Implant restorations can fail biologically or mechanically. Biological factors include unsuccessful osseointegration or presence of peri-implantitis. Mechanical failures include crown fracture, framework fracture, screw loosening, and screw fracture. Fracture of the implant abutment can be a serious problem as the fragment remaining inside the implant may prevent the implant from functioning efficiently. The procedure used for removal of the fractured screw portion is described in this clinical report.

Failure, as it relates to biomechanical issues, is often due to off-angled forces and/or overload on an implant fixture mixed with time. Fatigue of the implant material is often cumulative; certain breakdowns often happen along the way until catastrophic failure occurs (implant fracture). The first sign — “tell” if you are a poker player — of occlusal disharmony is usually the screw loosening. Most often the dentist will tighten the screw and think the problem is solved until loosening occurs again. After this exercise in futility is repeated without addressing the problem of occlusal dysfunction, the screw can ultimately break. Breakage of a screw in an implant fixture can present a complicated situation as the ease of screw removal often depends on the apical-coronal location of the fracture. The following case highlights a unique method of implant restoration when damage occurs to the implant fixture due to the attempted removal of a fractured screw.

Fractured implant extraction

Dental Implant Broken Screw Retrieval Method

A local dentist referred this implant case to me for broken screw retrieval. The dentist tried to use a screw removal kit from the implant company. He stated that the technique was too difficult to do without the use of a dental microscope. The dentist contacted me from watching my previous YouTube videos on broken screw retrieval (rescue cases). The treatment was successful and the patient was very happy avoiding surgical removal of his existing implant fixtures. The dentist can now comfortably restore the patient's mouth with a new implant bridge using the existing implant fixtures. GC

Dr. Gerard Cuomo - Fractured Dental Implant Fixture - Loose screw removal protocol 2 of 3

There are many methods shared today that include the retrieval of loose dental implant parts that have been placed in the mouth for several years. There are many dental implant companies that have upgraded their implant part designs to prevent screws from becoming loose and fixtures from becoming fractured. I have been asked to retrieve a loose dental implant screw previously attempted by a general dentist and periodontist. The radiograph reveals a slight radioleucency on the fixture at the height of crystal bone. The patient presented with a fractured implant in the tooth number 4 position and a loose implant crown/abutment in the tooth number 5 position. My personal protocol includes: securing the loose implant crown to the adjacent natural tooth via bonding techniques, gaining re-entry of the existing access hole, pre-soaking the screw head with soap and tarter/stain remover, creation of a straight line of axis parallel to the implant screw, seating a driver to maximize the necessary torque to remove the screw. Most mistakes that are made include failure to recognize the need for a straight line path to the screw head, inability of the operator to see the screw head configuration, and failure to pre-soak the head of the screw prior to applying force with a screw driver.