The cotton driver: An alternative technique for removing fractured screw fragments João Malta Barbosa, MSc,a João Ascenso, DDS,b Ronaldo Hirata, PhD,c and João Caramês, PhDd New York University College of Dentistry, New York, NY; Implantology Institute and Lisbon University College of Dentistry, Lisbon, Portugal Screw fractures in implant-supported restorations may compromise the viability of both the implant and the prosthesis if not adequately addressed.1 Although a low incidence of screw loosening or fracture has been reported, the resolution of such problems is time consuming, sometimes requiring multiple appointments.2-4 The depth and the possibility of having the screw fragment wedged in a damaged area of the implant internal
threads are factors that may influence the complexity and time involved in the retrieval attempt.4 A simplified technique for the removal of fractured screw fragments is described. This procedure allows the screw fragment to be retrieved without the risk of damaging or altering the surface characteristics of the components and avoids potential damage to the internal threads of the implant.4
PROCEDURE 1. Verify the level of the screw fracture by directly examining the remaining fragment, with magnification if necessary (Fig. 1).
1 Examination of remaining fragment.
2. If the fracture level is low, use an explorer with counterclockwise movements to raise the screw fragment closer to the implant platform level. 3. Reduce the handle of a cotton swab (Johnson & Johnson) so that it is short enough to be used vertically as a screwdriver (Fig. 2). 4. Press the cotton swab into the implant head and twist slowly counterclockwise (Fig. 3). 5. In case of unsuccessful retrieval, vibrate the screw fragment with an ultrasonic device (Cavitron; Dentsply Intl) under copious irrigation4 and try the procedure again. 6. Examine the retrieved screw to make sure no other fragments remain in the screw chamber.
2 Cotton swab adjusted for intraoral use.
a Resident, Department of Prosthodontics, New York University College of Dentistry; Department of Oral Rehabilitation, Implantology Institute. b Coordinator, Department of Oral Rehabilitation, Implantology Institute. c Assistant Professor and Associate Researcher, Department of Biomaterials and Biomimetics, New York University College of Dentistry. d Full Professor, Lisbon University College of Dentistry; Assistant Professor, New York University College of Dentistry; Clinical Director, Implantology Institute.
(J Prosthet Dent 2014;112:1601-1602)
Barbosa et al
1602
Volume 112 Issue 6 REFERENCES 1. Satterthwaite J, Rickman L. Retrieval of a fractured abutment screw thread from an implant: a case report. Br Dent J 2008;204: 177-80. 2. Theoharidou A, Petridis HP, Tzannas K, Garefis P. Abutment screw loosening in singleimplant restorations: a systematic review. Int J Oral Maxillofac Implants 2008;23:681-90. 3. Lee J, Kim Y, Kim C, Han J. Wave analysis of implant screw loosening using an air cylindrical cyclic loading device. J Prosthet Dent 2002;88:402-8. 4. Imam AY, Moshaverinia A, Chee WWL, McGlumphy EA. A technique for retrieving fractured implant screws. J Prosthet Dent 2014;111:81-3. Corresponding author: Dr João Malta Barbosa Avenida Columbano Bordalo Pinheiro No. 50 1070-064, Lisbon PORTUGAL E-mail: joaomaltabarbosa@implantologyinstitute. com Copyright ª 2014 by the Editorial Council for The Journal of Prosthetic Dentistry.
3 A, Implant with fractured screw. B, Cotton swab twisted counterclockwise. C, Retrieved screw fragment.
The Journal of Prosthetic Dentistry
Barbosa et al
threads are factors that may influence the complexity and time involved in the retrieval attempt.4 A simplified technique for the removal of fractured screw fragments is described. This procedure allows the screw fragment to be retrieved without the risk of damaging or altering the surface characteristics of the components and avoids potential damage to the internal threads of the implant.4
PROCEDURE 1. Verify the level of the screw fracture by directly examining the remaining fragment, with magnification if necessary (Fig. 1).
1 Examination of remaining fragment.
2. If the fracture level is low, use an explorer with counterclockwise movements to raise the screw fragment closer to the implant platform level. 3. Reduce the handle of a cotton swab (Johnson & Johnson) so that it is short enough to be used vertically as a screwdriver (Fig. 2). 4. Press the cotton swab into the implant head and twist slowly counterclockwise (Fig. 3). 5. In case of unsuccessful retrieval, vibrate the screw fragment with an ultrasonic device (Cavitron; Dentsply Intl) under copious irrigation4 and try the procedure again. 6. Examine the retrieved screw to make sure no other fragments remain in the screw chamber.
2 Cotton swab adjusted for intraoral use.
a Resident, Department of Prosthodontics, New York University College of Dentistry; Department of Oral Rehabilitation, Implantology Institute. b Coordinator, Department of Oral Rehabilitation, Implantology Institute. c Assistant Professor and Associate Researcher, Department of Biomaterials and Biomimetics, New York University College of Dentistry. d Full Professor, Lisbon University College of Dentistry; Assistant Professor, New York University College of Dentistry; Clinical Director, Implantology Institute.
(J Prosthet Dent 2014;112:1601-1602)
Barbosa et al
1602
Volume 112 Issue 6 REFERENCES 1. Satterthwaite J, Rickman L. Retrieval of a fractured abutment screw thread from an implant: a case report. Br Dent J 2008;204: 177-80. 2. Theoharidou A, Petridis HP, Tzannas K, Garefis P. Abutment screw loosening in singleimplant restorations: a systematic review. Int J Oral Maxillofac Implants 2008;23:681-90. 3. Lee J, Kim Y, Kim C, Han J. Wave analysis of implant screw loosening using an air cylindrical cyclic loading device. J Prosthet Dent 2002;88:402-8. 4. Imam AY, Moshaverinia A, Chee WWL, McGlumphy EA. A technique for retrieving fractured implant screws. J Prosthet Dent 2014;111:81-3. Corresponding author: Dr João Malta Barbosa Avenida Columbano Bordalo Pinheiro No. 50 1070-064, Lisbon PORTUGAL E-mail: joaomaltabarbosa@implantologyinstitute. com Copyright ª 2014 by the Editorial Council for The Journal of Prosthetic Dentistry.
3 A, Implant with fractured screw. B, Cotton swab twisted counterclockwise. C, Retrieved screw fragment.
The Journal of Prosthetic Dentistry
Barbosa et al
