Removal of fractured implant screws: any ideas?

I have recently seen a patient who was treated in a dental hospital in Norway and had 5 maxillary implants installed that were then restored with a BioMain ( CAD /Cam) framework. She apparently wore this successfully for 2 years and then came to see me as the entire framwork was mobile and later completely fell out. It seems that that the screws have fractured in all 5 of the implants. The patient was told by her dentist that they are 3.5/4.0mm Astra Osseospeed implants. However I am uncrtain about this as the screwheads in the framework are too large for the torque wrench that I have for this implant system. I have tried unsuccessfuly to use the required Astra attachment with the motor in reverse to remove the screws but was not able to retrieve them. I tried to vibrate the screw fragments with an untrasonic tip but was also unsuccessful. Of course the question remains as to why they fractured in the first place: I am assuming occlusal errors. But for now I am intent on trying to remove the screws so the 5, well osseointgrated,implants are not rendered completley unusable. Any more ideas?

8 Comments on Removal of fractured implant screws: any ideas?

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peter Fairbairn

3/29/2013

Use one the SOS type screw removal kits where after fitting a collar onto the implant you then use a reverse removal driver . Seems to work for many different Implant types. Peter

John

4/2/2013

I believe the most likely cause of screw failure would be that the framework did not fit passively placing excessive forces on the screws resulting in sequential failure over time. Removing fractured screws is a frustrating and time consuming process. As Peter suggested using a screw removal kit designed for this purpose would be your best bet.

Angela Bayat

4/2/2013

This happened to me once with a Densply implant that I had placed! Long story, but I got it out under a microscope ( good loupes and lighting should do too) with the end of a perio probe. I did check with an x-ray to make sure that the screw was in straight. Hope this works.

Moz Khudairi

4/2/2013

I work with Osstem Implant in the UK and we sell a fantastic screw and abutment removal kit which not only assists with removing fractured screws or screws which have lost their screw head but also removes abutments which have friction/cold welded due to the morse taper connection. more information on the kit is available via our website osstemuk.com and you can find this kit on Resource Centre > Kit Catalogue.

Dr shyam mahajan Aurangab

4/2/2013

Till you buy screw removing kit. Good loupes , sharp probe ,with lot of patience anti clock wise teasing of # screw. Sometimes ultrasonic scaler helps. If & when screw loosens , use our three way air syringe to blow air - pop it flies out. Can anyone tell how to put pictures of patient on this blog?

Dr. Gerald Rudick

4/2/2013

If all the screws have fractured such that the prosthesis is no longer in the patient's mouth, then no screwdriver will be helpful.....only the threaded shaft of the screws remain in the implants. Best advice is to be patient, place a drop of WD 40 oil into the implant holes to lubricate the threads, and with an endodontic explorer, slowly and patiently, massage the broken pieces in a counter clockwise direction.....they should come out, and then irrigate the area with peroxide and sodium hyperchloride to clean the implants and remove any oil that may have remained. Dr. Gerald Rudick Montreal Canada

Tuss

4/3/2013

If it is the Astra system then the Biomane bridge is probably sitting on whats called a "uni-abutment" it looks like a small flattich cone with a possibly a cross-cut into the top surface of the abutment. The screw from th e Bimane bridge to the uniabutment is really small and narrow (15Ncm insertion torque) They notmally break flush with the unibutment. If that has happend then you will not get the screw fragment out. Get a highspeed and cut a slot into the unibutment and unscrew it. You will have to push hard and dont cut into the bevelled shoulder of the implant. You have two uniabutment, a taller 20 degree and a flatter 45 degree - you can order a new set of uniabutments and reseat then bridge then check the occlusion. Get you local astra rep to look at a PA of th e implants and they will tell you immedialty if there are uniabutments seated.

Tuss

4/3/2013

sorry for the typo's above, I had those overgloves on. I think 100% that the biomane bridge is sitting on uniabutments and if so then cut a slot, remove, order new ones and reseat your bridge - you want the Aqua connection uniabutments

Removal of fractured implant screws: any ideas?

8 Comments on Removal of fractured implant screws: any ideas?

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