Implant crown occlusion: adjusting a high crown

Why is occlusion on an implant crown different?

Occlusion on an implant crown is different because the implant has no periodontal ligament. A natural tooth intrudes slightly into its socket under load and senses that load through ligament mechanoreceptors; an implant, fused to bone, barely moves and sends back less tactile information. A crown adjusted like a natural tooth takes the full load first.

Kim and colleagues (Clinical Oral Implants Research, 2005) list what overloads an implant: long cantilevers, parafunction, poor occlusal design and premature contacts. Koyano and Esaki (Journal of Oral Rehabilitation, 2015) note that the ligament cushions load and supplies the tactile sense an implant lacks.

The limits need saying. Both papers conclude that no implant-specific occlusal concept is backed by clinical trials: the guidance comes from biomechanics and practice. What follows is the clinical consensus in use, and each case is your call.

Where should contacts land on an implant crown?

Contact on an implant crown should be graded: light or absent in light closure, full only in firm closure, once the natural teeth have intruded into their ligaments. That’s the scheme Stilwell describes (British Dental Journal, 2024), with ITI illustrations, checked with shim stock.

On a posterior crown, the contact sits centered in a wide fossa, with shallow cusp angles where esthetics allow, and there’s no lateral or protrusive contact. Anterior guidance stays on the natural teeth where they exist. If the contact can land on the composite that seals the screw access, adjusting and renewing it is simpler.

Why do implant crowns arrive high?

An implant crown can arrive high for four reasons, and only two of them are fixed by grinding. The table sorts out the signs of each.

A digital bite record is accurate in many situations, though not all. In Shadid and Sadaqah’s systematic review (The International Journal of Prosthodontics, 2022) of 28 studies, virtual articulation matched conventional methods in complete arches with stable contacts and a single prepared or missing tooth.

Accuracy dropped with the articulation technique, the number, size and position of the buccal bite scans, the length of the scanned arch and the size of edentulous areas. In a patient missing several teeth, the bite needs extra care.

The opposing arch and bite that belong on the Rx are covered in why implant crowns get remade.

Adjust chairside or send it back to the lab?

Adjust chairside when the excess is local and the grinding stays well clear of the material’s minimum thickness; send it back when the whole crown is high or the adjustment would thin it out. A crown that’s high all over points first to the bite record, and grinding there hides the error.

After adjusting, the surface has to go back to a high shine. Stilwell (2024) calls for repolishing every adjusted area. In Aljomard and colleagues’ meta-analysis of in vitro studies (Journal of Esthetic and Restorative Dentistry, 2022), polished monolithic zirconia wore opposing enamel less than glazed zirconia. The authors conclude that surface texture matters for wear.

Minimum thickness for each material comes from the manufacturer’s instructions for use; reference numbers are in monolithic vs multilayer zirconia vs e.max.

What does a high crown do over time?

A high crown concentrates load on the implant, and the literature names occlusal overload as the main cause of mechanical complications. In Hsu and colleagues’ review (The International Journal of Oral & Maxillofacial Implants, 2012), those included ceramic and resin fractures and screw loosening or fracture.

Bruxism makes it worse. In Vidal and colleagues’ meta-analysis (Journal of Prosthodontics, 2025), it raised the odds of ceramic fracture 4.4-fold and of screw loosening 3.4-fold. Stilwell (2024) recommends a hard night-time appliance for these patients, such as a milled occlusal splint.

On the biological side, evidence is weak: Stilwell finds little unbiased evidence that overload causes bone loss around a well-integrated implant. If the screw has already come loose, the guide on implant screw loosening walks through what to do.

What should you tell the lab?

On the Rx, state the occlusal scheme you want: graded contact, no excursive contact on posterior crowns. Also say what the crown opposes (a natural tooth, an implant crown or a prosthesis) and whether the patient bruxes, because that changes the contact we design.

When a crown comes back for being high, send:

• The crown, with its Ti-base and screw if it’s screw-retained.
• Photos of the articulating paper marks in light closure, firm closure and excursions.
• The radiograph showing seating.
• A new bite record, scanned on both sides, if the whole crown was high.
• Where and how much you’ve already ground.

On a full-arch acrylic bridge, a worn tooth that has changed the occlusion is replaced as one of our repairs. We check every case when it arrives and on eight points before it ships. Ask how adjustments and remakes work before your first case. The crown itself is on the zirconia implant crown page.