Views: 222 Author: Dream Publish Time: 2025-03-09 Origin: Site
Content Menu
● Introduction to Broken Abutment Screw Removal
>> Why Abutment Screws Fracture
● Step-by-Step Techniques for Broken Abutment Screw Removal
>>> A. Montana Jack/Ultrasonic Scaler Technique
>>> B. Small Round Bur Notching
>> 2. Advanced Mechanical Extraction
>>> A. Reverse-Tapping Rotary Systems
>> 3. Customized and Emerging Techniques
● Essential Tools for Successful Removal
>> 3. Torque-Controlled Devices
● Overcoming Clinical Challenges
>> 2. Stripped Internal Threads
>> 3. Patient Anxiety Management
>> Case 1: Posterior Mandibular Implant
>> Case 2: Anterior Maxillary Implant with Corroded Screw
● FAQs
>> 1. Can a fractured abutment screw be reused?
>> 2. What's the cost of screw removal kits?
>> 3. How do I manage a screw fractured at an angle?
>> 4. Are there alternatives if the screw cannot be removed?
>> 5. Does insurance cover broken screw removal?
Removing a fractured abutment screw is a critical skill in implant dentistry, combining technical precision with advanced tools. This guide dives deep into broken abutment screw removal methods, offering actionable strategies, visual aids, and clinical insights to empower practitioners in managing this complex challenge.
Dental implants have revolutionized tooth replacement, but complications like broken abutment screw removal can jeopardize their success. A fractured screw disrupts prosthetic function and risks peri-implant inflammation or bone loss. Understanding the causes, prevention, and removal techniques is essential for preserving implant longevity.
1. Over-Torquing: Exceeding manufacturer-recommended torque limits (typically 25–35 Ncm) during screw tightening.
2. Cyclic Loading: Parafunctional habits like bruxism generate repetitive stress, accelerating metal fatigue.
3. Corrosion: Galvanic reactions in the oral environment weaken titanium alloy screws over time.
4. Improper Fit: Misfit between the abutment and implant creates uneven force distribution.
This first-line approach minimizes invasiveness:
1. Isolate the Area: Use a rubber dam to prevent debris ingress.
2. Engage the Fragment: Insert a Montana Jack scaler into the screw's fracture line.
3. Rotate Counterclockwise: Apply gentle, steady pressure to unscrew the remnant.
4. Ultrasonic Assistance: Use a piezoelectric scaler (e.g., Satelec P5 Newtron) at 25–30 kHz to disrupt debris adhesion.
For screws with limited surface exposure:
1. Create a Notch: Use a #2 round bur to drill a 1 mm groove on the screw's surface.
2. Extract with a Screwdriver: Engage the notch with a flat-headed screwdriver or Castroviejo needle holder.
Systems like the Komet EXS or Meisinger Screw Rescue Kit employ left-handed drills and extractors:
Procedure:
1. Guided Drilling: Align a pilot drill (1.0 mm) using a guide sleeve to ensure axial accuracy.
2. Reverse Thread Engagement: Insert a tapered extractor into the pilot hole and rotate counterclockwise at 300–500 RPM.
Advantages:
- High precision with minimal heat generation.
- Compatible with most implant systems (e.g., Straumann, Nobel Biocare).
Commercial kits streamline broken abutment screw removal with system-specific tools:
| Kit | Key Components | Best For |
|---|---|---|
| Nobel Biocare ASR Kit | Guide pins, claw reamers, left-handed burs | NobelReplace/Active implants |
| Meisinger Screw Rescue | Tungsten carbide extractors, alignment rings | Narrow-diameter implants |
Er:YAG lasers (e.g., Fotona LightWalker) offer a non-invasive alternative:
1. Targeted Ablation: Use 150 mJ/pulse at 15 Hz to vaporize screw fragments.
2. Cooling Protocol: Intermittent air-water spray prevents thermal damage to bone.
Digital workflows enhance precision:
1. CBCT Scan: Capture the screw's position and angulation.
2. Guide Design: Create a stereolithographic stent with drill channels aligned to the screw axis.
3. Guided Drilling: Use the stent to direct burs/extractors accurately.
- Diamond Burs (e.g., Komet 8350): Create clean access channels without slippage.
- Left-Handed Burs: Reverse rotation prevents screw advancement during drilling.
- Dental Microscopes (e.g., Zeiss OPMI Vario): Provide 8×–20× magnification for subgingival fractures.
- W&H Implantmed: Ensures optimal torque during reinstallation (20–30 Ncm).
- Solution: Use extended-length drills (e.g., Jota Implant Screw Removal Kit) and angled contra-angle handpieces.
- Repair: Utilize thread-repair kits (e.g., Bicon Rescue Kit) with tap-and-die tools.
- Protocols: Preoperative sedation (e.g., oral midazolam) and noise-canceling headphones reduce stress.
- Issue: Screw fractured 5 mm below the gingiva in a Straumann Bone Level implant.
- Technique: Combined piezoelectric vibration and Nobel Biocare ASR Kit.
- Outcome: Screw retrieved in 35 minutes; implant restored with a custom abutment.
- Issue: Titanium screw fused due to galvanic corrosion.
- Technique: Er:YAG laser ablation followed by reverse tapping.
- Outcome: No bone loss observed post-removal.
1. Implant Assessment:
- Thread Testing: Insert a dummy screw to confirm thread integrity.
- Radiographic Verification: Take a periapical X-ray to rule out microfractures.
2. Prosthetic Rehabilitation:
- Abutment Selection: Opt for titanium-base abutments for better stress distribution.
- Torque Sequencing: Follow two-stage torque tightening (15 Ncm → 30 Ncm after 10 minutes).
3. Patient Follow-Up:
- Schedule 1-week and 3-month check-ups to monitor osseointegration.
Broken abutment screw removal is a multifaceted procedure requiring meticulous planning and adaptability. From ultrasonic scalers to AI-guided 3D stents, modern dentistry offers diverse solutions tailored to each case's complexity. By mastering these techniques and investing in advanced tools, clinicians can confidently address screw fractures while ensuring patient satisfaction and implant longevity.
No—always replace with a manufacturer-approved screw to avoid recurrent fractures.
Prices range from $800–$2,500, depending on the brand and included tools.
Use a guided stent or digital template to correct drill angulation.
Consider abandoning the implant and placing a new one adjacent to the site.
Coverage varies, but most plans classify it under “implant repair” (CPT code 6199).
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[2] https://www.youtube.com/watch?v=f7zO0FgkqSM
[3] https://www.youtube.com/watch?v=IDh-a2Wr9fI
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[5] https://uniqa.dental/cases/removing-broken-screw-dental-implant-guide-dentists/
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[7] https://www.journalofosseointegration.eu/jo/article/download/502/358
[8] https://www.dit-usa.com/specialty-kits/screw-removal-kits.html
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[10] https://www.perioimplantadvisory.com/clinical-tips/article/16412202/fractured-dental-implant-screw-complications-3-methods-for-screw-retrieval
[11] https://pubmed.ncbi.nlm.nih.gov/25865293/
[12] https://www.youtube.com/watch?v=Voo4hNKZ0Yc
[13] https://www.perioimplantadvisory.com/clinical-tips/prosthodontic-complications/video/14209641/how-to-remove-a-loose-or-fractured-implant-abutment-screw
[14] https://www.southernimplants.com/pdf/Screw-Information/Broken_Screw_Removal_Protocol.pdf
[15] https://assets.speareducation.com/userfiles/remove_broken_abutment_screws_figure_1.jpg?sa=X&ved=2ahUKEwjCtLKzqPqLAxVTtokEHfbBGBAQ_B16BAgJEAI
[16] https://www.medreviews.co.il/en/photos/removal-of-a-broken-implant-screw
[17] https://www.youtube.com/watch?v=LaKfemQDLjg
[18] https://salvin.com/product-category/broken-screw-removal/
