Astratech implant: Any suggestion to get the broken screw out?

If you have a good relationship with an endodontist, they can retrieve screws. My endodontist does it successfully whenever the need arises. Even those that have not done it before find it doable with their microscopes. After all, they have been known to retrieve endodontic files from canals. It's worth a shot. Best of luck!

Simple solution , many Implant companies have srew removal systems that can be used in most implant systems . Just buy or borrow one and should be no issue to remove. Peter

Thanks for the comments so far...I have tried a removal kit but this did not work. When this screw broke it is very deep in the implant. Some screws are designed to break at the top under increased loads. I have been successful getting these out. This screw is broken at the base of the implant. I will have to flap the patient to get to the implant now as it has grown over. Not a great situation. Patient irritation level is going up! Scott

Scott, I have retrieved two similar screws with microscope. One of them I created a slot to unscrew it.. You need magnification and long pointy burs.. Good luck

Hi Scott the screw possibly loosened and then fractured due to the cantilevrer force on the Hex . Although deep I have removed tips before using a DIO , SOS kit even though the srews that needed to be removed were other systems . Good Luck patient anxiety is a hard one to pacify. A fixed bridge would have been better than a cantilever and slot arrangement , but easy in hindsight. Peter

Hi Scott, just dont worry, I've done this before. Take a narrow tipped metal cutting bur in your air rotor , dry the implant so that you can see the screw , place the bur with your handpiece on the screw and at slow speed move your bur in anticlockwise rotation as though you were removing the screw, once the screw moves (you can use a explorer to check) within the implant, use your explorer tip and turn the screw so as to remove it . You should succeed. If at all you dont succeed just drill out the screw , make a post and core and join it with the adjacent implant and close the case. Have done it before very successfully.

thanks for the tips! I tried the counterclockwise bur stuff to no avail. Neat idea about the post and core Great input Scott

Refer the patient to someone who can do this. You've said it already- it's a difficult patient who is not happy. They will be even less happy if you damage the threads of the implant beyond repair. Call you local oral surgeons or periodontists, I'm sure they know of someone who can do this. Getting this off your shoulders will feel great.

I would either remove the implant, and replace it more distal, amking a 3 unit bridge. Or bury this implant and place a new implant distal to the one with the broken screw. This may seem extreme, but even if you can get the screw out the implant has bone loss...and the trauma from the work done and heat in the implant will leave it with a poor prognosis...and you will have to deal with it. I would also suggest going back to the dentist that placed the implant. This is always a difficult problem ...I use Bicon implant with a 3mm post...and we have had not breakage problems ..and no loose screws...whic do cause peri-implantitis. Good luck....

Use a small round 1/4 bur TC friction grip, or similar diamond. Try to drill dead centre and gently drill vertically down the screw.... Difficult, but once you have a starter hole it becomes easier. Use good sharp drills. When it is 1 to 2 mms deep, introduce an endodontic file into the hole, you will determine which is the right size by trial error. Perhaps you might have to remove the extreme point. You will find as you rotate the file, it will grip the screw and it will come out.

Scott just get a proper removal kit ,I am sure Atra will have one ,using the bur holder and the correct removal bur and reverse it out , if you have the correct kit it is easy. Then simply make a new Implant bridge ,this is your patient do not try things out. Or just refer to someone who has done it as OMS said Peter

Hi Scott, don't refer, just do it yourself and win your patient over, ONLY THOSE WHO DARE WILL ENTER IN! . I tell my patients that these are 1 in 100 complications, and I'm gonna save this implant and avoid removal of the implant and unnecessary costs. Please give me a report it's going to be very satisfying and will do a great deal to our confidence.

apply few drops of zinc oxide eugenol oil on the broken area inside the implant then apply ultrasonic tip to the broken area the broken part rotate out

Dear Scott, I am an astra user for over 6 years now. They are a wonderful implant for all you astra haters!!!! Unfortunately, i have also seen this happen. I place implants for referring dentists who like to restore. I have one such GDP who is excellent at restoring, lots of experience and one day on fitting the final restoration the abutment screw fractured almost identical to yours. I tried for hours to remove it with every trick in the book, i conceded and referred to Michael Norton who is a huge Astra user and he tried for an hour and still could not remove it. It just would not budge despite using all the tricks and microscope that everyone else suggested. Onto plan B, i drilled out the fractured section which of course damages the internal thread and shape so had to compromise and tried a slightly "off piste" approach of restoring the tooth with a cemented post. this has functioned well for one year but we have had two recements to date. Next week i am removing the implant and im going to place another one!!! Moral of the story, you may never get that damn screw fragment out, its worth a try with the neobiotech implant remover to reverse torque it out and start again. Sorry to be the bearer of domm news but i think thats where you will end up xxxx

The Screw Remover Kit (SRKIT) of Neobiotech is safe and easy to use. Try it, really is amazing.

screw removal kit are doing well till on a fracture on stress on upper head, but once the screw fracture inside the ease of use is restrained and of very little scope.....................................................................................but using munce endo bur and 1/2 round bur to have a excavation point, then slow antirotation to make a frictional withdrawal force even if it wont moves, then followed endo-chunk, pui irrigation makes a much less heat generation n losening after a long vibration on screw point sleek, its worth attempting............................................................................despite that if its not coming out then sacrificing the implant and going for a new loader is the need of the hour.....................................................................................here its very important to make patient convince of the clinical reality and limitations ........thanks for referal

Used Astra for over 8 years, as an implant it is excellent. The head of the screwe has seperated from the shank so its basically just a knurled rod with no clamping force on it. If the shank is flush with the internal thread of the implant then if you do use a retrieval kit and hit the side wall of the implant it is pretty much game over, you can't bore out the implant or re-tap it (astra own protocol). Have you tried using an ultrasonic scaler with a fine sharp tip. put it right on the top of the fractured screw with high water flow and use a tapping motion, get a brand new caries probe and try to rotate the shank anti clockwise and it should come out. i would steer clear of the screw remoavl kits if possible with astra.

Never put a rotary instument into an implant! You'll just bung up the threads. I use the Nobelbiocare hand screw removal tool and it works every time. You can even use it down the small hole in the tissue as the tissue grows over the implant without having to flap. You don't need to look since you're not trying to drill on top of a little bitty screw fragment. The inserts have gnarly teeth on the end that can grab ahold of the broken screw and it should easily back out. That being said, if the threads are damaged by previous rotary attempts at screw removal your in trouble. You can possibly try to drive the broken fragment further into the implant to expose several threads above the fragment. Then shorten a new abutment screw and use it to retain the abutment. From an engineering standpoint, you only need to engage several threads to develop max. torque ant retention. I have done this several times when someone else has been in the implant first. If the threads are damaged, the new screw will help to recut the threads. I would then make a fixed bridge between the two implants to decrease the risk of this happening again. Don't worry about the minimal bone loss at the crest, it should stabilize once the torquing forces are off the implant.

P.S., the nobelbiocare screw removal tool is inexpensive too! (relatively speaking)

Thanks so much everyone! These are great ideas. It is excellent to hear how people think. We are going to try to remove this next week. Happens to be on my birthday. I have a microscope and the screw removal kit to start. I will let everyone know the outcome. Also liked the put it to sleep idea and place distal. Implants are too close and not well positioned for prosthetics. I am sure it was placed with the best of intentions. As the rule goes. The implants that are in a less ideal position are guaranteed to osseointegrate! Scott

Dear scott, Just in case, here is a suggestion for a plan B: if you can’t remove the screw at all, to avoid implant removal, take a burr and grind the screw down till you have sufficient depth and width. Then take an impression and send to your lab and request a post core to be cemented. Place the post core, adjust if necessary, and then take an impression. ideally you should splint the 2 implants to reduce cantilever forces and use a resinous cement to permit some compression compensation. Hope this helps

I think : You can make a deep notch, a small notch with a high speed round diamond bur in the centre of broken surface of implant after that choose a number 3 or 4 of low speed bur ( hand piece) and use it at anti clockwise with low speed turn not turn fast, I hope you'II be successfull to take it out. good luck

I agree with incisor. If you cannot get the screw out with ease then prep the inner implant portion for a post and core. Take impression, send to lab and get the post back. Air abrade the inner implant and also the post itself. Cement with Resiment cement. If you have enough room from the coronal aspect of the implant to the bone then you can also prep the implant to have a continuos chamfer from the post onto the implant. Place a vertical groove from the post onto the implant for antirotation if you are not going to splint it to the anterior abutment.

Got the screw out on thur. My birthday! Stay tuned for how I did it Scott

Here is how I got it out...Scott 1. spoke to patient and said. If you remain calm I think I can get this out to avoid you losing the implant. She was great. 2. Freeze, incision, open - good visability 3. Had look at screw with microscope. Could see in but would be difficult for me to use it during procedure due to angles 4. Modified and impression coping. Cut 6/8 of the hex off the impression coping and removed the impression screw. This would stay in the hex at the base but allow a bit of movement of the broken screw. 5. Placed nobelbiocare impant removal screw drill bit in the impression coping and inserted it into the implant. This lines the drill up with the broken screw. Dont want to hit the bottom of the hex of the implant. 6. made a piece of metal come up from the broken screw. checked with microscope. 7. placed the impression coping back in and used the astra screw removal instrument. Much like NobelBiocares. 8. Turned implant motor on reverse and set at 35 ncm. thus very slow in reverse. 9. screw came right out! grab with cotton forceps

Scott- I have used astra for years and had my share of broken screws. Usually they come out easily with an ultrasonic. Sometimes, they do not. I have done the post and core approach in a couple of situations and it works well. Just make sure you use a strong alloy. Once I used gold and it snapped do I had to make a second post!!! LDS

Sorry to get to this late. For all interested, I have retrieved several broken screws by placing the tip of a cavitron insert, a narrow one, gently inside the implant and on the broken screw , let the vibrations cause the screw to loosen. It usually starts to spin and vibrates itself out of the implant. Worth the effort. Good Luck.