Internal Connection Implant is Broken: Leave or Remove?

I have a 55 year old female patient with no medical complications who presented to my clinic for consultation. In her left lower side there were 2 old implants in positions #20 and 18 [mandibular left second molar and second premolar; 35, 37]. Both were of internal hex type and in x-ray as well as clinically I diagnosed that they were fractured and without healing screws in place and obviously no crowns. After examining the CBVT scan and after exploring the 2 implants under local anesthesia I realized that the implants were very well integrated in the bone at this point and there were absolutely no symptoms at all for years . The patient wants to fill the gap with teeth. Should I take the broken implants out and then replace them ? Would it be enough to leave the broken implants as is and install new implants in #17 and 19 sites [mandibular left third and first molar; 38,36] and connect them with a bridge?

12 Comments on Internal Connection Implant is Broken: Leave or Remove?

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CRS
12/14/2012
Is the abutment screw broken off? An X-ray would be helpful. What was fractured?
Richard Hughes, DDS, FAAI
12/15/2012
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
12/16/2012
Dr Hughes, does this mean that a "flowered"or broken implant can have cement directly placed in the hex inside the implant to hold an abutment? I have a case with an integrated implant above the v3 nerve which I don't want to remove but the first two threads are flowered. It can't hold a healing head. I ' m not sure what to do. The patient is stable but the is early peri implantitis but a stable implant. I was going to allow the implant to fail so that it would be easier to remove. I tried. The BTI implant remover with the torque wrench to no avail. It is a Nobel tapered implant. Please advise.
Richard Hughes, DDS, FAAI
12/17/2012
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.
CRS
12/17/2012
Thanks very helpful
Peter Fairbairn
12/17/2012
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
CRS
12/17/2012
Nobel 4.3 trilobed placed to buccal, but patient developed peri-implant its with a small abscess @6-8weeks I did not get case referred back to me for timely treatment so I had 50% bone height but osteointegrated. I attempted grafting no good. Nobel rep was no help, attempted removal with the BTI wrench, I suspect that's how flowering occurred. Now I am watching it fail I'm willing to try the Neobiotech but not sure if the flowering will effect the removal. It is getting to the point that I may be able to trephine without going to the base and remove. I think I 'll post the film when the patient comes in next month. Thanks for advice.
Dr G John Berne
12/18/2012
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
Gerald Rudick
12/18/2012
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.
Dr Trevor
12/18/2012
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.
aalhaio
12/19/2012
dear CRS the description of the case is not enough the most important thing we must ask about is the cause of fracture is it the bruxism or cleanching or any thing els. . second thing to which extend the fracture is and the depth of the gum at that site, I think if you can reach the intact level of implant by gingivectomy and smoothing the fractured internalhex so add another implant in between them and smooth the threads inside the implant and take impression and treat them as apost and crown but still the figure not clear about your case to decided which the best method of managing the problem
Alex
12/25/2012
Trephine them out. Graft and replace with new implants. Preferably of stronger alloy.

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