Fractured Dental Implant? (photo)

There are a few concerning issues you bring up both in your description and photos. First of all I am not sure what brand of implants were used.  If a "knock off" brand was used, there is very little quality control. Name brand implants back their products and will replace free of charge, not the "knock offs." Second of all you use the term "implantologist." That is a a made up term used by practitioners who do not have an ADA recognized specialty. There is no such thing as an "implantologist." Oral and maxillofacial surgeons have the most training and experience with dental implants, some periodontist and prostodontists may have training as well.  Several dentists that have taken a weekend course in the placement of dental implants will call themselves implantologists.  Next, since this is an "all on 4" case the only reasons for the fracture of the implant are overtorque or "tightening" of the abutment screw or the framework did not have a "passive" fit when placed on the abutments so when tightened the lateral forces fractured the implant.  The other reson would be a problem with implant manufacture which is a very rare event unless a knock off brand was used.  Speak to your "implantologist" who should correct this.  If Nobel biocare implants were used and a Nobel Procera Bar was used, it is guaranteed an there should be no cost to you.  If knock off brands were used, good luck. 

The All-on-4 procedure is a fantastic solution for many patients. However, there are many complications that can accompany this procedure. The most common is screw loosening and also chipping of the material that the teeth are made out of. Several percautions can be taken to avoid these problems. 
Screw fracture is not very common. I have seen it in cases in which there was a small inaccuracy in the metal framework so the metal frame did not seat fully on the abutment or the abutment did not set fully on the implant. This problem can definitely cause a screw to break over time.
It can also be possible to damage the implant when attempting to retrieve a broken screw. 

Jess, it is unfortunate that you have to go through this but when implants fracture, a new prosthesis needs to be made.  Since you had an all on four prosthesis, I would recommend having a total of 6 if not 8 implants to support 12 or 14 upper teeth only because your present prothesis failed.  Implants, no matter what brand can fracture if they are under stress.  I have patients in my practice with 40 year old root form implants, placed by one of the original 3 US doctors that studied under Dr Branemark, the inventor of root form dental implants in Sweden.  The better implant companies such as Nobel/Branemark will have their implants replaced at no cost and if those recommended components are used, they are guaranteed for 10 years.  Good luck to you and please keep us informed.

Based on the x-ray, the implant does appear to be fractured.  This was most likely not done by trying to remove  a broken screw.  you have to realize that you are using four implants to replace 12 or more teeth.  Sometimes the force is just to great on the implants.  Do not get me wrong, all-on-four does work and is very successful.  Your implant do seem narrow and may have just taken to much force and thus fractured.  Most likely best to see a periodontist or oral surgeon that works with a good prosthodontist.

Your dentist can still remove and replace the implant. You will probably need a new set of teeth since this is precision fit. (Implantologists do not exist, a specialist is to be referred to as the specialty field they studied. There is no implant specialist). According to your story you felt the debris after attempted removal. This attempt was done engaging it internally. The next attempt should be with a screwed in abutment and attempted externally with a wrench. Final attempt is trephining the implant out. Grafting or replacement with a wider implant implant may follow. Most implants of today are made of the same titanium alloy. Even if the manufacturer does not replace it free of charge (i choose those that do), your doctor should take care of it for you. The cause should be aware of, that way it won't repeat. Dr. Dorfman pointed a couple out. Your dentist should investigate. Its unfortunate you will have some down time, but you will be fine afterwards.

This is certainly unusual. But the only option is to remove the fractured implant as conservatively as possible. We use a special tool for removal of failed implants that does not require 'bone cutting'. This way the bone can be preserved for replacement of a new implant. Once the site heals in 2-3 months, a new implant can be placed.

 

Dr. Kazemi

I have been placing implants for 30ty years and have never had an implant crack from a screw removal tool in most cases the implant just cracked no real reason sometimes things happen you will remove the implant allow area to heal place another implant and may have to redo frame and prosthesis. perhap the prosthesis can still function with only 3 implants worth reviewing good luck

 

Kevin Coughlin DMD, MBA, MAGD      CEO Baystate Dental PC