How to safely remove a stuck healing abutment
A stuck healing abutment can be a little intimidating, especially the first few times you run into one. Often you are nervous you will torque the implant out. If that does happen with a stuck healing cap then the implant was not going to be successful anyway, so you did yourself a favor.
What are the first line of tricks to try to remove a stuck healing abutment?
First ensure you have the correct healing abutment brand and driver. If you have that then there are several tricks you can try up until the time you strip the head.
The first trick you can use is to put PTFE on the driver to give it better traction. This will help if you are having issues with the driver slipping out. If the driver is not slipping out you may need to switch to a torque wrench to remove it. Another trick you can use for a stuck healing cap can is to freeze it. This allows the healing abutment to contract and makes removal easier. You can do this with your endo ice. In conjunction with that put a piezo or ultrasonic tip on it to vibrate it. We have a tip that we use for post removals that is ideal for this but any tip should work.
Second line of tricks we can use
Typically at this point there has been some stripping of head of the healing cap. Your driver will no longer stay in place when trying to turn it. Thus now the second set of tricks involve alerting the stuck healing abutment. One of the best tricks is to drill a slot into the head of the abutment. Then use a slot driver.
To do this we use a 330 bur to drill a straight line through the abutment. Then we use a .017 slot driver from Avtec to engage the abutment. Lastly, we simply reverse it out with a standard torque wrench. Below you can see us using the technique on a ball attachment that had worn down.
The last trick to use to remove a stuck healing abutment
There are tools that reverse thread into a healing abutment and will remove it no matter what. They will destroy the healing abutment and will probably destroy the tool that you use to remove it. Most companies have a tool like this. We use the SXT from Implant Direct, which is in the picture below. We consider them a one and done instrument. However, you could get a vice and remove them from the healing abutment. They work the same way as implant removal
Stuck and custom final abutments finished
Besides the tricks above companies make kits to remove abutments that are stuck. Once you confirm the screw is out and that the abutment is one that is specific for the system then there is likely a kit. Nobel kits are here on youtube. One of the tools could be any piece of metal that you place into the abutment and is tall enough to give you more leverage to rock it back and forth.