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 Table of Contents  
Year : 2015  |  Volume : 5  |  Issue : 2  |  Page : 94-96

Prosthetic management of misaligned implants by cast post and core supported prosthesis

1 Department of Prosthodontics, Bharati Vidyapeeth Dental College, Pune, Maharashtra, India
2 Department of Orthodontics, Sree Balaji Dental College, Chennai, Tamil Nadu, India

Date of Web Publication28-Jan-2016

Correspondence Address:
Rupali Patil
Department of Prosthodontics, Bharati Vidyapeeth Dental College, Pune, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2229-6360.175028

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Encountering misaligned implants are a rare occurrence in the current scenario. Nevertheless, management of the same poses a significant challenge to restorative dentist. The concept of Richmond crown may be used as an alternative solution though it may not be the best in terms of stress management for implants. Customized UCLA abutments could not be used in the particular clinical situation. The present article discusses management of improperly placed implants in the esthetic zone using customized cast with Richmond crown.

Keywords: Dowel post; implants; misalignment; Richmond crown

How to cite this article:
Patil R, Bhide SV, Vijayaraghavan N V, Kumar K. Prosthetic management of misaligned implants by cast post and core supported prosthesis. Indian J Multidiscip Dent 2015;5:94-6

How to cite this URL:
Patil R, Bhide SV, Vijayaraghavan N V, Kumar K. Prosthetic management of misaligned implants by cast post and core supported prosthesis. Indian J Multidiscip Dent [serial online] 2015 [cited 2021 Dec 3];5:94-6. Available from: https://www.ijmdent.com/text.asp?2015/5/2/94/175028

  Introduction Top

Misaligned and malpositioned implants pose a significant challenge for the restorative dentist. This clinical report describes the successful use of conventional cast precludes the use of a separate crown and fabrication of Richmond crown in such situation is explained.

  Case Report Top

A patient reported to the Department of Prosthodontics, Bharati Vidyapeeth Dental College and Hospital requesting for replacement of teeth. Clinical examination revealed the placement of two implants in maxillary lateral incisor region 11 and 22 [Figure 1]. The cover screws were seen projecting through the labial cortical plate. Management of gross misalignment by UCLA abutments were ruled out because of the peculiar way they had been placed. The patient was unwilling to undergo the extensive procedure of implant removal and placement of new implant and thus it was decided to utilize the postspace for custom fabricated post and core.
Figure 1: Preoperative view

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The steps are given below:

  • Removal of gingival former was done followed by putty impression of maxillary arch with spacer
  • The depth of postspace was measured with 21 gauge orthodontic wire, and it was marked on the wire with permanent marker
  • Roughening of wire was done for retention of light body with tungsten carbide bur. the tip of wire was turned to J shape as in a conventional cast postimpression technique
  • Tray adhesive was applied over the orthodontic wire. Light body was injected into the implant postspace with intraoral tip followed by use of lentulo spiral to minimize voids
  • Light body was also injected over putty impression in the tray, and impression was made
  • Impression was poured with Type IV dental stone
  • Conventional cast posts with metal crowns were made [Figure 2]
  • Metal try in was done in the region of 12 and 22 [Figure 3]. Shade selection was done
  • Gingival porcelain was added on the cervical aspect of 12 and 22 Richmond crowns to match the level of adjacent gingiva. Thus, the appearance of unusually long crowns was managed
  • The crowns were cemented after eliminating the interferences in all protrusive and lateral excursive movements with zinc phosphate luting agent in 12 and 22 regions [Figure 4] and [Figure 5]
  • The patient was happy with the final results. She was also informed about the questionable prognosis of the treatment.
Figure 2: Cast post and dowel

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Figure 3: Metal try-in

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Figure 4: Lingual view of cemented final prosthesis

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Figure 5: Cemented prosthesis postoperative view

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  Discussion Top

Managing the malpositioned implants by computer aided designing/computer aided manufacturing bar supported overdenture has been reported by Moeller et al.[1] Tackling the situation with removable prosthetics is also reported.[2] Management of misaligned implants for a maxillary overdenture with spherical abutments is also reported in the literature.[3] In the clinical report presented the implants in maxillary lateral incisor region were placed such that the head of fixture was seen through labial cortical plate toward vestibule. Not many cases are reported about misaligned single tooth implants. When iatrogenic errors like the current situation happen, a compromised treatment plan has to be executed. Nevertheless, implants placed buccally or labially can be successfully managed by UCLA abutments. However, the current clinical situation cannot be managed by such abutments. The treatment explained in the present article is not ideal. Since the prosthesis height is more, the length of cantilever arm increase and more forces are expected. However, since fewer stresses are anticipated in lateral incisor region cast posts with crown as a single unit as Richmond crowns were made. This method was executed by Harshakumar et al. for the management of broken screw in implant postspace.[4] The effect of galvanic current (base metal post and titanium) is expected to be managed by the luting cement acting as an insulating medium. Considering the time constraint and the fact that removal of implants may compromise the bone width, the present treatment was executed. Instead of having implants being rendered useless a cast post and core supported prosthesis can salvage them.

Follow-up was done for 2 years, and the patient is satisfied without any complaint of dislodgment of crowns.

  Summary Top

The prosthodontic management of compromised placement of implants is explained in the article. It also reinforces the fact that prosthodontic opinion before treatment planning in implants is mandatory.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Moeller MS, Duff RE, Razzoog ME. Rehabilitation of malpositioned implants with a CAD/CAM milled implant overdenture: A clinical report. J Prosthet Dent 2011;105:143-6.  Back to cited text no. 1
Kurtzman GM. Management of malaligned implants with removable prosthetics. Int J Oral Implantol Clin Res 2010;1:101.  Back to cited text no. 2
Bidra AS, Agar JR. Management of misangulated implants for a maxillary overdenture with spherical abutments: A clinical report. J Prosthet Dent 2011;106:209-13.  Back to cited text no. 3
Harshakumar K, Bhatia S, Ravichandran R, Joy PT. Salvaging an implant with abutment screw fracture by a custom titanium post and core supported prosthesis – A novel technique. Int J Sci Stud 2014;2:36-9.  Back to cited text no. 4


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]


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