Dental implant Screw Fracture

What are the steps to treat a dental implant screw fracture?

A separated or fractured abutment screw is not a good day.  In my experience most are loose and come out easily with a piezo.  If it doesn’t move immediately with the piezo I have never gotten them out without out drilling them out.

dental implant screw fracture

Steps for dental implant screw fracture removal with piezo

  1. Tap with piezo gently and see if spinning.
  2. If it is spinning will usually come out pretty easily fairly quickly.
  3. If not moving at all may be cold welded and not going to come out at all.

Steps for dental implant screw fracture removal with fragment fork

  1. Clean area and you better have high power loupes, 4.5x or higher, and a headlight.  Check to see if thread are damaged (if damaged check steps below)
  2. Place correct size Fragment Fork in slow speed and center on fragment
  3. Apply force to ensure engaged
  4. Reverse torque

Steps for dental implant screw fracture without anything special

  1.  Endo explorer, make sure it is sharp, turn the broken portion of the screw clock-wise 1/2 to 1 full turn, then counter-clockwise the same amount you turned in the screw piece in the first place.
  2. Repeat this several times.
  3. Do not screw in more than 1 full turn!!!
  4. This will  release the bur on the screw that occurred when the screw broke. It is tedious.

References
Fragment Fork Feb 11
Dentsply kit Nergiz 2004 JPD
Doing it without a kit Williamson 2001 JPD

  1. 1/4 round bur in handpiece place a dimple in center screw
  2. Place a buccal and lingual groove from center dimple
  3. Form a screwdriver out of a #1 bur by cutting it with a stone.

Imam JPD 2014

  1. Use fork to insert screw fragment deeper
  2. Use retapping tool (Zimmer has one) Yilmaz JPD Aug 2015
  3. Use fork again to try to remove now
  4. Use ultrasonics as needed

Other prosthetic problems

Implant with damaged internal threads

Companies sell tapping systems that retread the internal aspects but I wonder how well that really works.  Another option is to simply make a post and cement the post into a prepared internal aspect.  The picture below was an even more complicated case but the idea is the same.

damaged internal threads dental implant

X-ray showing how a drill through an impression analog can accurately remove a screw or post inside a dental implant that has had the internal threads damaged.

 

Fracture zirconia abutment

Dentaltown thread on problem.

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