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Journal of Prosthetic Dentistry

Visual inspection of implant screw access hole with an endoscope camera

      Prosthetic complications may necessitate the removal of an implant-supported restoration.
      • Hebel K.S.
      • Gajjar R.C.
      Cement-retained versus screw-retained implant restorations: Achieving optimal occlusion and esthetics in implant dentistry.
      • Guichet D.L.
      Load transfer in screw and cement-retained implant fixed partial denture design.
      • Ma S.
      • Fenton A.
      Screw-versus cement-retained implant prostheses: a systematic review of prosthodontic maintenance and complications.
      • Gaddale R.
      • Mishra S.K.
      • Chowdhary R.
      Complications of screw-and cement-retained implant-supported full-arch restorations: a systematic review and meta-analysis.
      Retrieval of cement-retained implant prostheses without any preexisting index of the screw access hole is challenging as it requires precision from the clinician during attempts to locate the abutment screws.
      • Schwedhelm E.R.
      • Raigrodski A.J.
      A technique for locating implant abutment screws of posterior cement-retained metal-ceramic restorations with ceramic occlusal surfaces.
      ,
      • Maalhagh-Fard A.
      • Jacobs L.C.
      Retrieval of a stripped abutment screw: a clinical report.
      Implants placed in unfavorable positions make the visibility of the screw access hole difficult, and the retrieval attempts in such situations pose a threat to the implant components, the intaglio surface of the implant, or the abutment screw.
      • Malpartida-Carrillo V.
      • Tinedo-Lopez P.L.
      • Ortiz-Culca F.
      • Guerrero M.E.
      • Amaya-Pajares S.P.
      Techniques for retrievability and for registering screw access holes in cement-retained implant-supported prostheses: a scoping review of the literature.
      ,
      • Chee W.
      • Felton D.A.
      • Johnson P.F.
      • Sullivan D.Y.
      Cemented versus screw-retained implant prosthesis: which is better?.
      Although several ways of retrieving the abutment screws have been reported,
      • Satwalekar P.
      • Chander K.S.
      • Reddy B.A.
      • Sandeep N.
      • Sandeep N.
      • Satwalekar T.
      A simple and cost effective method used for removal of a fractured implant abutment screw: a case report.
      • Nergiz I.
      • Schmage P.
      • Shahin R.
      Removal of a fractured implant abutment screw: a clinical report.
      • Flanagan D.
      Management of a fractured implant abutment screw.
      • Carneiro T.D.
      • Prudente M.S.
      • e Pessoa R.S.
      • Mendonça G.
      • das Neves F.D.
      A conservative approach to retrieve a fractured abutment screw–case report.
      the assistance of a magnified view and a flexible intraoral camera cannot be disregarded. This article describes the use of a commercially available endoscope camera for remote and enlarged visualization of the screw access hole, facilitating noninvasive and live viewing systems for efficient clinical practice.

      Technique

      • 1.
        Obtain an endoscope camera (2m Waterproof Endoscope Mini HD 5.5mm lens Camera Tube; MatLogix Pvt Ltd) with inspection light-emitting diode (LED) and universal serial bus (USB) connector for a smartphone or personal computer. Select one that is waterproof and is compatible with the user’s phone or computer (Fig. 1).
        Figure thumbnail gr1
        Figure 1Inspection light-emitting diode (LED) lights at tip of endoscope.
      • 2.
        Connect the USB end to the phone or computer and follow the manufacturer’s guidelines for product setup and installation (Fig. 2).
        Figure thumbnail gr2
        Figure 2Universal serial bus (USB) end of endoscope camera connected to smartphone.
      • 3.
        Use the endoscope camera to view the screw hole vents and assess the abutment screw head before engaging the retrieval instruments (Fig. 3).
        Figure thumbnail gr3
        Figure 3Live images of screw access hole viewed on connected device.
      • 4.
        Disinfect the endoscope after use with high-level disinfection solution by immersing the device in 0.55% orthophthalaldehyde solution (CIDEX OPA; Johnson & Johnson) for a minimum of 12 minutes at 20 °C or higher to destroy all pathogenic microorganisms.
        CIDEX OPA instructions
        Marketed by advanced sterilization products, a division of Ethicon, INC. A Johnson & Johnson company.
        When glutaraldehyde is used, it should be at a 2% concentration level at 25 °C for 20 to 90 minutes.
        • Oh H.J.
        • Kim J.S.
        Clinical practice guidelines for endoscope reprocessing.
      The micromotion created by a high-speed handpiece to create indentations on the crown may be a disadvantage to using an endoscope camera during the process. However, visual inspection of an unfavorable screw hole vent position using a flexible camera head with adequate lighting from endoscope LED can assist the clinician while engaging the retrieval instruments. The use of an endoscope camera in clinical practice combines the principles of both magnifying surgical loupes in terms of optical benefits, as well as an intraoral camera for patient awareness, enabling the visualization of the oral conditions and allowing effective communication between the patient and clinician.

      CRediT authorship contribution statement

      Nirmal Kurian: Writing - review & editing, Visualization, Project administration. Kevin George Varghese: Conceptualization, Methodology, Writing - original draft, Writing - review & editing. Kusha Dhawan: Resources.

      References

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        Cement-retained versus screw-retained implant restorations: Achieving optimal occlusion and esthetics in implant dentistry.
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        • Guichet D.L.
        Load transfer in screw and cement-retained implant fixed partial denture design.
        J Prosthet Dent. 1994; 72: 631
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        • Fenton A.
        Screw-versus cement-retained implant prostheses: a systematic review of prosthodontic maintenance and complications.
        Int J Prosthodont. 2015; 28: 127-145
        • Gaddale R.
        • Mishra S.K.
        • Chowdhary R.
        Complications of screw-and cement-retained implant-supported full-arch restorations: a systematic review and meta-analysis.
        Int J Oral Implantol. 2020; 13: 11-40
        • Schwedhelm E.R.
        • Raigrodski A.J.
        A technique for locating implant abutment screws of posterior cement-retained metal-ceramic restorations with ceramic occlusal surfaces.
        J Prosthet Dent. 2006; 95: 165-167
        • Maalhagh-Fard A.
        • Jacobs L.C.
        Retrieval of a stripped abutment screw: a clinical report.
        J Prosthet Dent. 2010; 104: 212-215
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        • Tinedo-Lopez P.L.
        • Ortiz-Culca F.
        • Guerrero M.E.
        • Amaya-Pajares S.P.
        Techniques for retrievability and for registering screw access holes in cement-retained implant-supported prostheses: a scoping review of the literature.
        J Prosthet Dent. 2020; 123: 427-433
        • Chee W.
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        Cemented versus screw-retained implant prosthesis: which is better?.
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        A simple and cost effective method used for removal of a fractured implant abutment screw: a case report.
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        • Schmage P.
        • Shahin R.
        Removal of a fractured implant abutment screw: a clinical report.
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        Management of a fractured implant abutment screw.
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        A conservative approach to retrieve a fractured abutment screw–case report.
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        • CIDEX OPA instructions
        Marketed by advanced sterilization products, a division of Ethicon, INC. A Johnson & Johnson company.
        (Available at:)
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        Clinical practice guidelines for endoscope reprocessing.
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