Closing the open space next to a dental implant crown

Fixing an Open Interproximal Contact Between an Implant Crown and an Adjacent Tooth

An open interproximal contact on an implant crown is a common occurrence with dental implants. Since, dental implants are one of the best solutions for replacing missing teeth, offering durability, functionality, and a natural appearance, this problem is being seen more and more often. This space will most often show up on the front side, or mesial side, of the implant crown. Some of them form quickly and some take years to form. Some patients will have this as a continual problem and it reoccurs multiple times even after we fix it.

Why do we get open interproximal contacts by implant crowns?

A dental implant doesn’t change position in the bone but teeth do. Thus as time goes on some people will develop an open space in-between a dental implant crown and an adjacent tooth.  It usually occurs on the mesial (front side) of the dental implant crown (Wei 2008 IJPros and Varthis JOMI 2016) and is thought to be due to mesial drift.

These changes can happen in the first year and you can expect about half of patients to experience this issue. Shi JOMI 2019 Oddly enough it is more common in the mandible, which has denser bone and one would think would be less likely to happen there. French JPD 2019 Meta-analysis shows mesial and mandible are most likely spots as well. Bento JPD 2023 Bompolaki JPD 2022 shows it is more common in molars vs premolars. Our thought is this is more common the father back you go, therefore, second molar is the most common area.

What is the problem with an open interproximal contact by a dental implant crown?

This gap will create several problems, including food impaction, difficulty maintaining oral hygiene, and gum irritation. It is an annoying problem but not necessarily detrimental.  We fix these problems several ways as we discuss below. Research is showing 1/3 to 2/3 of single unit dental implant crowns develop an open interproximal contact. Greenstein 2016 JADA  full article supplies reference to other articles showing the percentages. Oh JOMI 2020 If a patient has it happen they are likely to have it happen again in the same spot. Liang JOMI 22. There is a really nice thread on DT that discusses this issue in depth.

Fortunately, there are multiple ways to address this issue. Let’s explore the options for fixing an open interproximal contact between an implant crown and an adjacent tooth. If you are looking to close a space between two natural teeth you have more options. We have a blog on spaces between natural teeth here.

Open interproximal contact implant crown between two implants

1. Adjusting the implant crown to close the open interproximal contact of the implant crown

One of the first approaches is modifying the implant crown itself. If the gap is small, your dentist may be able to do this themselves. We can do this with either an intraoral repair or removing and repairing outside the mouth or sending it to the lab to add porcelain.

  • Intraoral repair: Your dentist can treat your crown like a tooth and place a minor prep inside the crown to close the space. If your implant crown is a PFM or emax crown the steps are to use porcelain etch, regular etch, silane, bond, and then composite. If it is zirconia the steps are zirclean, Z-prime, bond, and composite. The zirconia is not as predicatble. You can also go old school and do a slot amalgam prep in any material. This actually works better but looks worse.
  • Extraoral repair: The same steps can be done from above but outside of the mouth to close a gap.This is the ideal treatment if the implant crown is screw retained and easily accessible.
  • Lab repair: You can remove the implant crown with an open interproximal contact and send it to a lab to add porcelain. This is the most stable method but also the more time consuming and expensive method. If you can accomplish with one of the above methods that is going to be preferable to the patient.
  • Remake the Crown: If the current crown’s shape or contour is the issue, a new crown with better anatomical design and proper contact points may be necessary. If the contact is because the crown broke this is also the method that one would most likely use.

Open interproximal contact implant crown and how to fix it

2. Interproximal contact adjustment on the natural tooth

In cases where there is a natural tooth adjacent to the implant crown, a dentist may suggest adjusting it by:

  • Adding composite bonding: A small amount of composite resin can be applied to the adjacent tooth to help close the gap. This is ideal if the tooth is a virgin surface or has an existing composite resin.
  • Adding amalgam: If the adjacent tooth has an amalgam filling your dentist can do a slot prep into the amalgam and add more amalgam to the existing filling.
  • Adding composite to porcelain or zirconia crown: A dentist can add composite to a porcelain crown by following the steps found in the previous section.
  • Adding amalgam to a crown: A dentist can add make a slot prep and add amalgam to any material.

3. Orthodontic Solutions

If the gap is caused by tooth movement over time, then orthodontic treatment can be an effective solution. Realistically unless the patient has other orthodontic issues this should not be the method you use.

  • Clear Aligners or Braces: If the adjacent tooth has drifted or rotated, orthodontic treatment can help reposition it to close the space.

Final Thoughts

An open interproximal contact between an implant crown and a neighboring tooth can be frustrating, but it’s a fixable issue. The right solution depends mainly on what the materials are on the two teeth next to the open space. Also, the BEST solution will often be the one your dentist is best at doing rather than a theoretical best solution. If you’re experiencing this problem, consult your dentist to determine the best treatment approach for your specific case.

Have you encountered this issue before? What solution worked best for you? Let us know in the comments!