. They appear as screw loosening, micromovement at the interface, and sometimes component or screw fracture months or years later, by which point the cause is difficult to establish.
It is a decision for the practice, involving cost, availability and how the case will be maintained. What matters is that it is made deliberately and recorded rather than happening by default.
How much interocclusal space is needed?
More than for a crown on a tooth, because the space is shared between the abutment and the restoration above it — and where a titanium base is used, the base needs adequate height for the bond retaining the ceramic.
A case that looks to have adequate clearance for a crown may not once abutment height, screw channel and material thickness are accounted for.
Measure at the planning stage. Once the implant is placed, the remedies are limited.
Screw or cement — which should I default to?
Screw retention where the angulation permits it, because retrievability matters more on implants than on teeth and because it avoids cement in a region that cannot be cleaned.
Cement retention where a screw channel would emerge through an incisal edge, a facial surface or a functional cusp and an angulated channel system is unavailable or insufficient.
Where you cement, use a custom abutment with the margin at or near tissue level, or have the crown cemented extraorally and delivered as a screw-retained assembly.
Can a restoration be remade from the original records?
Often, if the implant position is unchanged and the records were digital. A fractured ceramic superstructure can frequently be remade from the archived scan without re-appointing the patient.
What changes the answer is any alteration at the site: tissue recession, drift of the adjacent teeth, or a different abutment having been fitted in the interim.
Ask before relying on it, and confirm the situation is unchanged.
What if the screw will not come out?
Usually a stripped screw head or debris in the channel. Clear the channel thoroughly first — composite, PTFE and biofilm all obscure the head and are a common cause of a driver not engaging.
Where the head is stripped, retrieval kits exist and are worth having before you need one. Where the screw has fractured, retrieval is more involved and occasionally unsuccessful.
A screw that has loosened repeatedly before failing was reporting a mechanical problem — off-axis loading, a cantilever, or a component that never seated fully — and that should be addressed alongside the retrieval.
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Digital scans and conventional impressions are both accepted. Cases move by UPS and Purolator, and Fairmont works with practices throughout British Columbia and across Canada.