Cold welded healing abutment?

Àny xray pléiade?

Had this occur to me as well with a Camlog Promote Plus 5.0 in the #30 site. Stripped out the hex in the healing collar. Solved by cutting a slot in the healing collar and using a 90 degree flat head screwdriver from my toolbox. Wondering if the patient used the healing collar as a chewing surface resulting in overtorquing the threads. Created a bit of a "pucker" when it happened (GRIN) !

Grab the healing abutment with a hemostat and give it a crank. Or slot it as mentioned previously

This happens quite often with internal fixtures. I have had it occur with different brands of implants. It is not likely to be cold welded. Rather it seems to be more associated with different metals (eg titanium implant and stainless steel healing abutment) or different temperatures of implant (37 degrees C) and screwing in a healing abutment from cold room temperature. Thus you place the abutment to normal tension but later to remove it requires much greater tension - probably because of slight post insert expansion of the abutment. The moral is not to insert healing abutments to full tension - better they come loose than having the problem you have now. It also happens with crown abutments and some systems now have an abutment removal driver to dislocate "stuck" abutments. Unfortunately such a driver does not help in your situation. You might be able to remove the healing abutment by using a driver and wench and pushing downwards as hard as you can while trying to unscrew the abutment. If that does not work, then you might like to try cooling the healing abutment quickly (so the implant does not cool as much as the abutment) - eg using dry ice, and then unscrewing. The objective is the get minor thermal contraction of the healing abutment screw thread which might release the tension enough to allow you to unscrew it. Failing this then you could try slotting the abutment as mentioned above which can allow you to place greater unscrewing tension. However if you apply excessive reverse tension then obviously you could risk unscrewing the implant or fracturing the healing abutment screw (which is not as easy to remove as a normal abutment screw). In any event you might as well try to remove it because if you cannot get it off then the implant is useless anyway. That said, you can understand that you want to make sure the implant is properly integrated before you start using excessive force to remove the healing abutment.

Is the healing abutment tall enough that you could just prepare it like a tooth and make a cementable crown? BTW I have had this happen with various implant systems over the years. The slotting technique works well but beware if this is a maxillary implant. I explanted a cuspid this way once.

I would try using a Wyman crown remover to remove the healing abutment if cutting a slot and using a flat screw driver does not work. The Wyman crown remover will easily grasp the outer surface of the healing abutment and allow you to apply considerable reverse torque. Good luck.

I had this issue with Straumann tried chilling the abutment with ice/endo ice and giving it a tap. I was shocked that it came out so easily. I previously had tried everything to remove it with no success. It was suggested to me by the rep. He said the temp change would easily create enough contraction to loosen abutment and that he had seen it work many times.

Happened to me a few times. Blod or bone particules in connection? Also one of my refering dentisits was trying to remove the healing abutment with the torque but was istaken and oner tightening it, 90 Ncm? 120 Ncm? Then it would not come out. used forceps to retrieve.. Use Number 34 extraction forceps to unscrew. Also there is a golden curved hemostat in Salvin catalog with tungsten serrated tip that can get a lot of parts removed, abutments, crowns etc... Good luck

You can easily strip the crewdriver hole if your screwdriver does not go to the bottom of the hole because of food particles. Clean the hole very well before applying pressure.

I have had a similar problem with Ankylos syncone abutments under a /F. The patient is disabled and cannot come to the surgery. We forced the denture out and the female syncone cap remains on the abutment and patient uses 'secure' (née fittydent ) as well as the other supporting syncones.

Used the slot cutting technique to remove the healing abutment yesterday. Thank you all for the input. This was an interesting learning experience for me. I've been placing implants since 1998 and this has never happened to me before. Quite surprising that this is more frequent with other colleagues. Frank