The 'Can Opener' Technique

Coming into Dr. Spear's practice in the late 90s exposed me to a variety of implant restorations – a large number of which had been in place for many years. Given the year in which they were placed, a lot of these implants were the old external hex Branemark design. Inevitably I would come across a clinical situation where a cemented implant restoration had a loose abutment screw that needed to be tightened.

What options do we have to tighten the abutment screw on a loose implant crown?

One option is to just cut the old crown off and redo the restoration – although if the current restoration is fine, this is a large added expense for the patient. If you don't want to replace the old crown you could drill a hole through the existing restoration to access the screw, thereby turning it into a screw-retained implant restoration. The difficulty with this is trying to figure out where the screw access hole will exit the restoration. As long as the screw access hole exits on the occlusal surface of posterior teeth or on the palatal surface of maxillary anterior teeth, this can be a viable treatment option.

Probably the best way to tighten the abutment screw is to remove the existing crown to get access to the abutment. I will admit that this is often more easily said than done. To begin with, it helps if you know what the existing restoration is cemented with. As long as it is cemented with a temporary cement I feel like I have a good chance at removing the restoration but it can still be a struggle to get that crown off. That was until Dr. Spear showed me the "can opener" technique.

What you will need is a pair of GC pliers and a toothbrush. The GC pliers have rubber tips and when they are used with their gripping powder, give you a nice surface to grab onto the restoration.The difficulty in using them to remove the crown is two-fold.

First, you have to pull the restoration with enough force to get the crown off without pulling too hard that the pliers crash into the opposing teeth. The other difficulty is that you must pull the crown along its path of insertion. Using the "can opener" technique addresses both of these issues.

As can be seen in the video, the toothbrush is used as a fulcrum for the pliers and allows a significant amount of force to be used to remove the crown in the correct direction without the risk of slipping off and damaging the opposing teeth.

Try it the next time you want to remove an implant crown and tighten a loose screw, I think you'll be amazed how well it can work.