Broken Screw in All on 4 Case: Best Way to Proceed?

First determine why the screw broke. The angled abutments should only be torqued to 15 NCm and the screws should not be used multiple times. I have never seen a screw failure with the all on 4 that was not human error. With the preload removed you can usually easily back out the screw. Nobel has a kit to do just that. Put in a new screw and go forward. As long as the abutment is not damaged you should be able to use it. However, I again emphasize that I would determine why the screw broke.

Nobel biocare should have a screw removal kit named the abutment screw remover branemark system. I'm assuming that if the abutment itself is still intact, why replace it? However, the internal screw you obviously need to replace.

The head of the screw is mention to break at the neck if torque exceeded. If you have a piezo scaler take a thin tip. Put in the scaler tip in an up and down motion and screw should unwind and pop out. Do not torque more than 15nc. Good Luck

There has to be a reason why the screw broke. I use a scaler to vibrate the broken face of the screw 90 percent of the time it comes out with that. You will actually see it unwind. Best of luck.

i had the same thing happen with my implant direct overdenture abutment screw the other day. i have found the all on 4 cases are so much easier with implant direct. the angled abutments on nobel are tricky, but simple with implant direct.

Dear Anon, I use a piezo scaler too to take out the broken screws, just touch it at middle power. I don't understand why you say if you should change the abutment, I suppose you already have a Zirconium or metal frame structure. Unless you have a temporary abutment in to a provisional prostheses. You should be very acurate and think why it was broken maybe the torque or maybe the structure is not passive enough and it broke the screw while you where screwing it, maybe the abutment is not aligned with the implant. If that happened you should do again all the zirconium or metal structure. If you are using a temporary abutment into an acrylic prosthesis, you should take out the abutment and align it and process the acrylic again. Good luck.

hello there well come to the club , first don't panic it happens to almost all of us. now be advised that there is no specific protocol for unscrewing a broken screw and it's all about trial and error all of the above tips are valid try them until one of them succeeds ,nevertheless you should be very careful not to worsen the situation by using excessive force be gentle with the screw use technique use piezo or scaler or Nobel kit , GOOD LUCK