Broken locator abutment: best way to proceed?

This an 82-year old patient who presented for a comprehensive exam. She has an FUD and had implants placed at 6 and 11 many years ago. Implant 6 exfoliated several years ago. Patient gave me the Locator abutment thinking the entire implant came out. This is the radiogragh. I have a couple of questions. Does it appear that something is broken at the crestal end of the implant or is that just the shape of this implant? If the patient wanted to leave this alone for financial reasons, is it ok to not have a cover screw and let the tissue fully enclose it? Right now there is still a small opening and I offered to do a gingivectomy and re-insert the abutment . She understands that one implant is not a good situation.



11 thoughts on: Broken locator abutment: best way to proceed?

  1. Mark S says:

    Since I posted this I was able to get a closer look at the abutment and see the some of the screw is missing. I have to assume it is in the implant because I felt into the opening with an explorer and hit a blockage. The patient does not intent to retrieve the broken fragment at this time due to other health issues. I would still like to know if any of you would have worried about letting it close up without a cover screw. Thank you.

  2. Dok says:

    Smooth any rough/sharp spots around the fractured abutment and let it be. Zest probably has a fractured abutment removal tool if you ever decide to retrieve the broken piece. Sounds like the patient is fine with just leaving it alone and if so she should be brushing/rinsing the area regularly.

  3. Dale Gerke - BDS, BScDent(Hons), PhD, MDS, FRACDS, MRACDS (Pros) says:

    Ideally you would remove the broken screw using a simple reverse screw remover bur (cost about $50 from Nobel or Astra). The bur is easy to use but best done with a reduction handpiece. Then place a healing abutment and it should settle without any long term problems. If you reline the denture after placing the healing abutment you might even get some partial assistance for stability and retention (a soft lining will work best).

    • Ed Dergosits DDS says:

      I would likley do nothing. If the fractured abutment is removed and a healing abutment is placed you might gain some support when the denture is loaded. I do not think that stability or retention will be improved.

  4. Agim Hymer says:

    book the patient in end day or before lunch if you dont want to eat. Get the bur removal kit. Get good access and view of the screw and have a go. You will then be an expert. Like taking out a hooked root on a lower 8 with limited access. Breath and focus. Enjoy.. it is doable. I think if you leave it alone it may become infected then you are triphing the whole implant that I find is harder.

  5. Gregori M Kurtzman DDS says:

    The comments about retrieving the broken screw totally ignore the original posters comment “The patient does not intent to retrieve the broken fragment at this time due to other health issues.” So it does not matter if or how that broken screw is removed the patient does not wish to do it due to other issues.

  6. Carlo says:

    I do not see anything wrong with the cervical portion of the implant. I think this is just the shape of the implant.
    3i external hex implants looked like this on radiographs.

  7. Sean Yockus

    The external hex portion of the fixture will feel textured no matter what. Sometimes the hole in the gingiva will stay patent. Other times the tissue will gradually creep up over the implant fixture’s head. The suggestion to relieve the overdenture and place a dab of soft lining material there is smart. Chances are that the Locator abutment broke off at the juncture of the neck of the male threads: straight stalk on the abutment. However, if there are still male threads on the Locator abutment as you look at it in your hand, the thread portion could have broken off in the middle of the threaded portion of the abutment.
    In 24 years of Prosthodontic practice I have found some broken abutment screws stuck in external hex implants to be stubborn and feel like they are ‘cold welded’ to the implant. They simply will not budge. Other times light, magnification, & a 1/4 or 1/2 carbide round bur run in a high speed with counterclockwise hand motion can back them out easily.
    These cases typify the need for more than 2 implants to support a maxillary overdenture even if they are designed with full palatal coverage. Bruxism is hard wired into the brain and it persists even with removable prosthetics. This also begs the question, ‘does the patient sleep wearing her maxillary appliance’? Even as I suggest and educate patients not to wear their removable prostheses when they sleep old habits and vanity out weigh what we as dentists perceive as common sense. The Locator abutment is far and away the best overdenture abutment for both retention and ease of maintenance in my practice. There are lots of patients who will fall on the far side of the bell curve of normal load & fatigue scenarios for even the best implant componentry.

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