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27. ProblemPossible causesSolutions Hemorrhage during drilling Lesions or injury of an artery The implant placement will stop the bleeding Implant mobility after placement Soft bone, imprecise preparation Remove the implant and replace with one of larger diameter. If the mobility is small, prolong the healing time. Exposed implant threads Too-narrow crestCover the threads with coagulum or place a membrane. Swelling lingually directly after implant placement at the mandibular symphysis Incision of an artery branch sublingually Emergency: Send the patient to a specialist center for coagulation Substantial postoperative pain remaining after some days Osteitis due to a too-aggressive preparation or a bacterial contamination Remove the affected implant. Indian dental academy

28. Insensitivity of the lower lip Incision or compression of the mandibular inferior nerve If the insensitivity persists after a week, use a CT scan to determine which implant is causing the problem and remove it. Exposed cover screw after a few weeks Cover screw not placed deep enough; thin mucosa Never try to retighten the cover screw. Prescribe vigorous oral hygiene Abscess around a cover screw after a few weeks Implant is not integrating (low probability) infection around the cover screw (which often is a little loose) Remove the implant. Raise a flap, remove the granulation tissue, disinfect with chlorhexidine, change the cover screw, and re suture.

29. ProblemPossible causesSolutions Slightly sensitive but perfectly immobile implant Imperfect osseointegration Cover the implant for 2 to 3 months and test again Slightly painful and mobile implantLack of integration Remove the implant. Difficulty inserting a transfer screw, gold screw, or healing cap Damaged inner thread of abutment screw Change the abutment screw Inability to perfectly connect the abutment to the implant Insufficient milling Place local anesthesia, use a bone mill with guide, remove the bone, clean with saline solution, and replace the abutment.

30. Problem Possible causes Solutions Pain or sensation when tightening old screws (during try in of prosthesis) Misfit between prosthesis and abutment Cut the prosthesis, interlock the pieces, and solder the prosthesis at the laboratory. Retry prosthesis. Loosening of one or more prosthetic screw at the first inspection after 2 weeks Occlusal problemRetighten, verify the occlusion, and recheck after 2 weeks. Loosening of prosthetic screw at second check or later Occlusal problem or misfit between prosthesis and abutment Verify the occlusion and / or the prosthetic fit. Reduce the extension. Change the prosthetic design (add an implant, etc). In all cases, change the prosthetic screws.

31. Abscess close to an implantPoor fit of the abutment to the implant Verify the abutment fit with a radiograph. Remove the abutment, sterilize it, remove the granulation tissue disinfect with chlorhexidine, and replace the abutment. Development of pain after placement of the prosthesis Disintegration of an implant, peri- implant infection If the occlusion or the adaptation of the prosthesis seems right, modify the prosthetic design (reduce or eliminate extensions, reduce the width of occlusal surfaces, reduce cuspal inclination, etc).

32. Fracture of veneering materialOcclusal problem, bruxism or para function. Verify the Occlusion and make a night guard. Fracture of the frameworkWeak metal frame and or too- large extension Remake the prosthesis; modify the prosthetic design (reduce or eliminate extensions, reduce width and height of occlusal surfaces, reduce cups inclination) make a night guard Fixture fractureOcclusal overloadRemove the implant with a special trephine drill, wait 2 to 6 months, if possible, and place a wider implant.

33. Continuing bone loss around one or more implants Infection (peri-implantitis) Remove that etiologic factors. Look for bacterial pockets around the natural teeth.

34. Visibility of titanium abutment through the mucosa Place a connective tissue graft Substantial phonetic problems that do not disappear after 2 to 3 months. Close the interim plant space (pay attention of maintenance possibilities). Make a removable gingival prosthesis. Bleeding on probingMucositis or peri- implantitis Remove etiologic factors (poor plaque control, prosthesis geometry in relation to the mucosa, look for bacterial pockets around the natural teeth. Possibly take a bacteria test. Cut open the lesion. Adjust the peri-implant tissues (gingival graft). Consider a bone regeneration procedure

35. Dental implant prosthetics– Carl E Misch