The document discusses methods for retrieving fractured abutment screws from dental implants. It notes that screw fracture is an uncommon but serious complication, as the remaining fragment can prevent proper functioning. If the fracture is above the implant head, simple tools like probes can often remove it, while more involved techniques may be needed for deeper fractures. Commonly, drills or self-made screwdrivers are used to create a notch in the fragment to engage with counterclockwise rotation to extract it. Commercially available screw removal kits provide standardized guided tools as well. Proper technique depends on the specific fracture location and implant system.
Original Description:
It is a power point presentation on how to remove fractured screw from the Implant.
Original Title
Retrieval of fractured abutment screw from the implant 2
The document discusses methods for retrieving fractured abutment screws from dental implants. It notes that screw fracture is an uncommon but serious complication, as the remaining fragment can prevent proper functioning. If the fracture is above the implant head, simple tools like probes can often remove it, while more involved techniques may be needed for deeper fractures. Commonly, drills or self-made screwdrivers are used to create a notch in the fragment to engage with counterclockwise rotation to extract it. Commercially available screw removal kits provide standardized guided tools as well. Proper technique depends on the specific fracture location and implant system.
The document discusses methods for retrieving fractured abutment screws from dental implants. It notes that screw fracture is an uncommon but serious complication, as the remaining fragment can prevent proper functioning. If the fracture is above the implant head, simple tools like probes can often remove it, while more involved techniques may be needed for deeper fractures. Commonly, drills or self-made screwdrivers are used to create a notch in the fragment to engage with counterclockwise rotation to extract it. Commercially available screw removal kits provide standardized guided tools as well. Proper technique depends on the specific fracture location and implant system.
Implant therapy is an effective and reliable restorative
treatment option for the replacement of the missing tooth. The success of dental implants is based primarily on the extent of osseointegration. But the failure of the implant restorations may take place any time due to failure of either biological or mechanical factors. INTRODUCTION Biological factors include- unsuccessful osseointegration or the presence of peri-implantitis. Mechanical failures include- crown fracture, framework fracture, screw loosening, and screw fracture. SOME FACTS ABOUT IMPLANT SCREW FRACTURE:
The most common screw fracture is fracture of the
hexagonal head away from the main body of the screw.
Screws in the posterior region fracture more
frequently as compared to the anterior region. Chances of implant screw fracture are more in partially edentulous patients as compared to completely edentulous patients. SOME FACTS ABOUT IMPLANT SCREW FRACTURE:
In a recent study the incidence over a 5-year period of
abutment screw fracture was found to be 3.9% and that of abutment screw loosening was 6.7%. In another study Screw loosening was reported as the most common complication in a follow-up study of 76 Branemark single-tooth implants. Fracture of the implant abutment screw can be a serious problem as the fragment remaining inside the implant may prevent the implant from functioning efficiently. CAUSES OF IMPLANT SCREW FRACTURE: Undetected screw loosening is the primary cause of implant screw fracture. Causes of screw loosening may be- Bruxism Ill-fitting superstructure Overloading of the prosthesis. Note: Frequent loosening of the screw indicates change in the design of the prosthesis. METHODS OF RETRIEVING FRACTURED SCREW Many methods have been reported for retrieving screw fragments within the implant. Which method is to be used depends upon the level of the fractured screw in relation to the implant head. There are mainly two conditions- 1. When the fractured abutment screw is above the head of the implant. 2. When the fractured abutment screw is below the head of the implant. METHODS OF RETRIEVING FRACTURED SCREW If the fractured abutment screw is above the head of the implant: In this case an explorer, straight probe or a haemostat can be used to retrieve the fragment.
The tip of the probe is rotated anticlockwise on the
surface of fractured screw until it comes out. METHODS OF RETRIEVING FRACTURED SCREW If the fractured abutment screw is below the head of the implant: In this situation there are mainly three common approaches to retrieve the fractured screw from the implant- (1) Use of a probe (2) Use of a self-made screwdriver or (3) Use of a commercially available service set available for the specific implant system. METHODS OF RETRIEVING FRACTURED SCREW Use of a probe: Often it has been observed that the screw fragment inside the implant is not jammed. Hence an attempt to unscrew it using an explorer or a straight probe should be done. The tip of the instrument is moved carefully in a counterclockwise direction over the surface of the screw segment until it loosens and comes out. METHODS OF RETRIEVING FRACTURED SCREW Use of a self-made screwdriver : The basic idea behind this technique is to make an undercut area (notch or groove) on the occlusal surface of fractured screw and engage any self modified instrument in it to rotate it counter-clockwise. Different authors have described different techniques under this category. Few methods are described here- METHODS OF RETRIEVING FRACTURED SCREW A. Using small round bur – A small round bur with counter clockwise rotations can be carefully used to remove the fractured fragment. Counter clockwise movement prevents seating the fractured screw deeper in the implant. This bur is used in a low-speed hand piece to gently “tease” the fractured screw out. Care should be taken not to touch the threads of the implant. METHODS OF RETRIEVING FRACTURED SCREW B. Using carbide bur and ultra sonic scaler- In this method a fine tapered carbide bur is used to make a notch on the occlusal surface of abutment screw between the center of the screw and its periphery . This notch should not be at the center. Care should be taken not to touch the internal threads of the implant with the bur. METHODS OF RETRIEVING FRACTURED SCREW An ultrasonic scaler tip is then inserted into the implant and is made to engage the created notch. The ultrasonic scaler is then started at a very low speed, and mechanically the tip of the scaler is forced to move counter-clockwise to unscrew the fragment. The screw piece rotates and comes out of the implant. METHODS OF RETRIEVING FRACTURED SCREW C. Using carbide bur and modified spoon excavator- In this method also a fine tapered carbide bur is used to make a groove on the upper end of the broken screw. Sufficient amount of water is used to avoid heating of the Implant. Otherwise the implant may get failed. METHODS OF RETRIEVING FRACTURED SCREW While making the groove care should be taken not to damage the internal anatomy of the implant to facilitate further use of the same implant. A spoon excavator is modified by cutting its working end perpendicularly to serve the purpose as shown in the figure. METHODS OF RETRIEVING FRACTURED SCREW The cut end of the spoon excavator is used to engage the prepared groove on the fractured abutment screw and is rotated in counterclockwise direction. The prepared groove thus provides proper slot for the removal of screw. METHODS OF RETRIEVING FRACTURED SCREW D. Using a flame shaped bur and modified bur as screw driver- In this method a flame-shaped bur is modified to prepare a groove on the fracture screw. The diamond particles of the upper part of the flame-shaped bur are removed and polished in order not to damage the internal screw thread of the implant. METHODS OF RETRIEVING FRACTURED SCREW A thin groove is created on the screw piece, which remained in the implant with this modified flame-shaped bur. A handmade screwdriver is prepared from a detrited tungsten carbide bur. The upper part of the bur is cut to the desired length. The tip of the bur is made thin to make it 1.5 mm in width and is sharpened as a screwdriver with a carbon separating disc. METHODS OF RETRIEVING FRACTURED SCREW A handhold for this bur is made from autopolymerizing acrylic resin to hold and rotate it easily. The handmade screwdriver is positioned onto the groove that was prepared on the fractured screw and is slowly rotated counterclockwise to loosen it completely, and removed with a dental pincer. METHODS OF RETRIEVING FRACTURED SCREW Use of a commercially available service set available for the specific implant system. There are some commercially available fractured screw removal kits in the market. A typical screw removal kit contains- a. Drill Guide and Handle b. Reverse Latch Drill c. Left Hand Drill d. Hand Tap METHODS OF RETRIEVING FRACTURED SCREW Examples of commercially available fractured implant screw removal kits- 1. ITI Dental Implant System (Switzerland), consists of drills, two drill guides and six manual tapping instruments. 2. IMZ TwinPlus Implant System (Dentsply, Germany) 3. Screw Removal Kit Replace (Nobel Biocare, USA) 4. Certain Screw Removal Kit (Biomet 3i, USA). 5. Screw Removing Instrument Kit (SRT10) METHODS OF RETRIEVING FRACTURED SCREW Description of one of the commercially available kit ITI Dental Implant System, Switzerland: The extractor kit includes- 1 Claw Reamer Bur 1 Reverse Cutting Bur 1 Manual Extractor 1 Deeper Centering Device 1 Extension For Bur CONCLUSION:
Abutment screw fracture, although uncommon,
sometimes occurs in clinical practice. There are many techniques to retrieve that fractured screw from the implant. But there is no method of screw removal that can be universally applied to all cases. So we have to examine the case carefully and choose the suitable technique accordingly. THANK YOU REFERENCES: 1. Satwalekar P et al. Fractured Implant Abutment Screw. Journal of International Oral Health. Sept- Oct 2013; 5(5):120-3 [ 123 ]. 2. Reyhanian A, Parker S, Moshonov J, Fuhrman N. The use of Er:YAG in laser- assisted broken abutment screw treatment. Case report _ Er:YAG Lasers 2010;3:6-11. 3. Carlson B, Carlsson GE. Prosthodontic complications in osseointegrateddental implant treatment. Int J Oral Maxillofac Implants 1994;9(1):90-4. 4. Bragger U, Aeschlimann S, Burgin W, Hammele CH, Lang NP. Biological and technical complications and failures with fixed partial dentures (FDP) on implants and teeth after four to five years of function. Clin Oral Implants Res 2001;12(1):26-34. 5. Luterbacher S, Fourmousis I, Lang NP, Bragger U. Fractured prosthetic abutments in osseointegrated implants: a technical complication to cope with. Clin Oral Implants Res 2000;11(2):163-70. 6. Binon PP. Implants and components: entering the new millennium. Int J Oral Maxillofac Implants 2000;15(1):76-94. 7. Akour SN, Fayyad MA, Nayfeh JF. Finite element analyses of two anti rotational designs of implants fixtures . Implant Dent 2005;14(1):77-81. 8. Wiskott HW, Belser UC. Mechanical resistance of cemented post and core build ups for ITI- Bone fit implants. Clin Oral Implants Res 1992;3(3):128-35. 9. Sato Y, Shindoi N, Hosokawa R, Tsuga K, Akagawa Y. A biomechanical effect of wide implant placement and offset placement of 3 implants in the posterior partially edentulous region. J Oral Rehabil 2000;27(1):15-21. 10. Siamos G, Winkler S, Boberick KG. Relationship between implant preload and screw loosening on implant-supported prostheses. J Oral Implantol 2002;28(2):67-73.