Page 62 - DP Vol 20 No 3

IMPLANT DENTISTRY SECTION

RETRIEVAL OF FRACTURED IMPLANT

ABUTMENT SCREW USING OSSTEM ESR

KIT: A CASE REPORT

Amit Bhardwaj

INTRODUCTION
Implant therapy is an effective and reliable restorative treatment
option.
The success of dental implants is based primarily on the extent of
osseointegration.
Implant restorations can fail either biologically or mechanically.
a. Biological factors include unsuccessful osseointegration or the
presence of peri-implantitis.
b. Mechanical failures include crown fracture, framework fracture,
screw loosening, and screw fracture.
• A loose screw is more prone to excessive sideways load.
Fracture of the implant abutment screw can be a serious
problem as the fragment remaining inside the implant may
prevent the implant from functioning efficiently.
• Though implant abutment screw fracture is uncommon
(0.5–8%), the sheer difficulty in removing the fractured screw Fig 1: Removed prosthesis Fig 2: Removed broken screw
fragments makes its management challenging.
• Fractured screw fragments, loosely engaged and not locked
into the implant, can be easily retrieved with a sharp probe.
• Difficulty in removal arises if the fractured abutment fragment
is engaged tightly with the implant threads.
• Retrieving a retained fractured abutment screw following
excessive torque becomes challenging due to a lack of screw
loosening.
• Various methods for the retrieval of screw fragments from
within the implant have been reported.
• Irreversible damage to the implants may occur when removal
of the fractured screw fragment is attempted by low-speed
rotary instruments.
• When a fractured screw fragment removal becomes
impossible or when a problematic retrieval results in damage to
the internal threading of the implant, many clinicians choose
removal and replacement of the implant or leave it behind Fig 3: Radiograph depicting remaining screw
unconnected to the superstructure.
• However, once any fracture of an abutment screw has
occurred, it is always desirable to remove it. The clinical impression was of a loosened abutment screw but later, after
radiographical evaluation, it was found to be associated with abutment
CASE REPORT screw fracture. The crown was already loose due to a fractured abutment
A 29-year-old man reported to dental clinic with a loosened crown screw. Both were removed.
on the mandibular left first molar, which was cemented over an Once the crown and abutment were removed, a radiograph was taken
implant abutment 2 months back. to reconfirm the fractured part of the abutment screw inside the implant.

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60 Dental Practice I May-June 2024 I Vol 20 No 3