Abutment hex is welded to implant: options?

Generally the component is simply wedged tightly and there is limited leverage to remove the remaining portion. I use a customized instrument to insert tightly into the remaining abutment portion and the wiggle the piece loose. This is obviously not a routine procedure and experienced hands are needed. You might contact Dr. Michael Norton or Dr. Stephen Jacobs; both are amazing and have been around the block on complications. Good luck

A radiograph would be helpful. Contact the local Zimmer rep and ask to borrow the tool they have to remove a broken abutment. The hex isnt welded in but may be frictional pressed in. Can you post an intraoral pic of the top of the implants connector?

Hi Montana , thank you for the contacts, I will try and make contact with both doctors. Thank you, very much Gregor, the dental surgery has provided me with the radiograph as the oral surgeon is looking for any kind of guidance. I do not know if I can post these but will try.

Your surgeon or restorative doc can utilize a Zimmer Abutment Removal Tool to break the weld. It engages the threads of the implant and then pushes the abutment up/out.

Hi Mary, the Oral surgeon told me that he had contacted the suppliers of the Zimmer implant and abutment and the supplier only have equipment to remove a broken screw and not the remainder of the hex abutment. Does anyone know how I upload on this forum, if so, I can post my radiographs and pictures.

Top Doc in world for removing broken implant components. Dr Charles Mastrovich in Escondido California. Why not make it a Cali Vacation at the same time. He has a machine shop and can custom make a device to remove broken screws and parts. He is the "go to Doc " for many of the implant companies here in US. A flight to California is faster and less expensive than implant removal and replacement, in my opinion.

There are abutment "removal/remover/lifter" DRIVERS, specifically intended to "lift" the abutment out of the implant by dismantling the implant-abutment connection. It (this device) engages the broken and "contained with in the implant segment" of the original abutment. Note: I gather, that the abutment is broken at the top of the HEX and that, the abutment screw has come out as well. Since oral surgeons do not face this kind of complications on a regular basis, a prosthodontist would be the right person to come up with a solution for the problem/complication. Depending on the "maker" of this specific implant.... the problem is quite simple to resolve!!!

Hi Ashwath, thank you, I will seek to find an opinion from a prosthodontist and also from the doctors who Montana has recommended and will keep everyone updated. I have attached my radiograph.

The crown

Has anyone tried an ultrasonic tip to vibrate out the broken abutment, we have had success with a piezo scaler

It appears that the hex portion became separated from the rest of the abutment. An ultrasonic instrument with a fine tip applied the the broken hex portion for a few seconds may well loosen this component and vibrate it up out of the implant. The important thing is not to damage the inside of the implant.

Ask your dentist to try to use a fine diamond bur to cut through the broken abutment and then try to loosen it with a fine straight screw driver or a probe! They need to be careful not to cut through the implant itself. I am a prosthodontist who places implants too and work in London. If I can be of any help please let me know!

Hi Karen . I’m a Periodontist in Beverly Hills, CA , I have had EXACTLY the same case happened TWICE! And both times on the same patient ! .. and same implant !!! And wait .. it gets better .. both ZIMMER implant .. on lower right molar !!! I have gone through lots of hours, lots of $ spent , and EVERY SINGLE remedy and suggestion I read here , with no exception including: - the zimmer abutment remover tool; ( does not work in the case of hex head fracture!) , - the TLRT2 special hex removal tool (ordered , tried for 2 hrs, not fruitful ) - cutting in to the hex head: and carefully elevating ( not responsive) - the final remedy was ULTRASONIC scaler , very thin piezo tip , used gingerly and carefully not to touch the inner implant treads . Needs good level of patience , and manual dexterity /visual acuity. It shoild work , and it will be tiring , but it is FAR better than removing the implant ! Please feel free to let me know if I can help you .

Thank you all for your advice, this is sincerely appreciated. Dr Markzar, I will try and find a periodontist, if I am unsuccessful in the UK then I will have to come to the states. Can anyone advise what is the difference with a prosthodontist and periodontist. The surgeon who first attempted removal is an oral surgeon. From all your help and advise I know that I need either a prosthodontist or a periodontist but not sure which of the two would be better to go and see.

Might I suggest section the remaining hex head remaining in the implant at 4 points- Mesial, distal, buccal, lingual then in- fracture the 4 sections. Use illuminating loupes, water cool, use a flowable gingival dam to protect tissue from shards of titanium flying about. It's an internal hex stuck in the implant you're trying to remove, right? Can be done with patience, steady hand, and a few beers (beers after successful treatment).

It is not uncommon for the hex portion of the abutment to fracture off...whether it is a cast abutment, or a stock titanium abutment....... from an engineering point of view, when looking at the size of the crown that is being supported by this little piece of metal ....... it makes not sense...but until we figure a different way to add an antirotational device. this is what we have to deal with. The suggestion of using a peeso scaler with a small pointed tip to vibrate it out. is the best advice.

Dear Dr Rudick, thank you for your suggestion. My abutment was titanium and it makes perfect sense that it would fracture off as the screw is very slim in comparison to the crown. I contacted a Periodontist who advised they would apply dry ice to freeze the component and hopefully it will dislodge. As I had already contacted a dentist who has experienced this problem and agreed a date to attend his surgery I have not taken up this option. Does anyone have any experience or knowledge about the dry ice and freezing method.

Dear All, I wanted to update you regarding my broken abutment hex, Dr Michael Norton was able to remove the abutment hex a couple of weeks ago. He took roughly 6 minutes to dislodge the hex which was amazing . Neither did I experience any pain or swelling . I can not express how grateful I am that I do not have to remove the entire implant. Thank you Montana for recommending Dr Norton.

Hello Karen, I have never heard anything about using dry ice to remove a fractured off part of a hex......usually a fine tipped ultrasonic tool will do the job..... save the dry ice to put into the drinks you will be having with your dentist after he dislodges the broken hex.

What if you inserted the restorative screw a thread or two into the broken hex being careful not to engage the internal implant threads and simply take a hemostat to grab the head or the screw screw and wiggle the hex out?