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Screw job

From: Terry Pannkuk To: roots Sent: Friday, February 03, 2012 4:31 AM Subject: [roots] Screw Job Iíve done this about 3 times now for the same oral surgeon and I love the Munce bur for these specialty creative tasks. This is the third broken abutment screw from an implant Iíve removed, but this one was the deepest and most challenging being 7mm subgingival and deep into the implant. I explained to the patient we would proceed along three strategies from simple to complex: 1. Use a larger Munce bur deep in a slow speed on reverse and just see if that would spin it out. (It didnít) 2. Use the smallest Munce bur and drill two holes into the broken screw being extremely careful not to hit the peripheral threads, then connect the dots to create a slot to engage a small screw driver (for eyeglasses) and try to remove it (That didnítí work either because I couldnítí get enough grip to rotate it out without slipping off the created slot). 3. Drill out the screw to the base with a medium size Munce bur. Well after the second strategy didnít work I developed a different idea realizing I need a better grip on a small head screwdriver. I took a Sears Craftsman screwdriver out of my toolbox and drilled down the tip so that it was as small as the tiny eye glass screwdriver This gave me a great handle to grip and I was able to deepen the slot and unscrew it with ease. If any implant company is reading this, you can email me and Iíll sell you my idea for a Pannkuk Screw Job tool for an appropriate price. - Terry Screw job

Screw job Nice - Craig barrington John West was visiting my practice this morning and he only got to see the screw job no real endo. I charge was x if I didnít get the screw out and 3x if I did. John laughed and said you really worked hard to get that 3x. I did, x wasnítí going to pay my bills.- Terry Creative thinking and excellent work as usual !! - Hongsheng Whoa..... Great! Hmmmmm.... all of a sudden implants are not all that reliable :-) and even an implant surgeon would need a much hated endodude to save the screw :-)))) - Dmitri I have different types of relationships with different people and not hated unless I want to be.:) The oral surgeon who sent the case over is a good guy. Can't be an ass to everyone or you won't get any business! :):):) Selective behavior display is a great way to beat down fake gurus. We all put our pants on the same way. A good friend of mine told me yesterday, the only difference between our screwed up cases and a "fakers" screwed up case is that we work a lot longer and harder to achieve an F-up. :):):) - Terry Welcome to my world Terry! I have done a bunch of these and they can be fun, but very stressful to me. - Carlos Murgel CD, Dr. Sorry guys. Nothing new under the sun. weíve been taking straight chisels, modifying them as a straight screwdriver, for screw retrieval for years. And for the reverse spin terry mentioned as step 1, imho an inverted cone slow speed in reverse has a little better chance than a munce bur to reverse torque. And you guys will love this one. sometimes, a drop or two of coca cola, yes, you read that right, will act as a lubricant and digest any coagulum or protein materials that may have gotten in the threads and act as a gasket. Just donít let that stuff dry in the screw or you really screw things up, pun intended. Also, most manufacturers have a reverse tap you can place in a hole you make in the center of the screw to reverse it out, much safer than trying to grind the whole thing out and potentially damage the internal threads, scope or no scope. Lastly, when all else fails, and Iíve found the threads may have been compromised, explanting and replacing with a brand new fixture can save a lot of time and aggravation.- gary The oral surgeon who sent it over tried the reverse tap and it didn't work, probably because he didn't have a microscope. Each time I've tried chisels and other tools, the handles are too small. Besides each time the threads have all ready been dinged up from the previous removal attempts making the large handle even more important because the slot needs to be deep to firmly secure the screw driver and it really has to be "cranked" to reverse tap the threads. This technique with the non dental screwdriver is good for cases that are "really" screwed up. - Terry

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