27. Problem Possible causes Solutions
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 crest Cover 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. Problem Possible causes Solutions
Slightly sensitive but
perfectly immobile implant
Imperfect osseointegration Cover the implant for 2 to 3 months
and test again
Slightly painful and mobile implant Lack 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 problem Retighten, 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 implant Poor 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 material Occlusal problem, bruxism or
para function.
Verify the Occlusion and make a
night guard.
Fracture of the framework Weak 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 fracture Occlusal overload Remove 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 probing Mucositis 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
