There are some procedures that I hope you never have to do. Unfortunately, I've had to remove a damaged Straumann solid abutment more than once, so I have a few tips to share that may make things a little easier and, just as importantly, less stressful should you ever find yourself in this situation.

Case Study: Damaged Straumann for an Implant in the #12 Position

close up x-ray of teeth, implant is in #12 position
Figure 1: The implant in the #12 position.
close up of implant with crown removed
Figure 2: With the crown removed.

The abutment was severely damaged, and the regular Straumann tool couldn't engage and remove it. Plus, the existing solid abutment would not work as a support or act as retention for the new restoration. So, the question became, what can I do to get the abutment out?

Tip #1: Contact Straumann for a Rescue Kit

The first step was to contact Straumann and order a rescue kit, which was provided free of charge. For a case like this, the critical components of the kit are the drill guide, drills, ratchet, and extraction bolt. Additionally, there is a guidance mount, a handle you can attach to the drill guide if desired. I held the guide with my fingers because it gave me the best feeling.

It's worth noting that Straumann's rescue kit instructions were updated a few years ago from when I first did this procedure. Generally, the instructions were similar but improved. Besides updated instructions, the rescue kit came with fewer drills than in the past, which was disappointing.

Tip #2: Follow Instructions Carefully

My point in communicating these rescue kit changes is that it is critical that you read and follow the kit instructions. If something in this article does not correlate with what you have from Straumann, you need to contact them for clarification. Any information from Straumann trumps what I am writing in this article. This is supplemental information, not to supersede what you have from Straumann. Finally, please note that depending on the case, the rescue kit comes with different guides, drills, and tools.

In my case, the shoulder of the implant was not covered, so I could place the RN2 guide on the shoulder and then drill counterclockwise into the solid abutment. Following Straumann's drilling guidelines, instructions are critical to avoid heating the implant.

occlusal view of RN2 guide
Figure 3: Top or occlusal view of the RN2 guide.
Side view of the RN2 guide
Figure 4: Side view of the RN2 guide.
The part (left) that seats on the implant collar in yellow (right)
Figure 5: The part (left) that seats on the implant collar in yellow (right).

Holding the guide firmly and steadily in a fully seated and stable position is stressful. Still, I found it easier to use my fingers versus the guidance mount because it provided me more “feel,” and I had plenty of access versus if this had been a second molar.

Tip #3: Reach Proper Drilling Length

The next step is to reach the proper drilling depth. And by the way, this will take longer than you think, and you will likely use every drill in the kit. The next step is to use the extraction bolt and ratchet in a counterclockwise direction to remove the solid abutment. The result should be the extraction bolt with a solid abutment on it.

extraction bolt with solid abutment
Figure 6: The extraction bolt with the solid abutment on it.
extraction bolt without the solid abutment
Figure 7: The extraction bolt without the solid abutment.

Removing a damaged Straumann solid abutment can be stressful but by following a few quick tips, you can successfully start the process of getting your patient on the path to better long-term results.

John R. Carson, D.D.S., is a member of Spear Visiting Faculty and a contributor to Spear Digest.