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Abutment screw loosening: causes, preload and prevention

Fri, 13 Nov 2026 15:45:51 +0530

Abutment screw loosening is one of the most common prosthetic complications of implant-supported restorations. A patient returns with a crown that rocks, a clicking feeling on biting or soreness around the implant, and the clinician has to decide quickly whether the screw has simply lost its tension or something more serious has happened. Understanding why screws loosen makes both prevention and management far more predictable. This article explains the mechanics of the screw joint for dentists and dental students, the factors that lead to loosening, and a practical checklist for the clinic.

The screw joint and preload

When an abutment screw is tightened, it stretches slightly, like a spring. The elastic recovery of that stretch pulls the abutment and implant together. This clamping force is called preload, and it is what holds the joint closed.

Preload depends mainly on the torque applied, and also on the screw material, thread design, surface finish and lubrication. Much of the applied torque is spent overcoming friction in the threads and under the screw head, so only a part of it becomes preload. The joint stays stable as long as preload is greater than the forces trying to open it. When chewing forces, bending forces or an ill-fitting component overcome the clamping force, the threads slip a little with each cycle and the screw gradually loses tension.

The settling effect

No machined surface is perfectly smooth. When a screw is first tightened, the joint touches only on microscopic high spots. Under load, these high spots flatten and the surfaces move slightly closer together, so the screw loses part of its stretch and part of its preload. This is known as the settling effect or embedment relaxation. If settling is greater than the elastic stretch of the screw, the joint loosens. Settling is the reason many authors recommend retightening the screw a few minutes after the first tightening, to recover the preload lost in the first minutes.

Factors that lead to loosening

Reviews of the literature group the causes into a few areas:

Inadequate torque. A screw tightened by hand, or with an uncalibrated or worn driver, may never reach its intended preload.
Component fit. A poor passive fit, a misfitting framework, debris in the connection or components from different systems that are not designed to work together all reduce joint stability.
Connection design. Reviews report that internal and conical connections with anti-rotational features resist loosening well, while external connections are more prone to it.
Occlusal and bending forces. Cantilevers, steep cusps, heavy lateral contacts, parafunction and a crown-to-implant ratio that increases leverage all add joint-separating forces.
Repeated tightening and loosening. Each cycle can wear the thread surfaces and reduce the preload a screw can achieve. Reusing a screw that has been tightened many times, for example during laboratory and try-in stages, adds to the risk.
Screw condition. A deformed or damaged screw, or a screw thread contaminated with blood, saliva or cement, will not behave as designed.

Prevention: a chairside checklist

Use the correct components. Use the abutment and screw designed for that implant system, and keep a new screw for the final tightening where the manufacturer recommends it.
Clean and dry the connection. Remove debris from the implant connection before seating the abutment.
Verify seating. Confirm complete seating of the abutment, radiographically where the margin is subgingival.
Torque to the manufacturer's value. Use a calibrated torque wrench and the torque recommended for that screw, never an estimated hand torque.
Retighten after a few minutes. Retighten to the same value after a short wait to compensate for settling.
Check the occlusion. Aim for light, centred contacts on implant crowns, reduce cusp inclines and avoid heavy lateral contacts and long cantilevers.
Manage parafunction. For patients who clench or grind, consider a night guard and plan the restoration with this load in mind.
Record and review. Note the torque used and the screw details in the clinical record, and check the restoration at recall visits.

When a screw does loosen

A loose screw is a warning sign as well as a mechanical problem. Before simply retightening, it is worth asking why it loosened:

Remove the crown or access the screw channel and inspect the screw and connection for damage.
Check the fit of the restoration and the occlusion, including excursive contacts and any cantilever.
Replace a screw that shows thread wear or deformation rather than reusing it.
Look for signs of soft-tissue inflammation, which may follow micromovement or leakage at the joint.
Investigate repeated loosening as a sign of a design, fit or load problem that needs correcting.

If the screw has fractured rather than loosened, management changes completely. The fragment has to be retrieved without damaging the internal threads of the implant, which needs a careful stepwise approach and knowing when to stop.

Frequently asked questions

Is abutment screw loosening the same as implant failure?

No. Screw loosening is a prosthetic complication. The implant may remain well integrated, but loosening should be managed promptly because continued movement can damage the components or lead to screw fracture.

Why retighten an abutment screw after a few minutes?

Because of the settling effect. Part of the preload is lost soon after the first tightening as surface high spots flatten. Retightening recovers some of this preload.

Can I use any screwdriver if I am careful?

Hand tightening cannot reliably reach the intended preload. A calibrated torque wrench with the manufacturer's recommended value is the safer approach.

Learning implant complication management with ADC

The ADC E-Learning Hub is the online training platform for dentists run by Dr. Mohit Dhawan and Dr. Rosy Dhawan. Its courses include Hardware Complications in Dental Implants, the Basic Implantology Course and courses on analog and digital impressions and on long-term implant success beyond osseointegration. Lessons are video-based with downloadable notes, a digital certificate is awarded for each completed lecture and module, and offline clinical classes are also offered, with pre-enrolment online. Browse the full list at All courses. For a worked example of managing a fractured screw, read Retrieving a fractured abutment screw, and for choosing a first course, read Implantology courses after BDS.

This article is general education for dental professionals and students. It is not individual clinical advice, and it does not replace the implant manufacturer's instructions, formal training or individual clinical judgement.

Written by Dr. Mohit Dhawan, M.D.S., Prosthodontist and Implantologist, ADC- Centre for Restorative and Implant Dentistry, Chandigarh. ITI Fellow, ITI Section India.

References

Huang Y, Wang J. Mechanism of and factors associated with the loosening of the implant abutment screw: a review. Journal of Esthetic and Restorative Dentistry. 2019. https://doi.org/10.1111 /jerd.12494
Nithyapriya S, et al. Systematic analysis of factors that cause loss of preload in dental implants. The Journal of Indian Prosthodontic Society. 2018. https://doi.org/10.4103/jips.jips_294_17

Sensitivity after a new crown: what is usual and when to call the dentist

Tue, 27 Oct 2026 10:14:17 +0530

Many people notice that a tooth feels a little sensitive after a new crown is fitted. Cold drinks, a breath of cold air or biting on the tooth may cause a short, sharp feeling. In many cases this settles on its own over the following days or weeks. Sometimes, though, sensitivity after a crown is a sign that something needs checking. This article explains, in general terms, why a crowned tooth can feel sensitive, what is commonly expected, and when it is sensible to contact your dentist.

Why a tooth can feel sensitive after a crown

A crown is a cap that covers the visible part of a tooth. To make room for it, the dentist shapes the tooth by removing a thin layer from its outer surface. Underneath the enamel is dentine, a layer that contains tiny fluid-filled channels leading towards the nerve of the tooth, called the pulp. When dentine is exposed or disturbed, changes in temperature or pressure can move the fluid in these channels and the nerve may react.

Several steps in the crown process can make the tooth more responsive for a while:

Shaping the tooth: the preparation exposes fresh dentine and creates some warmth, which can irritate the pulp for a short time.
The temporary crown: a temporary crown protects the tooth between visits, but it may not seal as closely as the final crown, so cold or sweet foods can reach the tooth.
Cementing the final crown: the cement and the cleaning steps before it can cause brief sensitivity in the first days.
The gum line: if the gum around the tooth was a little sore or pushed back during the appointment, the root surface near the edge of the crown may be sensitive until the gum settles.

What is commonly expected

Mild sensitivity to cold, and sometimes to heat or sweet foods, is common in the first days after a crown is fitted. It usually lasts only a moment after the trigger is removed. For many people it eases gradually over a few days to a few weeks as the pulp settles. How long it lasts varies from person to person and from tooth to tooth. Teeth that had deep decay or a large filling before the crown may take longer to settle.

The gum around a new crown may also feel tender for a few days, especially if it was irritated during the preparation or the fitting.

When sensitivity may need checking

Some kinds of discomfort are less likely to settle on their own and are worth a review. These include:

Pain when biting: if the tooth hurts when you bite down, or the bite feels high or uneven, the crown may be touching the opposite tooth too early. This can often be adjusted at a short visit.
Lingering pain: pain that lasts for many seconds or minutes after a hot or cold drink, rather than fading at once.
Throbbing or pain on its own: pain that starts without any trigger, keeps you awake or needs painkillers to manage.
Sensitivity that is getting worse: rather than slowly easing over the weeks.
Swelling or a bad taste: swelling of the gum or face, a pimple-like bump on the gum, or a bad taste around the tooth.
A loose or chipped crown: a crown that moves, feels rough at the edge or has a gap where food collects.

These signs can have several causes. The bite may need adjusting, the cement seal may need checking, or the pulp may be inflamed. In some teeth, especially those that had deep decay or several fillings over the years, the pulp may not recover, and root canal treatment through the crown may be advised. A tooth that already had root canal treatment before its crown has no living pulp, so it does not usually react to cold, but the surrounding gum and bone can still feel tender when biting.

What the dentist may check

If you return with sensitivity after a crown, the dentist will usually ask when it started, what triggers it and how long it lasts. Common checks include:

testing the bite with thin marking paper and adjusting high spots on the crown,
looking at the edge of the crown and the gum line,
tests on the tooth to see how the pulp responds,
an X-ray to look at the crown, the root and the bone around it.

The next step depends on what is found. It may be a small adjustment, a desensitising treatment, time to let the tooth settle, or further treatment of the pulp.

Looking after a tooth with a new crown

A few general steps may help while a newly crowned tooth settles:

Use a toothpaste for sensitive teeth: regular use, as advised by your dentist, can help reduce sensitivity of exposed dentine.
Avoid very hot or very cold food and drinks: for the first few days, if they set off the sensitivity.
Brush gently with a soft brush: and clean between your teeth around the crown every day, so that the gum stays healthy.
Chew carefully: avoid biting very hard foods on the new crown in the first days, and with a temporary crown avoid sticky foods.
Mention grinding or clenching: if you grind your teeth at night, tell your dentist, because heavy forces can make a crowned tooth sore. A night guard may be suggested.

Frequently asked questions

How long does sensitivity last after a new crown?

It varies. Mild sensitivity to cold often eases over a few days to a few weeks. If it is getting worse, lingers after a cold drink or is still bothering you after several weeks, ask your dentist to check the tooth.

Is it normal for a crown to hurt when I bite?

A little tenderness in the first days can happen. Pain every time you bite, or a bite that feels high, usually means the crown needs checking and possibly adjusting.

Why is my crowned tooth sensitive to cold?

The tooth under the crown still has a living nerve unless it has had root canal treatment. Shaping the tooth and fitting the crown can make the nerve more responsive for a while. Sensitivity can also come from the root surface near the gum line.

Does sensitivity after a crown mean I need a root canal?

Not necessarily. Most mild sensitivity settles. Root canal treatment is considered when the tests and symptoms suggest the pulp is inflamed and will not recover, for example with lingering or throbbing pain.

Can a sensitive toothpaste help after a crown?

It may help with sensitivity from exposed dentine near the gum line. It will not fix a high bite or an inflamed pulp, so persistent pain still needs a check.

Booking a review

This article is general information, not advice for any individual. Please speak with your dentist about your own situation.

If a tooth with a new crown is sensitive, sore when you bite or not settling as expected, you are welcome to request a review with Dr. Mohit Dhawan or Dr. Rosy Dhawan at ADC – Centre for Restorative and Implant Dentistry, 1197, Sector 21B, Sector 21, Chandigarh 160022, through the appointment page. Saturday hours are 10:00 AM to 5:00 PM.

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Implantology courses after BDS: how to choose one, and what to ask before you enrol

Thu, 22 Oct 2026 23:53:49 +0530

Many dentists start looking at implantology courses in the first few years after BDS. Implant treatment is now a routine part of restorative care, patients ask about it, and the undergraduate curriculum gives most graduates only a limited introduction to it. The choice of course matters. A good first course builds safe habits in assessment, planning and prosthetic thinking; a poorly chosen one can leave a clinician confident with a drill but unsure of when not to use it. This article sets out, for young dentists and final-year students, how to judge an implantology course after BDS and the questions worth asking before you enrol.

Start with what you already need to know

Implant dentistry rests on foundations that are taught in BDS but are worth revising before any implant course:

Surgical anatomy of the maxilla and mandible, including the inferior alveolar canal, the mental foramen, the maxillary sinus and the lingual concavities.
Radiographic interpretation, especially reading cone-beam CT scans, measuring available bone and recognising anatomical structures in three dimensions.
Prosthodontic principles: occlusion, restorative space, emergence profile and the difference between a single crown and a full-arch case.
Periodontal health and medical history, because the condition of the remaining dentition and the patient's systemic health shape every implant plan.
Infection control and asepsis for a surgical procedure.

A course that assumes these foundations without checking them may move too fast. A course that revisits them in the context of implants is usually a better starting point.

What a sound basic implantology course should cover

Course names vary, but a basic implantology course for general dentists generally covers the following areas:

Case selection and assessment. Medical and dental history, indications and contraindications, risk factors such as smoking, uncontrolled diabetes and parafunction, and when to refer.
Prosthetically driven treatment planning. Planning the final tooth position first and placing the implant to support it, rather than placing an implant wherever the bone happens to be.
Imaging and digital planning. CBCT assessment, planning software and the role of surgical guides.
Surgical protocol. Flap design, osteotomy preparation, drilling sequences, primary stability and wound closure.
Healing and loading. Osseointegration, healing periods and the factors that guide the choice between conventional and earlier loading.
Implant prosthetics. Impressions, abutment selection, screw-retained and cement-retained restorations, and torque control.
Complications and maintenance. Biological complications such as peri-implant mucositis and peri-implantitis, technical complications such as screw loosening, and the recall and maintenance programme that follows treatment.
Consent, records and communication. Written informed consent, clear records of the system and components used, and realistic discussion with patients.

If a course outline spends most of its time on placing implants and little on planning, prosthetics and complications, that imbalance is worth noting.

Online, hands-on or both

Online and hands-on learning teach different things, and most clinicians benefit from both.

Online learning suits the theory: anatomy, planning principles, case discussions, recorded surgical demonstrations and complication management. It allows you to learn at your own pace and revisit a lecture when a similar case comes up in practice.

Hands-on training is needed for the manual skills. Work on models or animal jaws develops drilling technique, tissue handling and suturing. Supervised work on patients is a further step, and it raises questions of its own: who selects and consents the patients, who is responsible for the treatment, and what follow-up the patient receives after the course ends.

A sensible path for many young dentists is to build the theory first, then practise on models, then begin with straightforward cases under the guidance of an experienced mentor before treating more complex cases independently.

Questions to ask before you enrol

Before committing time and fees to any implantology course, it is reasonable to ask the provider:

Who teaches it? What are the faculty's qualifications and clinical experience in implant dentistry, and will they be teaching in person?
What is the curriculum? Ask for a written outline with the number of sessions, the topics and the balance between theory and practical work.
What practical work is included? Is it on models, animal jaws or patients? If patients are involved, how are they selected, who consents them and who looks after them afterwards?
What is the group size? Smaller groups usually allow more supervision during practical sessions.
Is the course tied to one implant system? Learning on one system is common, but the principles taught should apply across systems.
What support follows the course? Some providers offer case discussion or mentoring afterwards, which helps when you start treating your own patients.
Is continuing dental education credit available? In India, continuing dental education is overseen by the Dental Council of India and the state dental councils. If credit points matter to you, ask the provider which body has approved the programme and ask for it in writing.
What certificate is given, and what does it mean? A certificate of attendance shows that you completed a course. It is not a specialist qualification, and it does not replace clinical judgement or supervised experience.

Building competence after the course

A course is the start of learning implant dentistry, not the end. Competence grows through careful case selection, beginning with straightforward single-tooth cases in good bone, keeping detailed records, reviewing your own outcomes honestly and seeking a second opinion when a case is beyond your experience. Reading the literature, attending case-based study groups and returning for further training in areas such as bone grafting, full-arch rehabilitation or complication management all help. Postgraduate study in prosthodontics, periodontics or oral surgery is another route for those who want implant dentistry to be a major part of their work.

Frequently asked questions

Can I take an implantology course straight after BDS?

Many courses accept dentists soon after BDS. A strong grasp of anatomy, radiography and prosthodontic principles makes the learning far more useful, so revising these first is worthwhile.

Is an online implant course enough on its own?

Online learning covers theory, planning and case discussion well. Surgical skills need hands-on practice, and early clinical cases benefit from guidance by an experienced clinician.

Does one course make me an implantologist?

No. A course gives a foundation. Clinical competence develops over time through supervised experience, careful case selection and continued learning.

Learning implantology with ADC

The ADC E-Learning Hub is the online training platform for dentists run by Dr. Mohit Dhawan and Dr. Rosy Dhawan. Its courses include a Basic Implantology Course and courses on hardware complications in dental implants, analog and digital impressions in implant dentistry, and long-term implant success beyond osseointegration. Lessons are video-based with downloadable notes, a digital certificate is awarded for each completed lecture and module, and offline clinical classes are also offered, with pre-enrolment online. Browse the full list at All courses, and for a worked example of complication management, read Retrieving a fractured abutment screw.

This article is general education for dental professionals and students. It is not individual career, legal or clinical advice, and it does not replace formal training, supervised clinical experience or individual clinical judgement.

Dental implant after tooth extraction: immediate or delayed placement?

Tue, 20 Oct 2026 18:05:30 +0530

When a tooth has to be removed, one of the first questions people ask is when the gap can be filled. If a dental implant is the plan, the timing of an implant after tooth extraction is a real clinical decision. Some implants are placed on the same day the tooth is removed. Others are placed a few weeks or a few months later, once the socket has healed. This article explains, in general terms, the main timing options, what dentists assess before choosing one and what you can expect in the weeks after an extraction.

What happens to the socket after a tooth is removed

A tooth sits in a socket of bone, supported by the gum around it. Once the tooth is removed, the socket fills with a blood clot, and over the following weeks and months the clot is gradually replaced by new bone while the gum closes over the top.

During this healing, the bone ridge also changes shape. Research on healing sockets has shown that the ridge usually becomes narrower and, to a lesser extent, lower, with much of this change happening in the first few months. The thin outer wall of bone on the cheek side is often the part that reduces most. How much the ridge changes varies from person to person and from tooth to tooth.

This matters for implants because an implant needs enough healthy bone around it, and, in visible areas, enough bone and gum to support a natural-looking result.

The main timing options

Implant dentists often describe four broad timings for placing an implant after an extraction.

Immediate placement (on the day of extraction)

The tooth is removed carefully and the implant is placed into the socket during the same appointment. A gap between the implant and the socket walls, especially on the cheek side, may be filled with a bone graft material. Immediate placement combines the extraction and the implant surgery in one appointment, although the final tooth is still made later. It is usually considered only when the socket walls are intact after a gentle extraction, any infection can be cleaned out thoroughly, and there is enough bone at the root tip or along the socket walls to hold the implant firmly. If the outer wall is damaged or missing, the implant is often delayed and the area rebuilt.

Early placement with soft-tissue healing (about 4 to 8 weeks)

The extraction site is left to heal for several weeks so that the gum closes over the socket. The implant is then placed into a site where the gum has closed. Some reduction of the outer bone wall may already have taken place by this stage. This approach is often used when the gum needs time to heal or when a local infection needs to settle first.

Early placement with partial bone healing (about 12 to 16 weeks)

Waiting a little longer allows new bone to fill part of the socket. This can help when the root tip area did not have enough bone to hold an implant straight away.

Delayed placement (after about 6 months or more)

The socket is allowed to fill in with bone before the implant is placed, although the ridge may by then be narrower than it was on the day of extraction. Delayed placement may be chosen when there was a large infection, when the patient has health factors that affect healing, or when a bone graft is needed first. Some people also come for an implant years after losing a tooth. In those cases the ridge may have changed considerably, and additional bone grafting is more often needed.

Immediate placement and immediate teeth are not the same thing

Two separate decisions are involved.

When the implant is placed: on the day of extraction, after some weeks, or after some months.
When the implant is loaded: in other words, when a tooth is attached to it.

An implant placed immediately does not always receive a tooth on the same day. In many cases the implant is left to bond with the bone, a process called osseointegration, before the final tooth is made. In the meantime, a temporary option, such as a removable tooth or a bonded temporary bridge, may be used to fill the gap. A fixed temporary tooth is attached early only when the implant is held firmly and the bite will not overload it, and the dentist decides this for that site.

What the dentist assesses before deciding

The timing is chosen for each tooth after an examination and often a 3D X-ray of the jaw called a CBCT scan. The points commonly considered include:

The reason the tooth is being removed: for example a crack, decay that cannot be repaired, gum disease or a failed root canal treatment.
Infection: whether there is an abscess or long-standing infection around the root, and whether it can be controlled.
The socket walls: especially the thin outer wall, and whether it is intact after extraction.
Bone volume: whether there is enough bone beyond the root tip and around the socket to hold an implant firmly.
The position of the tooth: front teeth, where the gum line is visible, are often planned differently from molars, which have wider sockets with more than one root.
The gum: its thickness and health, and the position of the gum line around neighbouring teeth.
General health and habits: for example smoking, diabetes control and certain medicines that can affect healing.
The bite: including tooth grinding, which can place heavy forces on a new implant.

No single factor decides the plan on its own.

Preserving the site when the implant comes later

When an implant is planned for a later date, the dentist may suggest a procedure at the time of extraction to help limit the shrinkage of the ridge. This is often called socket preservation or ridge preservation, and it usually involves placing a bone graft material in the socket and covering it. It does not stop all change, but studies suggest it can reduce the amount of ridge lost compared with leaving the socket to heal on its own. Whether it is needed depends on the site and on the overall plan.

What to expect in the weeks after an extraction

Whichever timing is chosen, the first days after an extraction are about protecting the blood clot and keeping the area clean. Written aftercare advice usually includes avoiding smoking, avoiding vigorous rinsing on the first day and following the advice on food and medicines.

If the implant is placed later, a review visit checks healing before the implant appointment is planned.

Contact your dentist if you notice pain that increases after the first few days, swelling that is getting worse, a fever, a bad taste or discharge from the socket, or bleeding that does not stop with gentle pressure.

Frequently asked questions

How long after tooth extraction can I get an implant?

It varies. An implant can sometimes be placed on the same day as the extraction. In other cases dentists wait about 4 to 8 weeks for the gum to heal, about 12 to 16 weeks for some bone to form, or about 6 months or more for full healing. The right timing depends on infection, bone and gum at that site and on your general health.

Can an implant be placed immediately after extraction?

Sometimes. Immediate placement is considered when the socket walls are intact, any infection can be controlled and there is enough bone to hold the implant firmly. If these conditions are not met, a short wait is usually advised.

Is there a disadvantage to waiting too long after an extraction?

The ridge of bone usually narrows over time after a tooth is removed, and neighbouring teeth can slowly drift into the gap. If an implant is placed many months or years later, a bone graft is more often needed. It is worth discussing the timing with your dentist before or soon after the extraction.

Will I have a gap while the implant heals?

Not necessarily. Temporary options include a removable tooth, a bonded temporary bridge and, in selected cases, a temporary tooth fixed to the implant. Your dentist will advise which suits the site.

Do I need a bone graft for an implant after extraction?

Not always. A graft may be advised to fill the space around an immediate implant, to preserve the socket for a later implant, or to rebuild bone that has been lost. Your dentist will explain whether this applies to you after examining the site and the scan.

Booking a consultation

This article is general information, not advice for any individual. Please speak with your dentist about your own situation.

If you have been told a tooth needs to be removed, or you already have a gap and would like to understand the options and timing for a dental implant, you are welcome to request a consultation with Dr. Mohit Dhawan or Dr. Rosy Dhawan at ADC – Centre for Restorative and Implant Dentistry, #1197 Sector 21-B, Chandigarh 160022, through the appointment page. Saturday hours are 10:00 AM to 5:00 PM.

Retrieving a fractured abutment screw: a step-by-step clinical approach

Thu, 15 Oct 2026 08:21:22 +0530

A fractured abutment screw is one of the more stressful complications in implant prosthodontics. The implant itself is usually still integrated and healthy, yet the restoration cannot be retained until the fragment is out of the internal thread. How the fragment is removed often decides whether the implant can be restored again in the usual way or whether the internal connection is damaged. This article sets out, for dentists and dental students, a calm, stepwise approach to broken abutment screw removal, from assessment to prevention.

Why abutment screws loosen and fracture

Screw loosening and screw fracture are recognised mechanical complications of implant-supported restorations. Systematic reviews of implant prosthodontic complications report that screw loosening is more common than screw fracture, and that fracture is often preceded by a period of repeated loosening that was not noticed or not addressed.

The underlying mechanism is usually a loss of preload. When a screw is tightened to the manufacturer's torque value, it stretches slightly and holds the abutment against the implant platform. Settling of the mating surfaces, micromovement under load and cyclic loading can reduce this preload over time. Once the joint opens, the screw is exposed to bending and fatigue loads it was not designed to carry. Factors associated with this include:

Inadequate or unverified tightening torque, or no retightening after initial settling where the manufacturer recommends it.
Occlusal overload, parafunction such as bruxism, and cantilevers or wide occlusal tables.
A poorly fitting or non-passive framework.
Non-original or mismatched components.
Reuse of a screw that has already been tightened and removed several times.

Initial assessment

Before any instrument touches the fragment, take time to understand the situation:

Confirm the cause. A mobile crown on an implant may mean a loose screw, a fractured screw, a fractured abutment or, rarely, a failing implant. A periapical radiograph shows the level of the fracture line and whether the fragment sits above or below the top of the implant.
Identify the implant system. Check the patient's records, implant card or the original treating clinician's notes. The connection type, screw size and the availability of the manufacturer's retrieval instruments affect every later step.
Assess access. Note the angulation, the mouth opening and whether the fragment can be seen directly under magnification.
Explain the situation to the patient. Discuss that retrieval is often possible, that some cases need a different solution, and what the alternatives would be if the internal thread is damaged.

A stepwise approach to retrieval

The principle throughout is to begin with the least invasive method and escalate only when needed. Magnification and good illumination help at every stage.

Step 1: Remove the restoration and expose the fragment

Remove the crown and the coronal part of the abutment. Irrigate the screw channel to clear cement, debris and any fluid so that the top of the fragment is visible. Assess whether the fragment is loose or tight in the thread.

Step 2: Counter-clockwise rotation with a fine instrument

In many cases, once the load is removed, the fragment is not bound tightly. A sharp explorer, a fine probe or a small endodontic instrument can be placed against the edge of the fragment and moved in a counter-clockwise direction to rotate it out. Ultrasonic instruments used gently, with light pressure and irrigation, can help to loosen a fragment by vibration. Avoid contact with the internal threads of the implant.

Step 3: Manufacturer retrieval kits

When the fragment is bound, most major implant systems offer dedicated rescue or retrieval kits. These typically include a guide that centres a reverse-cutting drill or a fragment remover on the screw, so that the instrument engages the fragment rather than the implant threads. Using the drill at low speed with irrigation, as the kit instructions describe, is safer than improvising freehand. A guide sleeve matched to the implant system is the main safeguard against damaging the platform.

Step 4: Creating a slot

If no kit is available and the fragment is visible, some clinicians create a narrow slot in the top of the fragment with a fine bur under magnification, then use a small flat-bladed instrument to unscrew it. This carries a real risk of cutting into the internal connection, so it calls for care, steady support and a clear view.

Step 5: When retrieval is not possible

If the fragment cannot be removed, or the internal thread is damaged, options include thread repair with a manufacturer-specific tap where one exists, a custom post-retained restoration that does not rely on the original screw thread, leaving the implant submerged ("sleeping") or, as a last resort, removal of the implant and replacement. Referral to a colleague with experience in implant complications is a reasonable choice at this stage.

After retrieval

Once the fragment is out:

Inspect the internal thread under magnification and, where possible, test it with a new screw by hand.
Use a new original screw. Do not reuse the fractured screw's partner components without checking them.
Tighten to the manufacturer's recommended torque with a calibrated torque wrench, and retighten after a few minutes if the manufacturer advises it.
Check the fit of the abutment and the restoration radiographically.
Review the occlusion carefully, including excursive contacts, and adjust if needed.

Preventing recurrence

A screw fracture is often a sign of a mechanical problem in the restoration as a whole. Review the cause before replacing the components:

Is the occlusal scheme and the size of the occlusal table appropriate?
Is there parafunction, and would an occlusal splint help?
Is the framework passive, or does it need to be remade?
Were original components and the correct torque used?
Would shorter recall intervals help to pick up early signs of loosening?

Recording the implant system, components used and torque values in the patient's notes makes any future maintenance easier, for the treating clinician or for a colleague.

Frequently asked questions

Can a fractured abutment screw be removed without damaging the implant? Often, yes, particularly when the fragment is not bound and can be rotated out with a fine instrument. The risk of damage rises when drills or burs are needed, which is why system-specific guides are preferred.

Should I use a new screw after retrieval? Yes. A new original screw from the implant manufacturer, tightened to the recommended torque, is the general recommendation.

Is screw loosening a warning sign? Repeated loosening suggests that preload is being lost, and is worth investigating before a fracture occurs.

Learning implant complication management with ADC

Managing implant complications is one of the areas taught at the ADC E-Learning Hub, the online training platform for dentists, dental students and clinicians run by Dr. Mohit Dhawan and Dr. Rosy Dhawan. On training.theadc.dental Dr. Mohit Dhawan's teaching includes troubleshooting strategies for hardware and prosthetic complications, and the site refers to a lecture on Rescue of Broken Abutment Screws. Lessons are video-based with downloadable notes, a digital certificate is awarded for each completed lecture and module, and offline clinical classes are also offered, with pre-enrolment online. Browse courses at All courses.

This article is general clinical education for dental professionals. It does not replace the implant manufacturer's instructions for use, formal training or individual clinical judgement.

Do you need a crown after root canal treatment?

Wed, 14 Oct 2026 13:49:14 +0530

After root canal treatment, many people are told the tooth will need a crown, and many then ask whether that is always true. The answer depends on the tooth. A crown after root canal treatment is often recommended for back teeth, while some front teeth can be restored with a bonded filling alone. This guide explains, in general terms, how dentists in Chandigarh and elsewhere make that decision, why timing matters and what the crown process usually involves.

If you are still deciding about the root canal itself, read our patient's guide to root canal treatment in Chandigarh.

Why a tooth may need a crown after root canal treatment

Root canal treatment removes inflamed or infected pulp from inside a tooth, then cleans, shapes and seals the canals. The treatment deals with the inside of the tooth. It does not replace tooth structure that has already been lost.

By the time a tooth needs root canal treatment, it has often lost structure to decay, a crack or a large old filling, and the treatment itself needs an opening through the top of the tooth. The walls that remain can be thin. When chewing forces act on a weakened tooth, the cusps can flex and, over time, a crack can develop or part of the tooth can break. The final restoration is chosen to seal the tooth and to protect what remains.

A long-term study from the University of Iowa found that root-canal-treated teeth that were not crowned were lost more often than teeth that were crowned, once the type of tooth and decay were taken into account. It was an observational study, so it shows an association between crowning and keeping the tooth; it is not a reason to crown every root-canal-treated tooth.

Back teeth: molars and premolars

Molars and premolars do most of the chewing, so they carry heavier, repeated forces. For this reason, a restoration that covers and protects the cusps (known as cuspal coverage) is commonly advised for root-canal-treated back teeth. The European Society of Endodontology's position statement on restoring root-filled teeth recommends cuspal coverage for premolars and molars in most cases where at least one side wall of the tooth is missing, while keeping the design as conservative as possible.

Cuspal coverage does not always mean a full crown. An onlay covers the cusps but keeps more of the outer tooth when the side walls are sound. When a back tooth has only a small opening, thick walls and no cracks, a bonded filling may occasionally be considered. These decisions are made tooth by tooth.

Illustration: a back tooth usually needs its cusps covered, often with a crown over a core build-up; a front tooth with only a small access opening may be sealed with a bonded filling. Simplified. Not a patient photograph.

Front teeth: is a crown always needed?

Front teeth (incisors and canines) usually take lighter forces than back teeth, and their appearance matters more. If the only tooth structure lost from a front tooth is a small access opening, a bonded tooth-coloured filling can be enough. If the tooth has been weakened by a large opening, decay or large fillings on its sides, a crown should be considered.

A crown may also be discussed when a front tooth has darkened after treatment, when a person grinds or clenches their teeth, or when the tooth is needed to support a bridge.

What the dentist looks at when deciding

The choice between a crown, an onlay and a filling is based on an examination and, usually, an X-ray. The main factors are:

How much healthy tooth remains, above and around the gum line.
How many walls are intact. A missing side wall on a back tooth makes cuspal coverage more likely.
Cracks. A crack may change the plan, and a deep crack can affect whether the tooth can be restored at all. Read about cracked teeth and when they can be saved.
Bite forces, including grinding or clenching (see our bruxism page).
Existing fillings and their condition.
The tooth's role, for example whether it supports a bridge or a partial denture.

Timing: why the final restoration should not be delayed

After root canal treatment, the tooth is usually sealed with a temporary filling. A temporary filling is not designed to last. If it wears or leaks, bacteria from the mouth can find their way back into the cleaned canals. A tooth left without a final restoration is also more likely to crack. For these reasons, a root-canal-treated tooth should be restored as soon as reasonably possible after treatment.

Until the final restoration is in place:

avoid biting hard on the treated tooth, and avoid very hard or sticky foods on that side
brush and clean between the teeth as usual, gently around the treated tooth
contact the clinic if the temporary filling comes out, the bite feels uneven, or pain or swelling starts or gets worse

ADC patients can also follow our instructions after laser-disinfected root canal treatment (stage I).

What the crown process usually involves

The exact steps vary, but a crown after root canal treatment commonly follows this sequence:

A post, only if needed. A post is placed inside a root, before the core, only when too little tooth is left to hold the core. It helps retain the core; it does not strengthen the tooth.
Core build-up. The missing inner part of the tooth is rebuilt with a filling material so that the crown has a stable base.
Preparation. The outer surface is shaped so the crown can fit over it, removing only what the chosen material requires.
Impression or digital scan of the tooth, its neighbours and the bite.
Temporary crown to protect the tooth while the final crown is made.
Fitting. The fit, contacts, colour and bite are checked before the crown is cemented or bonded.

Illustration: after root canal treatment, a temporary filling seals the tooth; a core build-up rebuilds it; the tooth is shaped; and the crown is fitted. A post is added only when too little tooth is left to hold the core. Simplified. Not a patient photograph.

The NHS notes that root canal treatment itself usually takes two or more appointments. The crown stages are further visits, and the sequence is planned with you in advance. To understand how long a treated and crowned tooth can last, read how long a root canal lasts and what affects it.

Crowns, onlays and fillings: an overview

A full crown covers all the visible surfaces of the tooth. It is typically considered when a large amount of tooth structure has been lost.
An onlay (partial coverage) covers the cusps and keeps more of the natural outer tooth when the walls are sound.
A bonded filling seals the access opening and is mainly used where the tooth is largely intact, such as some front teeth.

Crowns and onlays can be made from different materials, including ceramics and metal-ceramic. The material is chosen according to the tooth's position, the bite and appearance. Once fitted, a crown needs the same daily cleaning as natural teeth; see how to care for dental crowns and bridges.

Root canal treatment and crowns at ADC, Chandigarh

At ADC – Centre for Restorative and Implant Dentistry, root canal treatment is usually carried out by Dr. Rosy Dhawan, and crowns are carried out by Dr. Mohit Dhawan. Because both treatments are done in the same clinic, the root canal treatment and the crown can be planned together. Learn more on our root canal treatment and dental crowns and bridges pages. The clinic is in Sector 21, Chandigarh, within easy reach of Mohali, Panchkula and Zirakpur.

Frequently asked questions

Do I always need a crown after root canal treatment?
No. Many back teeth need a restoration that covers the cusps, which may be a crown or an onlay. Some teeth, particularly front teeth with a small access opening, can be restored with a bonded filling. The decision is made after an examination.

How soon after root canal treatment should the crown be placed?
As soon as it can reasonably be arranged, once the dentist confirms the tooth is ready. A long wait with a temporary filling increases the chance of leakage or a crack. Your dentist will advise on the timing for your tooth.

Can I eat normally before the crown is fitted?
Chew on the other side where possible, avoid hard or sticky foods on the treated tooth, and do not use it for heavy biting until the final restoration is in place.

Does a front tooth need a crown after root canal treatment?
Not always. A front tooth with only a small access opening may be restored with a bonded filling. A crown is more likely to be suggested if the tooth has large fillings, has lost a significant amount of structure, is cracked or has darkened.

Will the crown procedure be uncomfortable?
Local anaesthetic is used when needed during preparation. Some people notice mild tenderness of the gum or the bite for a few days afterwards. Contact the clinic if discomfort increases, the bite feels high or a temporary crown comes off.

Does a crown add to the cost of root canal treatment?
Yes, the crown or onlay is a separate restoration with its own fee, which is explained in your written estimate. Instalment and financing options are available; ask our team for details.

Book a consultation in Chandigarh

This article is general information, not advice for any individual. Please speak with your dentist about your own situation. If you have had root canal treatment, or have been told you may need it, and would like to understand the options for your tooth, you are welcome to book a consultation with Dr. Mohit Dhawan or Dr. Rosy Dhawan at ADC – Centre for Restorative and Implant Dentistry:

Online booking: ADC Zoho Bookings
Phone: +91-708-780-0016
Email: help@theadc.dental
Clinic: ADC- Centre for Restorative and Implant Dentistry, 1197, Sector 21B, Chandigarh 160022

Mon–Fri 10:00 AM–6:30 PM; Sat 10:00 AM–5:00 PM; Sunday closed. You can also request a consultation online.

Reviewed by Dr. Mohit Dhawan, MDS (Prosthodontics, Crown & Bridge and Implantology).

References

European Society of Endodontology (Mannocci F, Bhuva B, Roig M, Zarow M, Bitter K). European Society of Endodontology position statement: the restoration of root filled teeth. Int Endod J. 2021 — PubMed 34378217
Aquilino SA, Caplan DJ. Relationship between crown placement and the survival of endodontically treated teeth. J Prosthet Dent. 2002 — PubMed 11941351
NHS. Root canal treatment — nhs.uk
American Dental Association, MouthHealthy. Crowns — mouthhealthy.org

A Guide to Avoiding Dental Emergencies During Diwali

Mon, 28 Oct 2024 07:48:10 +0530

Diwali, the Festival of Lights, brings with it an abundance of joy, celebrations, and delicious food. However, the festive season can also bring some hidden risks for your dental health. From indulging in hard sweets to forgetting oral hygiene in the hustle of celebrations, Diwali can unexpectedly lead to dental emergencies, including cracked teeth, gum issues, and toothaches. The last thing anyone wants is a trip to the dentist amid the festivities!

Here is a comprehensive guide with tips to help you prevent common dental issues during Diwali, so you can enjoy a safe, joyful, and pain-free celebration.

1. Be Cautious with Hard Sweets and Dry Fruits

Many traditional Diwali sweets, such as chikki (brittle made from jaggery and nuts) and hard candies, can pose a risk of cracking or chipping your teeth. Similarly, certain dry fruits like almonds and walnuts can be quite hard to bite down on.

Tip: Avoid biting down on hard sweets or dry fruits directly. Instead, break them into smaller, manageable pieces or soak them briefly to soften them. This will reduce the risk of damaging your teeth.

2. Don’t Use Teeth as Tools

It can be tempting to use your teeth to open packets or snack bags when you’re busy preparing Diwali goodies or setting up decor, but this habit can lead to chipped or cracked teeth.

Tip: Keep scissors and other tools nearby so you’re not tempted to use your teeth for anything other than eating. Using your teeth as tools can lead to painful dental injuries that may require emergency treatment.

3. Avoid Firecrackers use with Teeth

While it may sound strange, there are instances where people try to hold small firecrackers or sparkles in their mouth while lighting them, which is extremely dangerous. Aside from the fire hazard, this can also cause severe burns and injuries to your mouth, gums, and teeth.

Tip: Always keep firecrackers at arm’s length. Encourage everyone, especially children, to practice safe firecracker usage and avoid handling them near the face or mouth.

4. Limit Sticky Sweets and Mithai

Diwali sweets like gulab jamun, ladoo, and barfi are often sticky and sugary. These sweets cling to the teeth and can increase the likelihood of tooth decay by providing a food source for harmful bacteria.

Tip: Rinse your mouth with water immediately after consuming sticky sweets to wash away as much sugar as possible. Try to limit your intake of sticky sweets, and remember to brush and floss later to remove any remaining residues.

5. Practice Moderation with Sugary Beverages

Sugary drinks, such as cold drinks and sweetened juices, are a common part of Diwali gatherings. However, sugary beverages can weaken your enamel, increase the risk of cavities, and contribute to tooth sensitivity.

Tip: Opt for water or fresh fruit juices without added sugars as much as possible. If you do drink something sugary, use a straw to minimize contact with your teeth and rinse your mouth afterward to help reduce the sugar buildup.

6. Practice Good Oral Hygiene Despite the Festive Rush

With the busy schedules, parties, and travel plans, it’s easy to skip brushing or flossing during Diwali. However, neglecting oral hygiene during the festive season can lead to a buildup of plaque, cavities, and gum problems.

Tip: Stick to your regular brushing routine and floss daily, even on the busiest days. Consider keeping a small oral hygiene kit with a travel-sized toothbrush, toothpaste, and floss in your bag for convenience.

Diwali is a time of happiness, togetherness, and tradition, and it should be celebrated without any health worries. By being mindful of your oral health, you can enjoy all the festive foods and sweets without putting your teeth at risk. Taking small precautions can make a big difference and help you avoid painful dental emergencies during Diwali. Remember, a healthy smile is one of the best ways to light up the festival!

This Diwali, celebrate with moderation, keep your dental health in check, and make it a truly joyous occasion for yourself and your family.

Deep Cleaning vs. Regular Teeth Cleaning: Which One Do You Need?

Mon, 12 Jun 2023 10:04:34 +0530

Are you wondering whether you need a deep cleaning or a regular teeth cleaning for your oral healthcare? Understanding the difference between deep cleaning or a regular teeth cleaning is essential for maintaining optimal oral health. Let's dive into the topic of deep cleaning versus regular teeth cleaning to help you determine which one you might need.

Regular Teeth Cleaning:

Regular teeth cleaning, also referred to as Oral prophylaxis, is a Common dental procedure that plays a crucial role in maintaining oral health. It is recommended for individuals who have generally do not have any Gum Disease.The procedure begins with a thorough examination of your teeth and gums to identify any potential issues. The dentist then uses a scaler to carefully remove the plaque and tartar that have accumulated on the surfaces of your teeth. This process may involve some scraping sensations, but it is generally painless. Once the scaling is complete, the dentist proceeds with polishing your teeth using a rotating brush and a polishing paste. This step effectively eliminates surface stains and leaves your teeth smooth and shiny. Regular teeth cleaning appointments are typically scheduled every six months, although your dentist may recommend more frequent visits depending on your individual oral health needs. These routine cleanings serve as preventive measures to minimize the risk of developing dental problems such as cavities, gum disease, and bad breath. By adhering to a consistent schedule of regular teeth cleanings, you can keep your teeth and gums in optimal condition and enjoy a lifetime of healthy smiles. Remember, regular cleanings are not only beneficial for your oral health but also for your overall well-being. So, make it a priority to attend your scheduled appointments and embrace the refreshing feeling of a professionally cleaned mouth.

Deep Cleaning Treatment:

Deep Cleaning vs. Regular Teeth Cleaning

Deep cleaning treatment, also known as scaling and root planing, is a comprehensive dental procedure designed to address gum disease and periodontal infection. Unlike regular cleaning, which focuses on the visible tooth surfaces, deep cleaning goes beyond and targets the hard-to-reach areas below the gumline and along the roots of the teeth.When you have gum disease, bacteria and plaque can accumulate below the gumline, causing inflammation and damage to the supporting structures of the teeth. Deep cleaning aims to remove this buildup and promote healing of the gums.

The process of deep cleaning involves two main steps: scaling and root planing. Scaling involves the removal of plaque and tartar from the tooth surfaces and below the gumline. Special dental instruments are used to carefully access these areas and eliminate the accumulated debris. This step helps to reduce bacteria and infection-causing agents.

Root planing, on the other hand, focuses on smoothing out the rough surfaces of the tooth roots. This process helps to prevent the recurrence of bacteria and encourages the gums to reattach to the teeth. It also promotes a healthier environment for the gums to heal and regenerate.

Deep cleaning Treatment is typically performed in multiple visits, with each quadrant of the mouth treated separately to ensure thoroughness and comfort. Local anesthesia may be used to numb the area and make the procedure more comfortable for the patient. After deep cleaning treatment, it is important to maintain good oral hygiene practices and attend regular dental check-ups to monitor the health of your gums. Your dentist may recommend additional treatments or follow-up visits depending on the severity of your gum disease.

If you are experiencing symptoms of gum disease such as swollen or bleeding gums, persistent bad breath, or Loose Implant, it is essential to seek professional dental care. Your dentist can assess your condition and determine whether deep cleaning Treatment is necessary to restore the health of your gums.Remember, deep cleaning Treatment plays a crucial role in treating gum disease and preventing further complications. By addressing the underlying infection and promoting gum health, it can help you maintain a strong foundation for your teeth and enjoy a healthier, more vibrant smile.

Determining Your Needs:

To determine whether you need a deep cleaning or a regular cleaning, your dentist will evaluate the condition of your teeth and gums. They will assess the depth of periodontal pockets, the presence of gum inflammation, and signs of bone loss. If you are diagnosed with gum disease or have significant tartar build-up below the gumline, a deep cleaning may be recommended to address these issues and promote gum healing. On the other hand, if your oral health is generally good, a regular teeth cleaning will suffice to maintain healthy teeth and gums.

Remember, it's essential to visit your dentist regularly for check-ups and cleanings. They will assess your oral health, discuss any concerns, and recommend the most suitable type of cleaning for your specific needs. By following their guidance and practicing good oral hygiene habits at home, you can keep your teeth and gums in excellent condition.

In conclusion, the type of cleaning you need depends on the condition of your teeth and gums. Regular cleaning is recommended for preventive care, while deep cleaning treatment is necessary for addressing gum disease and more advanced oral health issues. Trust your dentist's expertise to determine the best course of action, and remember to prioritize regular dental visits to keep your smile healthy and vibrant.

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Medical Disclaimer:

The content of ADC-Centre for Restorative and Implant Dentistry's Blog/website is for information only, not advice or guarantee of any outcome. Information is gathered and shared from reputable sources; however, ADC-Centre for Restorative and Implant Dentistry is not responsible for errors or omissions in reporting or explanation. No individuals, including those under our active care, should use the information, resources or tools contained within to self-diagnosis or self-treat any health-related condition. ADC-Centre for Restorative and Implant Dentistry gives no assurance or warranty regarding the accuracy, timeliness or applicability or the content.

ADC-Centre for Restorative and Implant Dentistry accepts no liability for errors, inaccuracies, omission, or misleading statements. ADC-Centre for Restorative and Implant Dentistry excludes liability for any losses, demands, claims or damages of any kind regarding information, content, or services at this blog/website. The information may be updated at any time, especially as medical/dental discoveries and research evolves regarding the dentistry and its conditions. At no time does ADC-Centre for Restorative and Implant Dentistry take any responsibility for any action taken or care chosen in reliance on information contained in this blog or this website.

Essential Home Care Tips for Maintaining Healthy Dental Implants

Sun, 04 Jun 2023 09:08:11 +0530

By addressing few home care tips for maintaining healthy Dental Implants, we hope to provide you clarity on how to maintain longevity and prevent complications around Dental Implants.Cleaning around dental implants at home is a crucial part of oral hygiene to prevent potential complications. Dental implants, like natural teeth, require regular cleaning to remove plaque and bacteria that can accumulate around them. Here are some important steps to follow when cleaning dental implants at home:

Use a Soft Bristle Toothbrush

Using a soft-bristle toothbrush is essential as the soft bristles are gentle on the implant surface and minimize the risk of scratching or causing gum irritation. When brushing your teeth, it's important to use toothbrush in small, circular motions rather than aggressive scrubbing. This Brushing Technique helps remove plaque and debris effectively without putting excessive pressure on the dental implants or surrounding tissues. Remember, gentle and consistent brushing with a soft-bristle toothbrush is key to keeping your dental implants clean and maintaining their longevity.

Use low Abrasive Toothpaste

Using a low-abrasive toothpaste is essential for maintaining the integrity of dental implants. When cleaning your dental implants at home, choose a non-abrasive toothpaste which is specifically formulated for dental implants or low in abrasiveness and gentle on the implant surface. Some toothpaste brands contain baking soda or other abrasive substances that can scratch the implant surface. Check the toothpaste packaging and read the ingredients list. Look for toothpaste that is labeled as "non-abrasive" or "gentle." Avoid toothpaste that advertises deep cleaning or whitening properties, as they often have higher abrasiveness.

Clean All Surfaces

When cleaning your dental implants at home, you should pay attention to the gumline: Properly clean the area where the dental implant meets the gums. Plaque and bacteria can accumulate in this area, leading to Implant infection or Loose Implant. Angle your toothbrush slightly to reach and clean along the gumline effectively. By cleaning all surfaces of your dental implants, including the crown or prosthetic tooth, implant post, and gumline, you can effectively maintain oral hygiene and prevent complications.

Consider using Water flossers or oral irrigators

Water flossers or oral irrigators can be helpful in cleaning hard-to-reach areas or inter dental areas. These devices use a stream of water to dislodge debris and plaque. Most water flossers come with different attachments or tips. Select an attachment specifically designed for dental implants or consult your dentist for recommendations. Start with a low-pressure setting on the water flosser and gradually increase it to a comfortable level. Avoid using high pressure, as it can cause gum irritation or damage. Position the tip of the water flosser at a 90-degree angle to your gums. Gently guide the stream of water along the gumline and around the dental implants. Be thorough in cleaning all areas and take your time to ensure comprehensive cleaning. Read and follow the instructions provided by the manufacturer of your water flosser or oral irrigator for proper usage and maintenance.

Rinse with Anti-microbial Mouthwash and Salt Water

Rinsing with an antimicrobial mouthwash and salt water rinses are an excellent addition to your dental implant cleaning routine. Use a mouthwash that is alcohol-free, as alcohol can cause dryness and irritation. Remember that both antimicrobial mouthwash and salt water rinses are a supplement to your regular brushing and flossing routine. It helps reduce bacteria and maintain oral hygiene, but it should not replace proper oral care practices.

Maintain Regular Dental Visits

Maintaining regular dental visits is essential as even with diligent at-home oral care, plaque and tartar can still accumulate around dental implants. Professional dental cleanings remove these deposits, preventing gum inflammation and potential complications. During your dental visits, your dentist will carefully examine your dental implants to ensure they are functioning properly and in good condition. Doctors will check for any signs of infection, gum recession, or implant instability. Early detection of any issues allows for prompt treatment and better implant longevity. Regular dental visits often include X-rays or other imaging techniques to evaluate the underlying bone structure and ensure the implants are properly integrated. This helps detect any bone loss or implant failure early on.

By attending regular dental visits as recommended by your dentist, you can ensure the ongoing health and success of your dental implants. It is typically recommended to have dental check-ups every six months, but your dentist may adjust the frequency based on your individual needs. Remember to communicate any concerns or changes you notice with your implants to your dentist promptly.

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Root canal retreatment: when is it necessary?

Mon, 29 May 2023 08:01:32 +0530

Root canal treatment can save a tooth that might otherwise need to be removed, and many root-filled teeth last for years. Occasionally, though, a tooth that has had root canal treatment becomes painful or infected again, months or even years later. In many of these cases the tooth can still be saved with root canal retreatment: the old root filling is removed, the canals are cleaned and disinfected again, and the tooth is resealed. This guide explains the signs of a failed root canal, the common reasons it happens, what retreatment involves and what the alternatives are.

What is root canal retreatment?

Root canal retreatment (also called secondary root canal treatment, or non-surgical retreatment) is a further root canal treatment on a tooth that has already been root filled. It is done when bacteria remain in, or have got back into, the root canal system and the tissues around the root tip are inflamed or infected. The aim is the same as the first treatment: to remove the infection and keep your natural tooth. To understand the first treatment, see what happens during a root canal, step by step and our root canal treatment page.

Signs you may need root canal retreatment

pain when biting or chewing on a root-filled tooth
an ache or throbbing that comes back after the tooth had settled
swelling of the gum or face near the tooth
a small pimple or bump on the gum that may leak pus or a bad taste
tenderness when pressing on the gum over the root
a crown or filling on the tooth that is broken, loose or leaking

Sometimes there are no symptoms at all, and the problem is found on an X-ray at a routine check-up, as a dark area at the root tip. Swelling, fever or spreading pain needs attention the same day. If swelling makes it hard to breathe or swallow, or you feel very unwell, seek urgent care straight away. See the NHS advice on dental abscess and our toothache page.

Why do root canal treatments fail?

Illustration: bacteria left in the canals, a leaking crown or new decay, and a crack are common reasons a root-filled tooth becomes infected again. Simplified. Not a patient photograph.

A root canal treatment can fail even when it was carried out carefully, because the inside of a tooth is complex and bacteria are very small (Siqueira, 2001). The most common reasons are:

Bacteria left in complex canals

Roots can be curved, narrow or branched, and some areas are very hard to reach and clean. Limited mouth opening can make treatment of back teeth more difficult. Bacteria left in these areas can keep an infection going.

Missed or untreated canals

Some teeth have an extra canal that is hard to find. If a canal is not cleaned and filled, it can remain infected.

A leaking crown or filling, or new decay

After root canal treatment the tooth must be sealed with a good filling and, for most back teeth, a crown. If the crown is delayed, or if a filling or crown later cracks, loosens or develops decay at its edge, saliva and bacteria can leak back into the canals. A study of root-filled teeth found that a good seal on top of the tooth, as well as a good root filling, was linked to healthier tissues around the root (Ray and Trope, 1995). See crown after root canal treatment.

A crack in the tooth or root

A crack can let bacteria in. Small cracks in the crown can sometimes be managed, but a crack that runs down the root (a vertical root fracture) usually means the tooth cannot be saved.

How is a failed root canal diagnosed?

Your dentist will ask about your symptoms, examine the tooth and gum, test how the tooth responds to tapping and biting, and check the crown or filling. X-rays show the root filling and any dark area at the root tip. In some cases a 3D dental scan (CBCT) may be advised to look for missed canals, cracks or the size of the infection. Retreatment is recommended only when the tooth can still be restored and is worth saving.

What happens during root canal retreatment?

Illustration: the five main steps of root canal retreatment; numbing and the rubber dam come first and are not shown. Simplified. Not a patient photograph.

Numbing and isolation: the tooth is numbed with local anaesthetic and isolated with a thin rubber sheet (a rubber dam) to keep it clean and dry.
Access: the crown, filling or post may need to be removed, or an opening made through it, to reach the canals.
Removing the old root filling: the old filling material is removed, and the dentist looks for any missed canals.
Cleaning and disinfecting: the canals are cleaned, shaped and disinfected again. If there is a lot of infection, a medicine may be left inside the tooth for a while, so retreatment often takes more than one visit.
Filling and sealing: the canals are filled and sealed, and the top of the tooth is closed with a filling.
Restoring the tooth: a new crown or other restoration is placed as soon as the tooth is ready, to seal it and protect it from breaking.

Retreatment is often more complex than the first root canal treatment, so appointments may be longer. Healing of the bone around the root tip is checked on an X-ray at follow-up visits.

Is root canal retreatment painful?

The treatment is done under local anaesthetic, so you should feel pressure rather than pain. Tell your dentist straight away if the tooth does not feel fully numb. The tooth may feel tender for a few days afterwards, and this usually settles with the pain relief your dentist advises. Contact your dentist the same day if pain or swelling gets worse, or if a temporary filling falls out. Until the tooth has its final filling or crown, chew on the other side. Read is root canal treatment painful? Myths vs facts and our instructions after root canal treatment.

Retreatment, surgery or removing the tooth?

Retreatment is usually the first option when the tooth can be saved, and reviews of the research show that many retreated teeth heal well (Ng and colleagues, 2008). Other options may be discussed:

Apicoectomy (endodontic surgery): a small operation through the gum to remove the tip of the root and seal it. It may be suggested when retreatment through the crown is not possible, for example under a well-fitting crown with a long post, or when retreatment has not worked. Both approaches can work in suitable cases (Torabinejad and colleagues, 2009).
Extraction and replacement: if the tooth is badly cracked or cannot be restored, it may be better to remove it and replace it, for example with a dental implant or a bridge.
Leaving it untreated is not recommended when there is infection, because it can spread and damage more bone. Antibiotics on their own do not clear infection inside a root-filled tooth; the tooth still needs dental treatment.

Your dentist will explain the options, and the likely outcome, for your tooth.

Can a failed root canal be prevented?

Have the tooth restored with a permanent filling or crown as soon as your dentist advises after root canal treatment
Brush twice a day with fluoride toothpaste and clean between your teeth daily
Have regular check-ups, so leaking fillings, decay or cracks are found early
Wear a night guard if your dentist advises one for grinding
See your dentist promptly if a root-filled tooth becomes sore again

Read how long does a root canal last? for more on what helps root-filled teeth last.

Root canal retreatment at ADC, Chandigarh

At ADC – Centre for Restorative and Implant Dentistry, root canal treatment is usually carried out by Dr. Rosy Dhawan, MDS (Conservative Dentistry and Endodontics), and crowns are carried out by Dr. Mohit Dhawan, MDS (Prosthodontics). Because both treatments are done in the same clinic, the retreatment and the new crown can be planned together; see our crowns and bridges page. If a tooth cannot be saved, implant treatment is planned and carried out by Dr. Mohit Dhawan. Learn more in root canal treatment in Chandigarh and root canal treatment with laser disinfection. The clinic is in Sector 21, Chandigarh, within easy reach of Mohali, Panchkula and Zirakpur.

Frequently asked questions

Can a root canal be redone?
Yes. A tooth that has had root canal treatment can often be treated again if it becomes infected, as long as the tooth can still be restored.

How do I know if my root canal has failed?
Pain on biting, swelling, a bump on the gum or a bad taste near a root-filled tooth can be signs. Sometimes there are no symptoms and it is seen on an X-ray. See your dentist to find out.

How many visits does root canal retreatment take?
Often more than one, because the old filling must be removed and the canals disinfected before they are sealed again. Your dentist will tell you what to expect for your tooth.

Will I need a new crown after retreatment?
Often yes, especially if the old crown had to be removed or was leaking. A good seal on top of the tooth is important to stop reinfection.

Is it better to retreat the tooth or have an implant?
If the tooth can be restored and has good support, keeping it with retreatment is usually preferred. If it is cracked or cannot be restored, an implant may be the better option. Your dentist will explain the choices.

Book a consultation in Chandigarh

This article is general information, not advice for any individual. Please speak with your dentist about your own situation. If a root-filled tooth is painful or you have been told it may need redoing, you are welcome to book a consultation with Dr. Rosy Dhawan or Dr. Mohit Dhawan at ADC – Centre for Restorative and Implant Dentistry:

Online booking: ADC Zoho Bookings
Phone: +91-708-780-0016
Email: help@theadc.dental
Clinic: ADC- Centre for Restorative and Implant Dentistry, 1197, Sector 21B, Sector 21, Chandigarh, 160022, India

Mon–Fri 10:00 AM–6:30 PM; Sat 10:00 AM–5:00 PM; Sunday closed. You can also request a consultation online.

Reviewed by Dr. Mohit Dhawan, MDS (Prosthodontics, Crown & Bridge and Implantology).

References

Siqueira JF Jr. Aetiology of root canal treatment failure: why well-treated teeth can fail. Int Endod J. 2001 — PubMed 11307374
Ray HA, Trope M. Periapical status of endodontically treated teeth in relation to the technical quality of the root filling and the coronal restoration. Int Endod J. 1995 — PubMed 7642323
Ng YL, Mann V, Gulabivala K. Outcome of secondary root canal treatment: a systematic review of the literature. Int Endod J. 2008 — PubMed 19133093
Torabinejad M, Corr R, Handysides R, Shabahang S. Outcomes of nonsurgical retreatment and endodontic surgery: a systematic review. J Endod. 2009 — PubMed 19567310
NHS. Root canal treatment — nhs.uk
NHS. Dental abscess — nhs.uk

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