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
- A ceramic veneer holder, like OptraStick, will grasp a loose screw and aid in rotating it out.
- The screw shank if there is a diagonal fracture. Azpiazu-Flores JPD 2020
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
How to check for internal damage after screw removal?
After a screw is out there may be internal damage if one of the methods you use can cut metal. To check this you can simply inject impression material into the implant and place a wedge of some sort into the PVS before it sets. When you remove the impression you can visually check for any obvious damage.
What to do if you can not remove the screw
There are several options for what to do if the screw fragment will not come out. First off and easiest would be to shorten an existing screw and see if that is long enough to still work. As long as a screw is 1.4mm long or 3.5 screw threads this should work. Yi JPD 2020 references 10-14 support this claim.
If that does not work then the next step is to retap the implant. There are special kits that implant companies make to retap the implants Carneiro JPR 2016. You would only want to retap the implant if it has a thick coronal portion.
As a last resort there is always implant removal.
The abutment of either a titanium or zirconia can fracture
Zirconia dental implant abutments are far more likely to fracture
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.
Titanium abutment fracture is more rare but can also occur.
We have a lot of dental implants in our practice and we have only seen this type of fracture once. However, there will always be something that can break and this is far better than the implant flowering!
Other dental implant problems can be found on this page.