Healing Abutment Does Not Unscrew: Safest Way to Remove It without Damaging the Implant Threads?

PB Blaster. Then heat it with a torch.

Are you sure you were turning counter clockwise. I have heard of this before with a Zimmer product.

The only way you might have damaged it is if you cross-threaded the screw or maybe forced the wrong size in, but you should have noticed that at the time. If the HA went in smoothly, then you didn't cross thread it. Could you have possibly stripped the hex in it?

Dr Smith is right. That is why I was a touch sarcastic. Also, as Dr Hughes remarks, righty-tighty, lefty-lucy.

I do say...the questions that are posted on this website are quite scary. I recommend that you cut the healing abutment off with a crown removing bur. Then use a screw removal kit to remove the remaining screw that remains inside the implant. It works everytime.

You must be certain that no bone has grown over the healing screw

I recommend that you remove the implant entirely and start all over again. It is much easier and you get to charge for one more implant...win-win situation for everyone.

Can you paste a picture and radiograph, so we can advise you how to solve the whole situation. Of course you are trying to save the osseointegrated implant.

Hello! just for curiosity, what implant system do you use? heere some isues: -some system uses conical internal walls, ( bone level stramann) wich are strong retentive component. straumann recomend some clorhexidine gel inside the implant. - whenever posible, do not screw H. A. in presence of blood inside the implant. -longer implants requires greater forces to unscrew it. The same is for mandible bone. so if in your case is present the above, you can insist with 40 or maybe more N/cmm2. - at last, I ´d try to remove the healing abutment first with ultrasonic/piezoelectric device, and if dont, with a bur, like Dr. patel. good luck!

happened to me before, loosened it with ultrasound

In old car restoration, the adage is "never break a bolt". That applies here too. Break the screw, you're in trouble. Worry away at it with a piezo tool. Maybe even apply a bit of ice to shrink the healing cap threads so they let go. At some point, you have to admit you screwed up (pun intended) and start over at your own expense. You should contact the vendor for application information so you don't repeat this debacle.

You may have cold welded it. I'e done it before after trying in the wrong abutment screws(nobel) leaving titanium fragments that cold-welded the right sized healing abutment.One I got out by applying~ 50 N/cm the other one the whole implant came our and I did it again for free. Didn't think to charge for my error. I was just happy to get it out and learn a valuable lesson about cold-welding and that different size implants take different sized abutment screws(Nobel)! A real colon- clencher.

First and fundamental is what type of connection is it? Is it an external hex, an internal morse taper etc. Secondly what sex is the operator? For some strange reason women don't know how to unscrew a conventional screw. It is unbelievable how often females turn the opposite direction when turning on and off taps and screwing and removing screws. As mentioned previously this is a likely explanation. Also I think tightening a healing screw to 15Ncm is probably too tight for a healing abutment. The number one rule in removing these things is to never damage the screw head. I find that if you try numerous times unsuccessfully, the screw head inevitably stretches and you've got buckley's(=0) chance of removing it. I like to use a torque wrench in reverse if difficulty is experienced with a hand wrench, and I find this will give you better leverage whilst applying downward force on the screw head to stop the removing tool from slipping out of the head. Also as mentioned the whole of the top of the implant should be clear to ensure there is no overlying bone because that will certainly stop screw removal. If the healing cap is on an external hex then it may be possible to unscrew the healing cap by grabbing it with pliers around the outside and turning. If it's an internal connection and the head of the screw is damaged, then let this be an excellent learning experience for you as you discuss with the patient why you need to remove an otherwise excellent implant. Good luck.

Has happened a few times with me. Zimmer. I put ice on it for a minute and then no problem. ( Different expansion coeff. betw the implant (titanium) and the collar ( Alum. ) Also make sure when you put the healing collar on, there is no tissue within. Go ahead, and take it to 40 N. It is a test anyway.

On re-reading the question I find that it is about a healing abutment and not a healing cap. Just goes to show one should first understand the question before commenting-my apologies. The outlook is a lot brighter with a healing abutment as you have a lot more to grab onto. My comments about not damaging the hex or connection hole is still valid and so is the use of a reverse torque wrench. It is also possible you have x threaded it but you should have been aware of this at insertion. If it was ok at insertion, then use of a torque wrench should loosen the abutment. If the hole is damaged the use of pliers around the outside of the healing abutment should loosen it as long as the force is in the right direction.

I' m having the same problem with a bone level implant (straumann), can't remove the closure screw anymore even with a wrech. Surely the stargrip is worn out now. just my luck. Please help!

Why torque a healing abutment?

I don't think its on purpose, I know it wasn't the plan when it happened to me. I ended up with 3.5 abutment screws in a 4.25 implant and couldn't for the life of me get it to engage. I was thinking that I really should have referred this out and never touch an implant again. In the two that i tried the most to engage i knocked off some titanium of either the screw or the implant and after putting back in the healing caps two of them cold-welded by the time of the next appointment. I never torqued them in it just worked out that way after hand tightening. My Nobel rep figured it out, when he said there are two different sizes of abutment screws and checked that they delivered the wrong ones. Lesson learned.

i had a case in which screw was scratched out. i made groove of plus shape and then made pattern with handle and then got it casted. with that driver i was able to remove. all the best

I agree withRichard .Healing abutements should be finger tight ,why torque them?

Just happened to me. I removed by gripping with forceps very firmly and unscrewing. Worked a treat!