Cadillac’s Break Down Too!
Q: Many years ago I had four implants put in and very nice bridge work that has worked extremely well. It was, I was told, the Cadillac treatment. It has served me well for twenty plus years. In the past while, part of the bridge came loose, so I went to a dentist to have it re-cemented, but the dentist could not get the bridge to come away from the implants. He could not figure out what the problem was, so he called the original dentist, who told him it had been cemented with temporary cement. Again, he tried but to no avail. Meanwhile I’m walking around with a loose bridge and no one can figure out how to tighten it up. I thought it just needed some new glue and I’d be right as rain – silly me! Do you know what’s going on? How can I get this fixed? I’m afraid something bad might happen. I’ve been assured that the implants aren’t loose so it must be the bridge. I’m really perplexed and another “p” word that I can’t say! Please help me to understand.
A: The problem with your bridge is one that doesn’t happen very often, but it does happen. The rationale for temporary cement is that bite forces in the mouth might overload part of the implant system. In a person with a forceful bite, temporary cement will breakdown before any part of the implant/crown system will breakdown (at least in theory). Thus, the bridge supposedly comes loose because of cement breakdown instead of breakage of the bridge. Usually the bridge is easily removed and re-cemented. In some cases, the temporary cement breaks down too frequently, which is a nuisance. In your situation, you may have experienced the worst kind of luck - i.e. part of the implant system is loose or broken. Most of the time, it is the screws that secure the housings upon which the bridge is cemented, that have come loose. The temporary cement won’t give because all of the movement is in the screw/implant connection. If too much pressure is applied to the bridge to get it off, you may strip the threads of the securing screws and the inner threads of the implant. That would render the implants unusable. To salvage this situation, the bridge will have to be carefully cut off and the housings reattached. Yes, it does mean a replacement, but you have many options. If you replace the loose part of the bridge, I’d also suggest another implant or two before doing so. Doing this will prevent this from happening again. When your type of bridge was done, the theory was that four implants were enough. Most of the time it worked. Your bite has not overpowered the implants, but it has overpowered the bridgework.
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Based on actual patient cases
Calvin Ross Crapo