RETRIEVAL OF FRACTURED

ABUTMENT SCREW FROM

THE IMPLANT
INTRODUCTION

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
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