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Journal of Prosthetic Dentistry

Using the screw shank as a retrieval tool: A straightforward approach to removing screws with diagonal fractures

  • Francisco X. Azpiazu-Flores
    Correspondence
    Corresponding author: Dr Francisco X. Azpiazu-Flores, Division of Restorative and Prosthetic Dentistry, College of Dentistry, The Ohio State University, Postle Hall 305 W 12th Avenue, Columbus, OH 43210
    Affiliations
    Graduate student, Advanced Prosthodontics Program, Division of Restorative and Prosthetic Dentistry, College of Dentistry, The Ohio State University, Columbus, Ohio
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  • Damian J. Lee
    Affiliations
    Assistant Professor and Director of the Advanced Prosthodontics Program, Division of Restorative and Prosthetic Dentistry, College of Dentistry, The Ohio State University, Columbus, Ohio
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      Abutment screw fracture is a mechanical complication that has been related to the failure of dental implants.
      • Eckert S.E.
      • Meraw S.J.
      • Cal E.
      • Ow R.K.
      Analysis of incidence and associated factors with fractured implants: a retrospective study.
      With the advent of new prosthetic designs, new materials, and more specialized torque controlling devices, the incidence of these types of complications has decreased significantly
      • Katsavochristou A.
      • Koumoulis D.
      Incidence of abutment screw failure of single or splinted implant prostheses: a review and update on current clinical status.
      and has been reported to vary from 0.16% to 3.9%.
      • Kreissl M.E.
      • Gerds T.
      • Muche R.
      • Heydecke G.
      • Strub J.R.
      Technical complications of implant-supported fixed partial dentures in partially edentulous cases after an average observation period of 5 years.
      ,
      • Sadid-Zadeh R.
      • Kutkut A.
      • Kim H.
      Prosthetic failure in implant dentistry.
      Factors such as nonaxial loading of the screw joint,
      • Alkan I.
      • Sertgöz A.
      • Ekici B.
      Influence of occlusal forces on stress distribution in preloaded dental implant screws.
      nonpassive frameworks, presence of cantilevers, and inadequate preload of the abutment screw have been associated with screw fracture.
      • Kreissl M.E.
      • Gerds T.
      • Muche R.
      • Heydecke G.
      • Strub J.R.
      Technical complications of implant-supported fixed partial dentures in partially edentulous cases after an average observation period of 5 years.
      ,
      • McGlumphy E.A.
      • Mendel D.A.
      • Holloway J.A.
      Implant screw mechanics.
      Various techniques have been reported for managing this complication while trying to preserve the internal threads of the implant. In the majority of these reports, the abutment screw fractured horizontally at the level of the initial screw threads.
      • Williamson R.T.
      • Robinson F.G.
      Retrieval technique for fractured implant screws.
      • Walia M.S.
      • Arora S.
      • Luthra R.
      • Walia P.K.
      Removal of fractured dental implant screw using a new technique: a case report.
      • Yilmaz B.
      • McGlumphy E.
      A technique to retrieve fractured implant screws.
      • Yang C.-H.
      • Wu A.Y.-J.
      A technique to retrieve a fractured implant abutment screw by using a screwdriver fashioned from a needle.
      • Taira Y.
      • Sawase T.
      A modified technique for removing a failed abutment screw from an implant with a custom guide tube.
      • Gooty J.R.
      • Palakuru S.K.
      • Guntakalla V.R.
      • Nera M.
      Noninvasive method for retrieval of broken dental implant abutment screw.
      • Flanagan D.
      Management of a fractured implant abutment screw.
      • Nergiz I.
      • Schmage P.
      • Shahin R.
      Removal of a fractured implant abutment screw: a clinical report.
      • Luterbacher S.
      • Fourmousis I.
      • Lang N.P.
      • Bragger U.
      Fractured prosthetic abutments in osseointegrated implants: a technical complication to cope with.
      The following article describes a straightforward and conservative method of removing a fractured abutment screw with a diagonal fracture pattern using the screw shank as the retrieval tool.

      Procedure

      • 1.
        Make a periapical radiograph of the implant to assess the position of the fractured abutment screw inside the implant (Fig. 1).
        Figure thumbnail gr1
        Figure 1Periapical radiograph of implant with fractured abutment screw.
      • 2.
        Rinse the implant platform copiously with water and air spray to remove food debris, blood, and dental plaque that can interfere with the visualization of and access to the implant screw hole. Additionally, irrigate the screw channel with chlorhexidine gluconate (Peridex; 3M ESPE) for decontamination and lubrication (Fig. 2).
        Figure thumbnail gr2
        Figure 2Fractured abutment screw inside implant screw hole.
      • 3.
        Visually assess the integrity and the pattern of fracture of the screw at the shank level. If necessary, remove any distorted portion that can affect the engagement of the shank to the portion of the screw inside the implant.
      • 4.
        Mount the shank in the hexagon screwdriver (Hex Driver, with GemLock Retention; Zimmer Biomet Dental) and carefully introduce the shank into the screw hole until it engages the fractured screw. Apply moderate force apically to fully approximate both pieces. Rotate the shank in a counter-clockwise direction to remove the threaded portion of the abutment screw (Fig. 3).
        Figure thumbnail gr3
        Figure 3Shank mounted in hexagon driver being used as retrieval tool. A, Shank engaging the fractured screw. B, Fractured screw fully disengaged from internal implant threads.
      • 5.
        Evaluate the matching of the shank and the threaded portion of the screw extraorally (Fig. 4).
        Figure thumbnail gr4
        Figure 4Screwdriver and shank used to remove fractured screw fragment.

      References

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        Incidence of abutment screw failure of single or splinted implant prostheses: a review and update on current clinical status.
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        Influence of occlusal forces on stress distribution in preloaded dental implant screws.
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