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Journal of Prosthetic Dentistry

Removal of damaged implant components with a custom-made screwdriver

  • Dimitra Vakou
    Correspondence
    Corresponding author: Dr Dimitra Vakou, Department of Prosthodontics, School of Dentistry, National and Kapodistrian University of Athens, Dodekanisou 71, Nea Ionia, 14235, GREECE.
    Affiliations
    Laboratory Assistant, Department of Prosthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
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  • Nikitas Sykaras
    Affiliations
    Assistant Professor, Department of Prosthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
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Published:September 17, 2020DOI:https://doi.org/10.1016/j.prosdent.2020.05.010
      During implant treatment, technical complications related to the abutment, abutment screw, or prosthetic screw may develop.
      • Shah K.
      • Lee D.J.
      An alternative approach for the management of fractured implant abutment screws on a mandibular implant-retained overdenture: A clinical report.
      ,
      • Yang C.H.
      • Wu A.Y.J.
      A technique to retrieve a fractured implant abutment screw by using a screwdriver fashioned from a needle.
      Removing a damaged part can be challenging.
      • Arias S.R.
      • Rueggeberg F.A.
      • Mettenburg D.
      • Sharawy M.
      • Looney S.
      • Elsayed R.
      • et al.
      Heat generation during removal of an abutment screw fragment from dental implants.
      Various retrieval systems are available but most require drilling and are not easily applied to every implant design.
      • Shah K.
      • Lee D.J.
      An alternative approach for the management of fractured implant abutment screws on a mandibular implant-retained overdenture: A clinical report.
      ,
      • Yang C.H.
      • Wu A.Y.J.
      A technique to retrieve a fractured implant abutment screw by using a screwdriver fashioned from a needle.
      ,
      • Chen J.H.
      • Cho S.H.
      An accessory technique for the intraoral removal of a fractured implant abutment screw.
      This report describes an alternative method for removing a damaged 1-piece abutment by using a custom screwdriver.

      Procedure

      • 1.
        Identify the damaged structure from detailed clinical and radiographic examination.
      • 2.
        Cut the active end from a round tungsten carbide bur size 016 (H1 RA 016; Komet), and modify the remaining shaft with a crown cutter bur (H4MC FG 012; Komet) to form a slotted screwdriver tip with flat base and side walls (Fig. 1A.).
        Figure thumbnail gr1
        Figure 1A, Round bur after modification. B, Assembly of custom screwdriver.
      • 3.
        Insert the custom screwdriver shaft into a connector for the rachet (034.005; Straumann) (Fig. 1B.).
      • 4.
        Form a receptive notch in the center of the damaged abutment with a cavity preparation high-speed bur (H7S FG 010; Komet), and unscrew it with the screwdriver (Fig. 2).
        Figure thumbnail gr2
        Figure 2Clinical application of custom screwdriver to damaged abutment.
      This custom slotted screwdriver is an effective and relatively straightforward solution. Selecting low-speed rotary instruments (burs and drills) of various lengths for modification, screw fragments can also be reached inside the implant. An important advantage of this technique is the elimination of drilling systems for fragment removal
      • Azpiazu-Flores F.X.
      • Lee D.J.
      Using the screw shank as a retrieval tool: A straightforward approach to removing screws with diagonal fractures.
      and the application of reverse torque with a rachet.
      • Shah K.
      • Lee D.J.
      An alternative approach for the management of fractured implant abutment screws on a mandibular implant-retained overdenture: A clinical report.
      Limitations include the difficulty in forming the receptor notch when the fractured surface has been damaged by previous retrieval attempts. Knowledge of the prosthetic connection design and structure of each component of the implant system is required to avoid damage to the neighboring implant structures.

      CRediT authorship contribution statement:

      Dimitra Vakou: Resources, Writing - original draft, Visualization. Nikitas Sykaras: Conceptualization, Methodology, Writing - review & editing, Supervision.

      References

        • Shah K.
        • Lee D.J.
        An alternative approach for the management of fractured implant abutment screws on a mandibular implant-retained overdenture: A clinical report.
        J Prosthet Dent. 2016; 115: 402-405
        • Yang C.H.
        • Wu A.Y.J.
        A technique to retrieve a fractured implant abutment screw by using a screwdriver fashioned from a needle.
        J Prosthet Dent. 2019; 121: 709-710
        • Arias S.R.
        • Rueggeberg F.A.
        • Mettenburg D.
        • Sharawy M.
        • Looney S.
        • Elsayed R.
        • et al.
        Heat generation during removal of an abutment screw fragment from dental implants.
        J Prosthet Dent. 2018; 119: 620-625
        • Chen J.H.
        • Cho S.H.
        An accessory technique for the intraoral removal of a fractured implant abutment screw.
        J Prosthet Dent. 2018; 120: 812-815
        • Azpiazu-Flores F.X.
        • Lee D.J.
        Using the screw shank as a retrieval tool: A straightforward approach to removing screws with diagonal fractures.
        J Prosthet Dent. 2020; 123: 535-536