What are the steps to treat a dental implant screw fracture?
Dental implant screw fracture on you and need a solution? A separation or fracture of the 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. The dental code for a broken screw removal is D6096.
When the dental implant screw is loose
If the screw is loose there are many tricks you can use.
- Place a small piece or rubber band in the access, cotton, or maybe even plumbers tape to give a better grip
- Sharp explorer
Steps for dental implant screw fracture removal with piezo
- Tap with piezo gently and see if spinning.
- If it is spinning will usually come out pretty easily fairly quickly.
- 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
- 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)
- Place correct size Fragment Fork in slow speed and center on fragment
- Apply force to ensure engaged
- Reverse torque
Steps for dental implant screw fracture without anything special
- 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.
- Repeat this several times.
- Do not screw in more than 1 full turn!!!
- This will release the bur on the screw that occurred when the screw broke. It is tedious.
Mechanical kit without guide tube may be the fastest Panadero 2017
- 1/4 round bur in handpiece place a dimple in center screw
- Place a buccal and lingual groove from center dimple
- Form a screwdriver out of a #1 bur by cutting it with a stone.
- Use fork to insert screw fragment deeper
- Use retapping tool (Zimmer has one) Yilmaz JPD Aug 2015
- Use fork again to try to remove now
- 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.
Fracture zirconia abutment
Dentaltown thread on when a zirconia abutment breaks
JPD study from 2017 from Saponaro showing the novel use of a plastic perio probe to rock the piece back and forth.