03/25/2026
Part II: Once you've removed these failed hybrids, you can finally confirm what you're dealing with. In most instances, what happens next is dependent on 1. patience, 2. having the necessary equipment/supplies in office, and 3. patient factors.
Point 1. Handling this emergency took me 2.5 dedicated (meaning my full attention) 'in the chair' hours. If you choose to help these people you better not be in a rush. Since the vast majority of these prostheses are poorly made or fitting, the priority is on trying to save the implants, if possible. This gives the patient choices once reconstructive options are discussed.
Point 2. If you're someone who has to call the implant rep for help/advice, don't take these emergencies. Our 'tackle box' of implant drivers now includes over 70 different sizes and types. You never know what implant/screw is actually there until you see/feel them. I also recommend magnification for the broken screw removal steps.
Point 3. The patient you are helping needs to be fully informed. This is for their knowledge/safety but also for yours as the provider. These are never good situations. Many patients don't really understand how difficult/bad a situation they are in. Those that do are also usually emotionally distraught if not downright angry. It's tempting to promise to be a hero. Don't. Give them doom and gloom. That way, if it turns out even half way good, you're the savior. Lastly, don't attempt to help unless you are REALLY SURE of what you are doing.
This topic is a half day lecture, so I'm only going to give basic highlights...
A. Implant #20, as noted was mobile. I was able to back it out uneventfully. I removed the loose granulation tissue within the osteotomy and sealed the thoroughly cleaned screw access channel/interface on the hybrid at this site.
B. The prosthetic screw in the straight multi-unit abutment at site #27 was found to be still slightly mobile (miracle #1). Under magnification the broken screw piece was backed out leaving a useable abutment. I confirmed at this point I was dealing with a Branemark (Nobel) Multi-unit abutment clone. These were all NeoDent implants.
C. The prosthetic screw in the angulated MU abutment for implant #29 was found NOT mobile. After various attempts at removal I aborted prosthetic screw removal and instead confirmed that the abutment being used on implant #29 was the same as the abutment that was used on the failed implant #20. I therefore removed the abutment from #29 and replaced it with the abutment that was on the failed implant #20 (miracle #2). He now had useable abutments at #27 and 29.
D. The now buried implant at site #22 was accessed by removing the overgrown soft tissue. BTW, I confirmed that it was PVS impression material encapsulated within the peripheral gingiva of this implant. The PVS was removed. Once I had access and visualization of the broken abutment screw I went through my usual sequence of screw removal techniques. With a little luck I was able to get the piece of the screw to move (miracle #3). However, when they are so deep within the implant they are difficult to actually retrieve. I had fun using a pic-it-stick to grab the unscrewed/loose piece and remove it.
E. Now I had a usable implant at site #22. Problem was that the abutment was broken. I actually chose to use the broken abutment in it's original place. This implant design has a long internal connection zone. This means that despite not engaging with a screw, the abutment still sat fairly stable within the implant. So from a support perspective, the hybrid had three implants.
F. The two new active prosthetic screws at #27 and 29 (I keep spares of these in stock for the primary US brands) are enough to retain the hybrid while the three abutments/implants are enough to TEMPORARILY keep the hybrid in place. I did use a prosthetic screw for the abutment at implant #22 to maximize the lateral stability/support provided by the broken abutment.
Obviously, the left posterior segment was heavily reduced to take that side out of occlusion (by 2+ mm's). So yes, this guy left with the hybrid in. While everyone was very 'happy' once it was back on, everyone also understands this hybrid's days are numbered and a definitive plan is now needed before things get even worse.
The patient, having seen how we can handle these issues, now rightly trusts us to try and help him with the next step. Whatever that may be.
Thank you for the interest. My main lesson here is that implant complications are common, difficult, costly, and require specialty level skill. This is a primary reason implant treatments should not be considered without full disclosure of risk. Conventional treatments tend to be safer and are generally equally effective. These need to be given their just place in the treatment planning algorithm's.
4 part II
