retrieving a broken implant abutment

Recently, I had the not-so-pleasant experience of retrieving a broken implant abutment. This was a really challenging case. As a result, I would like to share some tips with you about what I learned.

1. First, the more magnification and light you have available, the better. I was really happy that I had put microscopes in my office last year. If you don’t have enough light and magnification to get great visualization of the piece you need to retrieve, I suggest you refer your patient to someone who does. Being able to clearly view things is critical to ensuring you don’t damage the implant. If you do damage the implant, you’ll have to replace the abutment and crown - and also remove the implant to place a new one.

2. If there is a portion remaining you may be able to grasp it and pull out the abutment.

3. Try to get an instrument under the most apical portion of the remaining piece and pull it out.

4. The next thing I suggest trying is vibrating the broken piece loose with an ultrasonic. The key here is to only touch the abutment and not the implant itself.

5. Without it spinning, take the largest football bur you can fit inside the abutment without touching the implant surface and “bip” your rheostat. The goal is to knock the abutment loose.

6. After trying the previous steps above, I was left with only one option - and a stressful one to say the least. I placed two grooves in the internal surface of the abutment. This allowed me to place a small flathead screwdriver in them and break the abutment out.

7. My final tip is to make sure you have allocated plenty of time. You might get lucky and have it come out easily; however, in my particular case it took about an hour and a half.

What other methods have you tried? Let us know below.

John R. Carson, D.D.S., P.C., Spear Visiting Faculty and Contributing Author - www.johncarsondds.com


Comments

Commenter's Profile Image Tom Ryan
April 11th, 2013
John, was the abutement screw broken?
Commenter's Profile Image John Carson
April 11th, 2013
Tom, no the screw was fine, literally just the top half of the zirconia abutment had fractured. The pieces pictured here are actually what I got out of the impant.
Commenter's Profile Image Sandra Cove
November 12th, 2013
How would you suggest removing a broken screw? It seems very scary to me!!
Commenter's Profile Image John Carson
November 12th, 2013
Sandra while I have never had to remove a broken screw from what I have heard from others I know that have had to do this there are various screw removal tools from implant manufacturers and in addition if you can touch a bur, rotating counterclockwise, that may work. This being said my first call, before trying anything, would for sure be to the implant manufacturers tech support line for their suggestions. Then what ever you use the more light and magnification you have the better...and yes, it's going to be at least a bit stressful but just be calm, careful, and take your time the worst thing here is to rush. Know that there is a good chance the screw is already a bit loose due to it breaking so you have that on your side.
Commenter's Profile Image Sten
February 18th, 2014
John, have you got any idea of how to retrieve an AstraTech abutment (w/ internal hex) that has sort of being "welded" onto the inner surface of the implant? Bridge screw removed. Tried then to knock out abutment but stuck.
Commenter's Profile Image John Carson
February 18th, 2014
Sten, that's exactly what happened in my case pictured here. The small piece in the bottom of the picture was "welded" in the implant. My suggestion would be to follow the tips and steps I went through above. Let me know how it goes and good luck, John
Commenter's Profile Image Sten
April 8th, 2014
John, my colleague (prosthodontic specialist) managed finally after a long time of hammering and ultrasonic (an hour and a half and after that he had to send the patient home and she needed a second visit!!) to remove the abutment w/out damaging the implant in the end! Thanks for your good advice! /Sten
Commenter's Profile Image John Carson
April 8th, 2014
Sten, I am glad it worked out!
Commenter's Profile Image Jason Fligor
December 4th, 2014
I had this situation yesterday. Two screw retained crowns, 13 and 14. Both were Keystone implants. Abutments were Atlantis Zirc. Both were broken off at the implant level and both had a collar of zirc left in the implant. The internal shape was a lobed-flower type design.... so no luck spinning anything out. Also, as another mentioned, it seemed like the broken pieces were 'cold welded' into the implant. Careful bur work allowed me to get the pieces thin enough that I could use a variety of instruments on my normal restorative tray to break out little piece of zirc one by one. Good vision was key, proper time would have been great.... the other issue was tissue management as the tissue was quite inflamed and bled continuously.
Commenter's Profile Image Sam W.
November 2nd, 2017
I have an implant crown I need to remove, due to tissue discomfort (secondary to pressure exerted by the implant crown). Despite removing the screw. The implant crown (screw-retained) will not come out of the implant. It seems as though a cold weld has formed between the implant and final abutment. Any suggestions on this front? Have been contemplating taking exo forceps the crown and wiggling it. My concern is breaking or damaging the implant itself. Please advise!
Commenter's Profile Image John C.
November 2nd, 2017
Hi Sam, Sounds like you have something like an Astra or Straumann connection so you still have a very tight seal I would try these http://www.gcamerica.com/products/operatory/GC_Pliers/ As you have already been doing (smartly) just be careful and as gentle as possible. Hope that helps, John