Perforated the implant: best way to seal it?

With all due respect, it might be best to remove the implant and replace it with an intact, new one. In the short term this would be an inconvenience but in the long term it would get you over all the problems that you have been encountering. Good Luck

DITTO :)

As always, take a step back - why did the abutment screw fracture ? Probably occlusion - related as modern screws are better engineered than previously and rarely break. So if the patient can generate sufficient forces during 6 month's usage to fracture the screw, what will he/she be capable of doing to your custom post supported by a damaged implant? Consider also that the perforation means the wall of the implant is thinner, and to enable a custom post, you will have to cut some taper into the hex coronal section, which will also weaken the walls of the implant. I think anyone can guess what will happen - the implant will split. The solution, already posted above is to replace the implant. In treatment planning for the new implant, CONSIDER THE OCCLUSION. Can the crown be protected in the occlusal scheme, or will the patient commit to wearing a protective splint (possibly full time)?

Of course this is a strange case, and I guess that few Doctors have experience in "perforated implants". If you think and consider that saving the implant is better than removing it, I would use MTA. (considering that the perforation is at the bone level). Good luck.

There is no way to seal it. The oral bacteria will trickle down along your post and invade the bone through the perforation. Normally I would recommend you reverse torque the implant and remove it, however you have removed the internal aspect so no removal tool will fit most likely. Refer the patient to a surgeon/periodontist who is experienced in either using a trephine or a piezo to remove implants. Most likely they can place an immediate implant the day of removal. For future reference MacGuyvering only works on TV. Broken screws have two predictable possible treatment scenarios. Screw removal kits or implant removal.

A fractured abutment screw can be easily removed by taking a #558 latch burr, grind off the flukes with a heatless stone leaving he end cutting blades. Put the burr in the slow speed handpiece and reverse the rotation. Then start the rotation and gently touch the burr end against the fractures screw. It may take continuous contact or pecking action to get the fractured piece out. Dennis Flanagan DDS MSc

The risk of failure with an attempted repair to this damaged implant is one that you will be taking on if you proceed with a repair. Explain the risk to your patient, along with the additional costs for the repair, and the cost removal and replacement, including additional bone grafting and time for healing until a replacement could be functional. The risk and expense of removal and replacement of the implant is far less than repair and removal and replacement after a year with more bone loss and probable infection.

Liquid titanium. Just kidding if the perforation is deep and protected from the oral flora it may be okay but the stability of the retention screw will be suspect. If it is deep there is no PDL and the metal is inert and non-mobile unlike a fractured natural root. Since this is so early in the implant's life I would replace it. I had a similar case with a flowered Nobel implant, I removed it since the screw would be unstable.

Dennis Flanigan gave you the answer ..... a round bur, with the flues cut off, set in reverse going slowly......will roll it out; or use an endodontic explorer, and massage gently in reverse...it will come out......with a perforated implant, the best solution is to remove it and start over.

I see no real future in this treatment, just take the bullet and start over.... is better than later when it crashes luck

I would probably use MTA or glass ionomer (e.g. fuji ix)

While there's not enough records to say this is the answer to this case, Geristore is biocompatible in furcation perforations and we've used it as a "patch/post" material to old basket style implants with success for decades.

With Voco U binder, it'll attach to metal and the Voco is a very biocompatible blonder.