Internal Connection Implant is Broken: Leave or Remove?

Is the abutment screw broken off? An X-ray would be helpful. What was fractured?

You may want tontry cementing the abutment to the implant with Panavia. Read the instructions first. You may be quite amazed at how well this works. I have donenthis in the past (6 yrs ago) and it's still going strong and in a bruxer.

CRS, in your case remove the abutment, rem one the damaged portion of the implant and smooth out and put it to sleep or let fail.

Hi Again CRS , cemneting abutments was protocol for many systems 20 years ago , personally I thought it was a nightmare as hard as I tried they came out regularly. Was the Implant a 3.5 with a trilobe whcih had not been placed to manufacturers protocols ( ie a lobe facing buccaly ) which is a sight often seen . This would be difficult to cement due to the nauture of the "flowering " you described , but you can re-use some types of fractured Implants. The Neobiotech system is great for removal at 250 nm reverse torque not sure if the BTI system is similar. Wating for the "peri-implantitis " to help do the job may take a lifetime unfortunately. Regards Peter

Without radiographs it makes it a little difficult to comment, but if the implant itself has broken, then it is probably kaput. One of the problems of using cp titanium implants with internal connections-they can be very weak. Suggest you keep to titanium-alloy implants if you want to use internal connections, particularly if they are narrow implants. As to what to do with the remaining broken implants? I would suggest that you surgically remove them, with a trephine if possible, and then replace them after healing. If the implants are well integrated, then the bone should be excellent for implant replacement

It is difficult to offer advise when we do not have all the facts. We are told the an internal hex implant had a fracture.....where? at what level? is it only a part of the wall forming the internal hex? With the tapered implants that have aggressive threads that literally cut their way in as you are driving them home, a great deal of force is put on the internal hex walls..... as we are told by the manufacturers that you can put a lot of torque on them to drive them in......the walls of the internal hex are the weakest part of the implant, and I am certain that many implants installed into tight osteotomies are suffering stress fractures at the time of placement........ in other words they are weakened and damaged even before they are loaded. That being said, if an abutment can be screwed tightly on to an implant, and there is no rotation, then why not build temporary or provisional crowns and watch them for several months to see how they respond...you might be surprized to see that they will function just fine. The idea of trying to remove a well integrated implant would be my last choice....reverse torquing will usually only cause more harm to the implant, and trephining it out will destroy a lot of bone........... so as stated above, try to use it as is before being too judgemental. The implant manufacturers must start to make a TAP SET to correspond to each implant body, to preform the osteotomy, thereby eliminating excess force as the actual implant is screwed into place ....this should be manitory.

Many good suggestions. I am assuming the remaining mandibular teeth are stable and restored. My thought: if you decide to leave the implants in place and place the cantilevered 4 unit bridge (17-20), I would restore it with a screw retained bridge in case the original implants need attention in the future. If I were the patient, I would be receptive to that course of treatment. Strange to find two fractured implants. Do these have horizontal or vertical fractures? I have one patient with a a vertical fracture in the area of the internal hex, but the internal threads remained stable. It has supported a Locator abutment with no complications for 5 years.

Trephine them out. Graft and replace with new implants. Preferably of stronger alloy.