The Case of the ‘Broken Implant Screw’
In this episode of CDA Oasis Live, Dr. John O’Keefe, Director of Knowledge Networks CDA, talks to Dr. Beatrice Leung, a prosthodontist from Toronto, about the management of implant complications.
Although many of these complications fall under the banner of “broken implant screw”, Dr. Leung argues that presentations in her practice are frequently more involved than that, and they require a clearly defined strategy for treatment.
Here are some of the key takeaways from the conversation…
- According to current literature, the incidence of screw loosening is as common as 67%. The incidence of broken screws is a lot lower at 2%.
- The term “broken screw” tends to be used for a wide range of implant complications, including broken implant, broken abutment, broken screw, or loose screw. Investigating thoroughly and being more precise with terminology in these cases will lead to better management of patient expectation and better outcomes.
- Assessment – conservative exploration to assess the fragment. Is it visible? Is it deep inside the implant? Is there a restoration in the way? What is the access?
- Attempt to remove conservatively – wedge explorer in fragment in a counter clockwise direction to see if you can take it out. Can usually do this where it is a hex-like connection where the weak link is the screw.
- Modify the screw - to help engage the fragment, make a defined notch/slot in a way that one of your drivers is able to engage.
- Drill it out – a last resort as it carries a high risk of damaging the threads and not being able to use the implant again.
- Treat internal implant like a canal space and restore it as a one piece cast post and crown and cement.
- Remove implant and start all over again.
- Prevention requires a lot of understanding at the treatment planning stage. If treatment planning is weak, the forces are loaded unfavourably and this can create loosening.
- Important to ensure you use the correct screw for the implant and that you apply the correct torque.
- Prosthesis must fit passively
We hope you find the conversation useful. We welcome your thoughts, questions and/or suggestions about this post and other topics. Leave a comment in the box below or send us your feedback by email.
Until next time!
CDA Oasis Team