Broken Abutment Screw on Implant?

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Dr. S. asks:

I have a patient with a broken abutment screw. The dental implant has an internal hex configuration and it is difficult to even visualize the broken screw head. How do I get the screw out? I do not have a surgical microscope. In all the courses I took to learn how to place and restore implants, this was never covered. Can someone provide some suggestions?

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15 Responses to “ Broken Abutment Screw on Implant? ”

• King of Implants May 27th, 2008

  
  

  Take a 1/4 round bur and make a trough from one side of the screw to the other. Then take a flat head driver and remove screw. I have tried screw removal kits and this technique works the best.

• Alejandro Berg May 27th, 2008

  
  

  Actually if this is an internal hex implant and the head of the screw is gone, you have to pull the abutment out and the remainder of the screw will be an easy reach with tweezers or an similar thing.
  If part of the head its still on the screw and stops you from pulling the abutment out, grind it untill its gone and the remove the abutmet and the screw.
  Remember that the screw will be in the center of the implant and there will be some space between it and the internal wall of the implant. I would practice this first on an analog so you will know what to use when the real thing comes.
  The small bur and slot driver works better on external hex implants.
  cheers

• david,omfs May 27th, 2008

  
  

  i slow speed in reverse can soetimes grab the screw and unscrew it the companies sometimes sell something that helps. a perio probe/explorer cansometimes be used to reverse

• Implant Rep May 27th, 2008

  
  

  The best thing is, of course, to avoid a broken screw in the first place. If not defective, or twisted off during abutment sitting, then it is due to the inherent flaw in all such implant abutment connections that allow a microgap and susequent micromovement that can, and frequently enough does, break off the screw.

• drwitt May 27th, 2008

  
  

  A 1/4 round bur in a contra-angle low speed running in reverse should spin the screw right out.

• Richard Cook DDS May 28th, 2008

  
  

  Nobel Biocare makes a tool which is somewhat like an end cutting inverted cone bur that is designed to be run in reverse. The end cut on the bur is reversed from that of an inverted cone used for cutting tooth structure. The Nobel Biocare tool is meant to be run counterclockwise very slowly and it “bites” into the broken screw and spins it out. It works fine for me. I only get one use out of it though. It dulls down and I have not had success reusing it a second time. So buy a spare. I have also removed broken screws by carefully cutting the broken piece down the middle with a quarter round bur such that you have made a slotted screw out of it and then place a very thin screwdriver into the slot that you have made and spinning it out. The implant manufacturers have thread taps to refresh the internal threads that you ( and I ) inevitably have damaged during the process. If no tap is available, I have used up one screw as a “tap”, run it in and out a couple of times until it feels smooth, and thrown it away and then place a brand new screw. Both methods have worked for me.

• Dr. Gerald Rudick May 28th, 2008

  
  

  The first thing you must do is to be able to see the top of the implant. If the abutment post has been off for even a short while, and the implant is submerged below the soft tissue; you will have to do a minor soft tissue procedure to see the implant.

  If you have access to a soft tissue lazer, then just reduce the tissue in a circular fashion…the same can be accomplished using electro surgery…..just be careful and avoid touching the metal.Either of these techniques will prevent bleeding, and visualization of the top of the implant will be accomplished.

  The diameter of the screw in an internal hexed implant is too small to even attempt to drill a slot into it.Drilling the screw will lead to the bur chattering and ruining the threads of the implant.

  Remember, regardless how tight you torqued that screw into place, with the head missing, the shaft of the screw is loosely fitting into the threaded area, and is easy to reverse turn buy messaging the top of the screw in a reverse ciruclar motion with a #5 dental explorer. Visualize it carefully, use drugstore available #3 reading glasses to magnify the field.

  Assuming you see clearly, you can also blow a blast of air on it and see it vibrate……if it does not move, you can try placing the point of an ultrasonic scaler on the top of the screw, and message in a reverse direction.

  Always look at the screw, check exactly where the top of the broken shaft is in relation to the threaded hole, and you will see it change…have patience….it will come out and you will not damage the implant.

  Gerald Rudick dds, Montreal

• Don Callan May 28th, 2008

  
  

  best to contact the implant company that made the implant. They SHOULD have the solution–Good luck
  You may want to contact Nobel Biocare, they have a lot of ideas about broken screws.

• Michael Feldman May 28th, 2008

  
  

  Find an endodontist who uses a microscope. Let him/her use the ultrasonic tips designed for post and separated instrument removal to unwind the screw. I have successfully done it for two of my referring Doctors patients. I found it quite fun!!
  Good luck,
  Michael Feldman
  Endodontist
  Hewlett, Massapequa
  New York

• Dr. J May 29th, 2008

  
  

  In the few times that I have had to recover a screw, I used an ultrasonic scaler with a thin tip on the top of the screw, the oscillations from scaler slowly reversed the screw out until I was able to grab to grab it with thin cotton forceps or use sticky wax on the end of a thin instrument.

• serge goldmann May 30th, 2008

  
  

  you can also try to lubricate the broken screw before unscrew it: just a few dops od the “old and well known” eugenol (or IRM liquid) will be perfect. wait a few minutes to action and try to unscrew, with probe and if not goes well, try a few times. in last try, precautionously make a slice in the head of the broken screw to be able to unscrew it with an instrument. trying to drill the screw along it could easily crate damage to internal wall of the implant, that could sometime be dealt by a special instrument (available at some copanies) for renewing the internal part of the implant (i didn’t try this: be cautious). last chance for using this implant: to cast a post an glue it. obviously, drilling the screw can move to perforation of the implant wall and you’ll loose it for sure/ good luck

• dr.amit narang May 30th, 2008

  
  

  its high time we should switch to tap in abutments and hence avoid these kind of screw fracture trauma for the surgeon and the patient

• GWB May 30th, 2008

  
  

  A simple technique that works the majority of the time is to simply take a cotton tip applicator, (the cotton end) and place it against the screw. begin turning it counter clockwise with light pressure against the screw. The fibers usually grab the screw and allow you to unscrew it with ease.

  If all else fails, try the above mentioned techniques with the last being attempting to drill a slot into the screw. It is nearly impossible to do because the screw will tend to rotate.

  I also recommend against sending the patient to another practitioner. If you made the money placing the crown, learn to handle the occasional prosthetic complications. Screws rarely break unless there is a problem with the restoration. Usually the use of clone parts that do not fit properly or hyper-occlusion.

  good luck.

• Dr. Emil Shiri June 4th, 2008

  
  

  It is rare to have an internal hexed implant with a fractured screw. I have been using internal hexed implants here in MONTREAL for over 20 years. But in your case the screw would only break if it was overtorqued during its initial insertion. In this case it will not be easy to remove. Don’t expect it to come loose with anything but a firm grip on it. To do this you must have adequate access. This may require that you cut away as much of the abutment as possible. Using lots of water cooling your highspeed drill section the abutment from buccal to lingual and take a screwdriver and break the abutment by twisting the screwdriver like you are removing a crown. When you can see and have access to the actual screw remaining use your judgement and either try to make a slot, or try flattening the sides so you have a grip on a flat end to rotate it. Good Luck

• nancy kohls June 6th, 2008

  
  

  Please Help. I had 2 implants tightened down and one the screw was broken, My bar is slightly higher on the broken side. The implants are intact. I had my over dentue relined and new claps, and Still not fitting correctly and painful,, couldn’t remove the broken screw. There must be a way~ Help me PLEASE.
  Sincerely, Nancy Kohls

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