Removal of multiple fractured implant screw

Although dental implants have a very high survival rate as a natural tooth replacement option, failures do occur. Fracture of implant screws is considered as a mechanical complication of late failure. Removal of broken implant screw is a time-consuming and challenging process. If the fractured screw cannot be retrieved, the entire implant may need to be removed and replaced.

This patient lives in Sydney. He had his implants done overseas. One of the implant crowns came off during the COVID. Unfortunately, only urgent dental treatments were allowed during the COVID lockdown. He left it until recently. He went to a general dentist in Sydney and was referred to a specialist who had attempted to remove the broken screw but failed, then advised him to remove the implant and have a new one. He saw another specialist for a second opinion - attempted again, failed again and same advice. But he didn't give up. Found our case study about broken abutment screw retrieval. Contacted us. Took the Sydney to Melbourne overnight sleeper train to see us.

This was a very, very difficult case. The screw had been broken for a few years, and the retained fractured fragment was firmly embedded in the internal threading of the implant. Any conservative ways like probing or ultrasonic I tried simply didn't work. I had to try screw modification with manual instruments, which may potentially damage the implant. After modification and instrumentation, the broken screw started to move - I thought I had seen the light at the end of the tunnel. The broken screw did come out, but it was only a part of it - the screw had broken into two pieces, only the top piece came out, the deeper piece was still in the implant. The deeper it stuck, the harder to be removed. Everything had to start again. More time and effort, but it's worthy at the end. Eventually, the other broken piece was successfully removed without damage of the implant.

It was an absolutely time-consuming and challenging process. There seems to be no case report of multiple fractured implant screw retrieval yet. Luckily, the patient didn't give it up after having seen two specialists - third time's a charm. Now he had gone back to Sydney for further restoration.