Noninvasive method for retrieval of broken dental implant abutment screw
Identifieur interne : 000149 ( Pmc/Corpus ); précédent : 000148; suivant : 000150Noninvasive method for retrieval of broken dental implant abutment screw
Auteurs : Jagadish Reddy Gooty ; Sunil Kumar Palakuru ; Vikram Reddy Guntakalla ; Mahipal NeraSource :
- Contemporary Clinical Dentistry [ 0976-237X ] ; 2014.
Abstract
Dental implants made of titanium for replacement of missing teeth are widely used because of ease of technical procedure and high success rate, but are not free of complications and may fail. Fracturing of the prosthetic screw continues to be a problem in restorative practice and great challenge to remove the fractured screw conservatively. This case report describes and demonstrates the technique of using an ultrasonic scaler in the removal of the fracture screw fragment as a noninvasive method without damaging the hex of implants.
Url:
DOI: 10.4103/0976-237X.132382
PubMed: 24963261
PubMed Central: 4067798
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Noninvasive method for retrieval of broken dental implant abutment screw</title><author><name sortKey="Gooty, Jagadish Reddy" sort="Gooty, Jagadish Reddy" uniqKey="Gooty J" first="Jagadish Reddy" last="Gooty">Jagadish Reddy Gooty</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Palakuru, Sunil Kumar" sort="Palakuru, Sunil Kumar" uniqKey="Palakuru S" first="Sunil Kumar" last="Palakuru">Sunil Kumar Palakuru</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Guntakalla, Vikram Reddy" sort="Guntakalla, Vikram Reddy" uniqKey="Guntakalla V" first="Vikram Reddy" last="Guntakalla">Vikram Reddy Guntakalla</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Nera, Mahipal" sort="Nera, Mahipal" uniqKey="Nera M" first="Mahipal" last="Nera">Mahipal Nera</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24963261</idno><idno type="pmc">4067798</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4067798</idno><idno type="RBID">PMC:4067798</idno><idno type="doi">10.4103/0976-237X.132382</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">000149</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000149</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Noninvasive method for retrieval of broken dental implant abutment screw</title><author><name sortKey="Gooty, Jagadish Reddy" sort="Gooty, Jagadish Reddy" uniqKey="Gooty J" first="Jagadish Reddy" last="Gooty">Jagadish Reddy Gooty</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Palakuru, Sunil Kumar" sort="Palakuru, Sunil Kumar" uniqKey="Palakuru S" first="Sunil Kumar" last="Palakuru">Sunil Kumar Palakuru</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Guntakalla, Vikram Reddy" sort="Guntakalla, Vikram Reddy" uniqKey="Guntakalla V" first="Vikram Reddy" last="Guntakalla">Vikram Reddy Guntakalla</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Nera, Mahipal" sort="Nera, Mahipal" uniqKey="Nera M" first="Mahipal" last="Nera">Mahipal Nera</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author></analytic><series><title level="j">Contemporary Clinical Dentistry</title><idno type="ISSN">0976-237X</idno><idno type="eISSN">0976-2361</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Dental implants made of titanium for replacement of missing teeth are widely used because of ease of technical procedure and high success rate, but are not free of complications and may fail. Fracturing of the prosthetic screw continues to be a problem in restorative practice and great challenge to remove the fractured screw conservatively. This case report describes and demonstrates the technique of using an ultrasonic scaler in the removal of the fracture screw fragment as a noninvasive method without damaging the hex of implants.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Wennstrom, Jl" uniqKey="Wennstrom J">JL Wennström</name></author><author><name sortKey="Ekestubbe, A" uniqKey="Ekestubbe A">A Ekestubbe</name></author><author><name sortKey="Grondahl, K" uniqKey="Grondahl K">K Gröndahl</name></author><author><name sortKey="Karlsson, S" uniqKey="Karlsson S">S Karlsson</name></author><author><name sortKey="Lindhe, J" uniqKey="Lindhe J">J Lindhe</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Br Nemark, Pi" uniqKey="Br Nemark P">PI Brånemark</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nergiz, I" uniqKey="Nergiz I">I Nergiz</name></author><author><name sortKey="Schmage, P" 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Contemp Clin Dent</journal-id><journal-id journal-id-type="iso-abbrev">Contemp Clin Dent</journal-id><journal-id journal-id-type="publisher-id">CCD</journal-id><journal-title-group><journal-title>Contemporary Clinical Dentistry</journal-title></journal-title-group><issn pub-type="ppub">0976-237X</issn><issn pub-type="epub">0976-2361</issn><publisher><publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24963261</article-id><article-id pub-id-type="pmc">4067798</article-id><article-id pub-id-type="publisher-id">CCD-5-264</article-id><article-id pub-id-type="doi">10.4103/0976-237X.132382</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Noninvasive method for retrieval of broken dental implant abutment screw</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Gooty</surname><given-names>Jagadish Reddy</given-names></name><xref ref-type="aff" rid="aff1"></xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Palakuru</surname><given-names>Sunil Kumar</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Guntakalla</surname><given-names>Vikram Reddy</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Nera</surname><given-names>Mahipal</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib></contrib-group><aff id="aff1"><italic>Department of Periodontics and Implantology, Kamineni Institute of Dental Sciences, Narketpally, Andhra Pradesh, India</italic></aff><author-notes><corresp id="cor1"><bold>Correspondence:</bold> Dr. Jagadish Reddy Gooty, Department of Periodontics and Implantology, Kamineni Institute of Dental Sciences, Narketpally - 508 254, Andhra Pradesh, India. E-mail: <email xlink:href="drjagadishreddy@gmail.com">drjagadishreddy@gmail.com</email></corresp></author-notes><pub-date pub-type="ppub"><season>Apr-Jun</season><year>2014</year></pub-date><volume>5</volume><issue>2</issue><fpage>264</fpage><lpage>267</lpage><permissions><copyright-statement>Copyright: © Contemporary Clinical Dentistry</copyright-statement><copyright-year>2014</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>Dental implants made of titanium for replacement of missing teeth are widely used because of ease of technical procedure and high success rate, but are not free of complications and may fail. Fracturing of the prosthetic screw continues to be a problem in restorative practice and great challenge to remove the fractured screw conservatively. This case report describes and demonstrates the technique of using an ultrasonic scaler in the removal of the fracture screw fragment as a noninvasive method without damaging the hex of implants.</p></abstract><kwd-group><kwd>Dental implants</kwd><kwd>dental restoration failure</kwd><kwd>osseointegration</kwd></kwd-group></article-meta></front><body><sec sec-type="intro" id="sec1-1"><title>Introduction</title><p>Oral implantology is an ever growing field that is reaching the practice of general dentist due to the simplification of technical procedures.</p><p>Implant treatment is considered as a safe technique with high rates of success.[<xref rid="ref1" ref-type="bibr">1</xref>] Titanium endosteal implants are widely used due to the advantages offered by their mechanical properties and excellent anchorage in the jawbone, known as “osseointegration.”[<xref rid="ref2" ref-type="bibr">2</xref>] This type of anchorage of the implant in bone is considered as essential criteria for a successful dental implant. Nevertheless, it has, as every surgical procedure, several complications that can occur and that must be known in order to prevent or solve them.</p><p>The failure of dental implants is due not only to biological factors, such as unsuccessful osseointegration or the development of periimplantitis, but it may also result from technical complications.[<xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref4" ref-type="bibr">4</xref>] These complications are relatively rare. In contrast, prosthetic complications are not uncommon.[<xref rid="ref5" ref-type="bibr">5</xref>]</p><p>In general, these complications can be grouped into the following five categories:[<xref rid="ref6" ref-type="bibr">6</xref>]</p><p><list list-type="order"><list-item><p>Veneering material fracture</p></list-item><list-item><p>Prosthetic screw loosening</p></list-item><list-item><p>Prosthetic screw fracture</p></list-item><list-item><p>Implant fracture</p></list-item><list-item><p>Framework fracture.</p></list-item></list></p><p>Failures of implant-supported restorations result from technical problems and can be divided into two groups: those relating to implant components, and those relating to the prosthesis.[<xref rid="ref7" ref-type="bibr">7</xref><xref rid="ref8" ref-type="bibr">8</xref><xref rid="ref9" ref-type="bibr">9</xref>] Technical problems related to implant components include abutment screw fracture.[<xref rid="ref9" ref-type="bibr">9</xref>] Jung <italic>et al</italic>., 2004 reported that prosthetic screw fracture has an incidence rate of 3.9% and the rate for prosthetic screw loosening is 6.7%.[<xref rid="ref10" ref-type="bibr">10</xref>] Fracture of prosthetic retaining screws is more common than implant fracture and it is normally due to a metal fatigue following an overload of materials. Though several systems from different manufacturers are available, a simple and unique non-invasive technique to retrieve the broken abutment screw is described in this case report.</p></sec><sec id="sec1-2"><title>Case Report</title><p>A 36-year-old male presented for treatment, reporting the detachment of an implant-supported crown in the region of the lower left first molar. The patient stated that the implant and crown had been placed 3 years earlier. Clinical examination of the patient revealed a missing tooth at the location of lower left first molar with no sign of an implant. The patient brought the abutment with cemented crown.</p><p>Radiographic examination of the area showed the presence of a root-form cylindrical implant, consistent in appearance with an 11.5 mm long, 4.2 mm diameter abutment with an internal hex. The implant appeared to be well-positioned in all three-dimensions (mesiodistal, buccolingual and apico-coronal) and the radiographic examination did not indicate any damage to the implant body.</p><p>The apical part of the abutment screw remained threaded into the implant [<xref ref-type="fig" rid="F1">Figure 1</xref>], but had fractured below the level of the hexagonal lock. Although the implant was osseointegrated, there were radiographic signs of periimplantitis with some crestal bone loss having occurred.</p><fig id="F1" position="float"><label>Figure 1</label><caption><p>Broken abutment screw</p></caption><graphic xlink:href="CCD-5-264-g001"></graphic></fig><p>After anesthetizing the area, using the tissue punch, the implant was exposed. Using a ¼ round bur in a high-speed hand piece, a 1 mm deep pit was made across the most occlusal portion of the broken screw fragment [<xref ref-type="fig" rid="F2">Figure 2</xref>]. The hand piece is held with both hands to avoid having the bur inadvertently jump into the implant body. Using ultrasonic scaler with no 3 tip placed in the pit prepared moving in anticlockwise direction slowly the broken abutment screw was retrieved [<xref ref-type="fig" rid="F3">Figure 3</xref>]. Using close tray transfer impression was made and the model with implant analog and the abutment was sent to the lab for prosthesis preparation. Metal ceramic prosthesis was cemented to the abutment in position which was tightened to the implant body with screw which was torque to 35 N [<xref ref-type="fig" rid="F4">Figure 4</xref>].</p><fig id="F2" position="float"><label>Figure 2</label><caption><p>Slot prepared on the fractured screw</p></caption><graphic xlink:href="CCD-5-264-g002"></graphic></fig><fig id="F3" position="float"><label>Figure 3</label><caption><p>Abutment screw retrieved</p></caption><graphic xlink:href="CCD-5-264-g003"></graphic></fig><fig id="F4" position="float"><label>Figure 4</label><caption><p>Cemented crown showing the broken screw part</p></caption><graphic xlink:href="CCD-5-264-g004"></graphic></fig></sec><sec sec-type="discussion" id="sec1-3"><title>Discussion</title><p>The abutment screw fracture presents a rare, but quite unpleasant failure and can be a serious problem as the fragment remaining inside the implant may prevent the implant from functioning efficiently as an anchor.[<xref rid="ref11" ref-type="bibr">11</xref>] The primary reason for screw fracture is undetected screw loosing which can be due to bruxism, an unfavorable superstructure, overloading or malfunction.[<xref rid="ref3" ref-type="bibr">3</xref>] Fractures of the implant abutment or of the abutment screw have been observed as a consequence of screw loosening and undetected micro-movements of the abutment under functional loading[<xref rid="ref12" ref-type="bibr">12</xref>] and consequently, it is advised that the repeated loosening of an abutment screw should alert the clinician to possible significant contributing causes [<xref ref-type="fig" rid="F5">Figure 5</xref>].</p><fig id="F5" position="float"><label>Figure 5</label><caption><p>Final prosthesis placed</p></caption><graphic xlink:href="CCD-5-264-g005"></graphic></fig><p>However, the behavior of the implant/abutment joint components with respect to critical bending force is still unclear.[<xref rid="ref12" ref-type="bibr">12</xref>] Studies show that implant abutment failure occurs when lateral forces exceed 370 N for abutment with a joint depth of at least 2.1 mm and 530 N with a joint depth of at least 5.5 mm.[<xref rid="ref13" ref-type="bibr">13</xref>]</p><p>The number, position, dimension and design of implants, as well as the design of the prosthesis are critical factors to be considered during the treatment planning phase.[<xref rid="ref14" ref-type="bibr">14</xref>] To withstand high bending stresses, implants should be as long and as wide as possible, used in adequate numbers, and be positioned such as to allow axial loading.[<xref rid="ref15" ref-type="bibr">15</xref><xref rid="ref16" ref-type="bibr">16</xref>] Implant components are known to fracture more frequently in the posterior region and in partially dentate patients compared to completely edentulous patients.[<xref rid="ref16" ref-type="bibr">16</xref>] Retightening an abutment screw 10 min after the initial torque applications should be routinely performed, and increasing the torque value for abutment screws above 30 N can be beneficial for the abutment, implant stability and to decrease the possibility of the screw becoming loose.[<xref rid="ref17" ref-type="bibr">17</xref>]</p><p>The methods employed to grasp the broken fragments or screw are determined according to the location of the fracture abutment-above or below the head of the implant. If an abutment screw fractures above the head of the implant, an explorer, a straight probe or hemostats might be successful.[<xref rid="ref18" ref-type="bibr">18</xref>] The tip of the instrument is moved carefully in a counter-clockwise direction over the surface of the screw segment until it loosens.[<xref rid="ref3" ref-type="bibr">3</xref>] If the screw fracture occurs below the head of the implant, other methods are required. There are several available implant repair kits:</p><p><list list-type="bullet"><list-item><p>ITI<sup>®</sup> Dental Implant System (Institut Straumann AG, Switzerland), consists of drills, two drill guides and six manual tapping instruments[<xref rid="ref8" ref-type="bibr">8</xref>]</p></list-item><list-item><p>IMZ<sup>®</sup> TwinPlus Implant System1 (Dentsply Friadent, Germany)</p></list-item><list-item><p>Screw Removal Kit Replace (Nobel Biocare<sup>™</sup>, Yorba Linda, California, USA)</p></list-item><list-item><p>Certain<sup>®</sup>-Screw Removal Kit (Biomet 3i<sup>™</sup>, Florida, USA).</p></list-item></list></p><p>Prosthesis screw fracture was noted almost equally with fixed complete dentures (3%) and fixed partial dentures (5%). The mean incidence was 4% but was found to range from 0.0% to 19%. Of 7094 screws evaluated, 282 fractured.[<xref rid="ref7" ref-type="bibr">7</xref>]</p></sec><sec sec-type="conclusion" id="sec1-4"><title>Conclusion</title><p>Abutment screw fracture, although uncommon, occurs in clinical practice. In most circumstances, the fractured end can be retrieved and replaced by a new abutment screw. However, sometimes the screw cannot be removed conservatively. By using rotary instruments, internal threads of the screw hole may be damaged and the implant rendered useless.</p><p>The use of osseointegrated implant-supported prostheses in the replacement of missing natural teeth has become an accepted clinical protocol in dentistry. Success in this area is enhanced through correct diagnosis, treatment planning, and maintenance; however, complications often occur, which may be significant and compromise the long-term success of the implant abutment and associated prosthesis. 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