Fractured ratchet driver in internal hex: how to remove?

Last Updated: Jul 13, 2014

I was inserting a 6mm diammeter implant in #19 [mandibular left first molar; 36] and upon torquing down the implant, the ratchet driver fractured inside the internal hex connector. The fractured segment is firmly wedged in the internal hex connection and cannot be grasped and removed. In order to not disturb the primary stability of this implant, I decided to not attempt retrieval of fractured portion at the time it happened and have submerged implant to heal for 3-4 months. Can anyone recommend to me how to remove this fractured segment in 3-4 months when I do 2nd stage uncovery?

Fractured ratchet driver in internal hex connection

9 Comments on Fractured ratchet driver in internal hex: how to remove?

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CRS

07/18/2014

I hate to say this but the time to remove the fractured instrument was at placement when the implant could have been removed, it would have been a lot easier. Now whatever you do to drill this thing out there is a chance the internal threads of the implant can be damaged. Unless the hex driver was very old and fragile the force to seat the implant should not be enough to fracture it in dense living bone. Now you have an integrated implant which can be damaged vs a non integrated implant with more options. That said drill in the center of the damaged instrument let the edges flake off irrigate the implant and place the healing head. Using the neo biotech screw remover kit will also help. At the surgery it seems there was plenty of stability and if there was an issue the implant could have been replaced with a slightly longer implant since there is space on the film. The waiting just made it harder, the stakes are higher since the implant is integrated there are less options if the piece can't be removed without damaging the threads. Good luck and learn from it. I hope you see my logic and don't take it personally.

a yong

07/18/2014

Hi CRS, thanks for your reply. Yes, I will definitely learn from this experience. I understand your logic that waiting narrows my options if the fracture portion can not be removed. I decided to bite the bullet and called the patient back today (5 days after implant placement) and did as you said, drilled centrally through the fractured fragment with a tungsten carbide fluted bur, thinning out the fractured portion. After thinning out, still could not get the thing to budge, so I had to drill through one part of the fractured portion and inadvertently knicked 1 wall off the hex connection. However, this allowed me to get the fracture portion out and placed a healing abutment. So all good now!

CRS

07/18/2014

Well done!

Richard Hughes, DDS, FAAI

07/19/2014

This is a sticky wicket! I am suggesting an ultrasonic scaler and endodontic files. This could happen to any of us. I wonder if PVS impression material would help to remove the fractured driver.

a yong

07/19/2014

Hi Richard, thanks for reply. Can you explain to me how PVS impression would help remove the fractured portion? Were you thinking of the suction force the material would create as I lift it off the implant platform??? I did try using ultrasonics, but it didn't work as the fractured portion was FIRMLY wedged into the hex connection.

Richard Hughes, DDS, FAAI

07/20/2014

I really don't know if it would work. This depends on how tight the driver is wedged into the female portion of the implant. I have done tis in the past to retrieve items from teeth.

Darwin

08/09/2014

May I ask what implant this is? Thanks, Darwin

andrew

08/09/2014

Darwin, this is a cortex internal hex implant - equivalent to an MIS 7 implant.

Richard Hughes, DDS, FAAI

08/10/2014

The time to remove the fractured driver is at the time of surgery. The use of rotary instruments is required. This is unfortunate and could happen to any doctor. It's not a MIS-7 but some other internal hexed implant. This point is moot. The use of an ultrasonic scaler may be useful

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