Unfortunately, sooner or later, we all must deal with retrieving a broken implant abutment or screw. I would like to share a new challenge that I came across in my practice the other day, as I am sure other clinicians will have to face this situation at some point.
It started with a patient that came in after his implant restoration was giving him problems because the crown had come off. When we examined the patient, it was quickly apparent that while this was a cemented restoration, it was not the cement holding the crown or the abutment that had failed but, rather, the abutment itself.
In this case, the abutment was a custom abutment that was fabricated using a stock ti-base and a custom zirconia mesostructure that had been bonded or cemented to the ti-base. The failure was at the bond of the zirconia mesostructure to the ti-base. The ti-base was still 100% intact. Along with the screw, they were still in the implant while the zirconia mesostructure was out of the mouth and still firmly cemented in the crown.
As I looked at this, I naively thought to myself, “cool, this is going to be so easy to deal with” and “man, I am so glad something is not broken inside the implant.”
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I proceeded to remove the screw holding the ti-base in place. As I did so, it came out with no issue at all. At that point, I was even more excited and thinking, “oh man, this is sweet” and “now I am just going to grab it and it’s going to come right out ... life’s gonna be so good” and how after it’s out I will clean it and the intanglio of the mesostructure and re-bond the two, make an access hole in the crown and – presto! – we will be back in business with a screw-retained restoration that at minimum will be a great provisional and at best will continue to serve him as a definitive restoration for some time.
Well, those were great thoughts and I can bet you can make a good guess as to the sequence of events that unfolded next. First, I grabbed the ti-base with the normal hemostats I have in my tray for matrix band removal and gave it a gentle tug only to get no movement. As you might guess my next thought was, “well I just need to get a better grip and try a little harder,” so I tried that a few more times with the same hemostats. Of course, I still got nothing.
Naturally my next move was to go with a stronger, heavier hemostat. Still nothing. I began thinking to myself, “come on, this is not supposed to be this hard” and “well I guess I need something even stouter to grab the ti-base with.”
I grab a rongeur. As I do this, of course, I am thinking, “now this is going to do it for sure, yes it will mess the ti-base up, but we are getting it off now for sure.” Well it didn’t help a bit.
Lucky for me, I was able to get one of my great implant reps on the phone who not only knows his stuff when it comes to implants but since he worked in a lab for many years he also knows the restorative and lab side of things really well. He had seen this before. It turns out that sometimes ti-bases (and I’d guess abutments, too) can get sort of “wedged in,” particularly with implants like Astra, which this happened to be, and Straumann, or even if third-party abutments or ti-bases are used.
What was the implant rep’s suggestion? Well, it was to use something like endo ice to freeze or chill the ti-base, thereby slightly shrinking it so that those same tugs I had been trying would work.
Guess what – it worked! So, how do you do it? Well, it’s simple. You take a can of endo ice and attach the small diameter tube it comes with. Then you spray the abutment, being careful not to freeze or damage the surrounding tissue. It would be very easy to burn or freeze the tissue and damage it.
In my case, I actually put the small tip inside the screw access hole of the ti-base to assure I was not going to damage the tissue and to be certain I was getting the ti-base hit really well with the endo ice. It is also worth noting that it took several short, controlled sprays (just I was advised by my rep that it likely would) for it to work – so if you must do this, be patient. Don’t give up after just a few tries.
Be short, controlled and deliberate in your application, allowing the spray to do its job if you don’t let the ti-base re-warm fully each time. You will slowly get it colder and colder and eventually it will shrink enough to allow you to remove it.
While I hope you never need to try this if you find yourself in this predicament, I hope you find this solution helpful!
John R. Carson, D.D.S., is a member of Spear Visiting Faculty and a contributor to Spear Digest.