Salvaging an implant with a fractured hex via post/core

Dr. Carter, Thank you so much for sharing those pics. Very informative and much appreciated. Good rescue!!

The fiber core will break. Your on the right path. A casted gold or SP metal core could work. Cement with Panavia. Interesting case.

Please repost the result in 5 years. I doubt it will last that long. Either the bone loss will continue due to the exposed rough surface or the neck of the implant/core material will break again due to occlusal over load. When something rare like an implant fracture, or more often porcelain on crowns breaks, those are BIG RED FLAGS ....occlusal overload. 1) Bruxers, 2) Men, 3) lack of molar support, 4) apposing arch is teeth or worse implant supported with no proprioception. Good luck.

I have had to repair a broken implant by fabricating a new post-crown with a 1mm cervical collar and knife edge margin. It was not an ideal situation but with existing bone loss and some limited recession, fabricating a new crown with the crown margin AT the gingival margin was a satisfactory and clinically viable option. Explanting, regrafting, reinplantation and new crown is just not an option for some patients. This is clinical dentistry. And yes, all those factors that went into creating the implant hex fracture mentioned above have to be taken into account when addressing a solution, and they are all great comments. Thank you for sharing. Bill

I would also like to add that in this particular case, the implant situation is very underengineered for the job. It is too small and the patient should be told that in the long run this fix IS a temporary solution. Very light occlusion and axial loading with give this the best chance for some longevity.

Looks like a difficult fix. Just rigging it as suggested seems doubtful. More dental fun with implants......

From the radiograph provided, It obvious this implant is undergoing bone loss...which will continue until the support is no longer sufficient to maintain the implant ….. that being said, if the patient does not want to go through a surgery to remove it at the present time, and wants to ride it out for as long as it will last....then so be it......to add to Richard Hughes' suggestion.....I full agree, and recall the days when angled abutments were not available......so what we would do was to loosely fit a plastic swizzle stick into the internal portion of the implant, cut it to the right height; lubricate the internal portion of the implant with separating medium, and then place a thin mix of Dura lay or other acrylic resin into the hole, and seat the swizzle stick.....wait a few minutes, until it would set and bond to the swizzle stick.....then prepare the plastic post in the same fashion as would be done to a natural tooth..With a pair of plyers, or very tiny vice grip, hold the coronal portion of the newly fashioned post....and lift it off.... if it does not come off....place a spring loaded crown and bridge remover under the plyers or vice grip.... as close to the post as possible....and tap it off..... then it can be cast in any sort of metal.... a fibre post and composite build up is not a good idea...it must be a casting…. and I have some of these posts that were used to correct angulation problems...going on 40 years...…..

A better approach in general is to lute an implant abutment into the implant with Panavia then prep as needed. That will be stronger then a composite core and easier then a cast post/core. But in this particular case the implant has 50% bone loss and better approach would be explant and new implant placed at the correct depth

These are all great comments. Like everything else in life, experience is important. Keep in mind the patient wants you to fix their problem. They do not want or deserve temporaries. Take the implant out or refer back to the original dentist or a prosthodontist.

I recently had a similar fix . I carefully drilled into the implant where a cemented abutment that had broken was stuck . I prepped the implant head and using durallay built a cast core that I cemented onto the beveled implant .

I think this is valuable information for a difficult situation, have the patient sign a very detailed informed consent. Sometimes and I’ve seen this patient will be happy with the extra time with a failing implant if they are forewarned. I’m very impressed with these treatment scenarios well thought out.

Wow. Thanks for sharing this case, much appreciated and a very interesting solution indeed. I would add that there is a way to ensure longevity of such a restoration, which has to do with proper distribution of occlusal forces. Implant fractures happen for a reason. Dr. Greg Kammeyer has mentioned above the magic word - occlusal overload - yet the whole concept of overload is ill-defined in the literature and we don't currently have a set of criteria to judge whether there would or would not be an overload in specific cases. We think that in any implant-restoration case, we shouldn't talk about overload but rather about proper distribution of the occlusal forces, and we achieve that by providing passive and definitive seating on all implants, eliminating lateral shearing forces as much as possible, and therefore reducing leverage as much as possible. In the case above, I would have suggested to prepare a shoulder upon which the restoration would be definitively seated. In knife-edge margins minor movements of the restoration vs. the abutment keep happening all the time, while on a shoulder it can come to a visible resting position - and we all remember from Physics 101 that it's much more difficult to move a resting object than one that's already slightly mobile. All my suggestions may sound unachievable like the Holy Grail, yet we already have solutions to provide for them in every restoration, and you're welcome to click on my name here to take a look.

And by the way - those of you worrying about the bone around fractured implants fixed with composite buildups - here's a nice case of a single implant repaired with a telescopic abutment in 2012. The follow-up x-ray is from 2017. I apologize for the quality of the first x-ray, it was badly scanned - but on the follow-up you can clearly see the amount of new bone around the implant. See both x-rays here: https://www.dropbox.com/s/ierdn4dgyanmpzj/sos-repair-bone.png?dl=0

As per my comment above, I had a similar situation. See the case photos below. I carefully drilled into the implant where a cemented abutment that had broken was stuck . I prepped the implant head, and using durallay, built a cast core that I cemented onto the beveled implant.