When your dental implant healing cap falls out, you should strive to have it screwed back on within 24 hours by your dentist. If you're able to do so, it will be a quick and painless procedure.
However, if you can't get the healing cap back on within 24 hours it will become much more complicated to put it back in. Instead of it being a pain-free procedure, your dentist will need to perform mild surgery in order to reattach it.
24 hour cutoff for easy fix
If your implant healing abutment comes off and you can get to your dentist within 24 hours, they can simply screw it back on easily. The entire procedure should take about 1 minute in total and it should be absolutely painless.
If you look closely at the healing cap, it actually just looks like a screw. You see the screw threads on one end and the screw cap on the other. The cap has an indentation where you can fit a screwdriver in it. That is precisely where your dentist will attach their screwdriver and screw it back on for you.
What to expect during the appointment:
Dentist will insert the driver into the healing cap.
Screw the entire healing abutment back into the implant.
Give it one extra twist to make sure it is tight and you're all done.
That entire process should take less than a minute to complete. We're emphasizing this because if you can get to your dentist the same day, the appointment will be a breeze.
We've created a video to show you how quick and painless the procedure is to screw the healing abutment back on. We'll be showing it to you on a stone model of an implant case which we did.
Solution is more difficult after 24 hours
If you don't manage to get the dental implant healing cap back on, the fix will become exponentially more complicated. Without the healing abutment on, the gums around it will collapse and grow into the space.
The perfect analogy for what the healing abutment does for the gum is what an earring does for your ear. While you're wearing the earring, it prevents the ear hole from closing. However, if you don't wear the earring for a while, sometimes the hole closes and you need to have it repierced in order to wear it again. An analogous situation occurs with your healing abutment screw!
In other words, you will NOT be able to screw the healing cap back in because the gum hole will have closed. Yes, the gums will grow into the hole and completely close it off!
In our experience, whenever we have a patient that has had the healing cap off for about 2-3 days, the entire hole is gone. The body's healing capability is very proficient because it can close the hole within that time frame.
When the healing abutment is in place, it prevents the gums from collapsing inwards. In fact, it forces the gums to heal around it which is why it is called the "healing" abutment. The shape of the abutment is a similar size as the implant crown so it prepares the gums to be the correct size.
Without it in place, the body thinks that its been injured so it will begin to heal and close the hole. It will actually close up the gums to the point where you can't even see the implant anymore
How to fix it once the gums have closed over
The only way to get the implant healing cap back on once the gum hole has closed is by redoing second stage surgery. Your dentist will need to make an incision into the gums and peel it open to reveal the implant. They will screw the abutment back on and stitch the gums back up.
Essentially this appointment will be like dejavu in that you're redoing second stage surgery all over again. Of course you will need to be numb for this procedure otherwise it would hurt to make an incision and peel the gums back.
We weren't kidding when we said that it would be painless if you can get it screwed back on within 24 hours. If you wait until after the 24 hour mark you will need local anesthesia to make it through the process.
Why did the healing abutment screw fall off?
There are two reasons which we can think of which may have loosened the healing abutment and caused it to come off.
It wasn't tightened enough. Maybe your dentist didn't tighten it enough. They typically want it tight enough so that it won't come off but they also don't want it too tight where they can't remove it.
Loosened while eating. Sometimes it can loosen and come off while you're eating. It's no fault of yours nor your dentist's. You were simply unlucky and it got unscrewed.
Having it too tight can be a problem for your restorative dentist because they need to remove it to take the crown impression. As an example, the surgeon that we work with who places the implant usually screws them in just tight enough.
However there have been instances where they stronghand tighten it that we have difficulty removing it. Sometimes we need to break out the torque wrench just to be able to remove it!
Can I screw my healing cap back in myself?
It is impossible for you to screw your implant healing cap back in at home because you don't have the proper implant driver. The driver is essentially a "screwdriver" but it is meant for implants.
Your screwdriver does not work because the shape and size of the implant driver are different. In fact, these implant companies have purposefully created a proprietary shape and size of the healing cap. That means whatever tool you have at home will not fit into your fallen off cap.
The image above is just an example to show you the amount of variety that the drivers may have for your healing cap and implant. Credit goes to Dr Ramsey Amin who does amazing implant cases and even showcases them in our dental facebook group.
Note: As a matter of fact, each implant brand insists on creating their own unique shape and sized driver that it has become a problem in the industry. If your dentist doesn't know what brand yours is, they most likely cannot help you put it back in. There is a complete lack of standardization in the entire industry.
In summary, you can't put it back in yourself because you don't have the right driver. You also have no experience in doing it either so the best thing to do is to see your dentist.
Is the healing cap even necessary?
The purpose of the dental implant healing cap is to shape the gums as it heals so that your dentist can take the proper crown impression. Essentially it forces the gums to grow around it in a certain shape that is identical to the crown shape.
It also acts as a placeholder so that the gums don't collapse in and close the hold. Whenever it comes off and you wait too long, your body will actually try to reclose the hole thinking that you've been injured.
If the gums close over because you've been missing the cap, your dentist will NOT be able to take the implant crown impression. That means you won't be getting your crown unless you get the healing abutment back on!
How long does the abutment take to heal?
Typically, the implant gets uncovered with the healing abutment placed durinimplant crowng second stage surgery. After it is placed, you must wait a minimum of two weeks of healing before the healing cap is ready for an implant crown impression.
Prior to the 2 week mark, there may be too much bleeding and not enough healing for the impression. It'll make for a very inaccurate mold of the implant if you do it before allowing it to heal for two weeks.
What to expect during the impression appointment:
Place impression coping.
Remove coping and replace with abutment.
Wait for lab to make the tooth cap.
If your healing abutment comes off, you should contact your dentist immediately. Having it placed back on within 24 hours is a much simpler solution than waiting longer than that. If you wait too long, the gums may collapse inwards and completely close the implant hole. Once that happens you will need to do minor surgery to reopen the hole just to get the healing cap back on!