Clinical assessment of fractured implant abutment screws ......J Prosthet Dent 2001;86:549-50. 8....
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DENTAL TECHNIQUE Clinical assessment of fractured implant abutment screws: The Bernese silicone replica technique Kensuke Igarashi, DDS, PhD a and Kelvin I. Afrashtehfar, DDS, MSc b With implant dentistry increas- ingly associated with satisfactory long-term clinical and patient- centered outcomes, 1,2 implant complications have also inc- reased. 3-5 Mechanical compli- cations include a 3.9% incidence of fractured implant abutments screws and a 6.7% incidence of loosened implant abut- ments screws, 4 with loosening often being the precursor to a fractured screw. 6 Consequently, completely retrieving the fractured abutment screws without damaging the implant is a clinical challenge. 7-12 Using a dental exca- vator 13 or ultrasonic scaler 14 may be the most straight- forward methods; however, they may not always be successful, and a repair or rescue device for the retrieval of fractured implant abutment screws may be necessary. 15 Although these devices may remove the fractured screws by drilling and hand tapping into the implant body, the condition of the internal implant body may be impossible to observe clearly, even with magnification. Moreover, the presence of fragments of the fractured screw in the depth of the implant screw hole may prevent seating of the new abutment and may not be perceived by the clinician. Prosthesis misfit may cause a new mechanical complica- tion 16 in addition to peri-implant soft tissue damage and marginal bone loss. 17 A reliable method of evaluating the internal implant condition is needed. This article describes the Bernese silicone replica technique developed for a precise assessment of the in- ternal implant condition. This dental technique uses an elastomeric impression material such as polyvinyl siloxane 18 or vinylsiloxanether. 19 TECHNIQUE 1. After retrieving the fractured abutment screw with the repair device (RSS; Straumann AG), rinse thoroughly with 10 mL of saline from a disposable syringe (Omnifix; B. Braun Medical Inc) with a stainless steel 25-gauge irrigating needle (ProRinse; Dentsply Sirona). 2. Air-dry the inner implant fixture using a 3-way sy- ringe and clean with a microbrush (Microbrush; Microbrush Intl). 3. Insert the intraoral tip of an impression cartridge (Identium Light; Kettenbach GmbH & Co KG) as deeply as possible inside the implant body (Fig. 1). 4. Inject the light-body impression material until it extrudes from the implant shoulder. As the tip is withdrawn, keep injecting material until excess material is approximately 5 mm coronally from the shoulder of the implant (Figs. 2, 3). Materials provided by the Department of Reconstructive Dentistry & Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland. a Postdoctoral Fellow, Department of Reconstructive Dentistry & Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland; and Assistant Professor, Department of Life Science Dentistry, The Nippon Dental University, Niigata, Japan. b Fellow, Advanced Studies in Oral Implantology, Department of Reconstructive Dentistry & Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland. ABSTRACT Fractured implant abutment screws can be retrieved with repair or rescue devices. However, whether the screw was completely retrieved or the inner implant body was damaged may be uncertain. A silicone replica technique was recently implemented in Bern and may be the most predictable method available at the moment for clinically assessing the internal implant body. This technique is straightforward and precise and may help dentists determine the internal implant condition when managing a fractured screw. (J Prosthet Dent 2018;119:717-9) THE JOURNAL OF PROSTHETIC DENTISTRY 717
Transcript of Clinical assessment of fractured implant abutment screws ......J Prosthet Dent 2001;86:549-50. 8....
DENTAL TECHNIQUE
Materials proaPostdoctoraAssistant ProbFellow, Adva
THE JOURNA
Clinical assessment of fractured implant abutment screws: TheBernese silicone replica technique
Kensuke Igarashi, DDS, PhDa and Kelvin I. Afrashtehfar, DDS, MScb
ABSTRACTFractured implant abutment screws can be retrieved with repair or rescue devices. However,whether the screw was completely retrieved or the inner implant body was damaged may beuncertain. A silicone replica technique was recently implemented in Bern and may be the mostpredictable method available at the moment for clinically assessing the internal implant body. Thistechnique is straightforward and precise and may help dentists determine the internal implantcondition when managing a fractured screw. (J Prosthet Dent 2018;119:717-9)
With implant dentistry increas-ingly associatedwith satisfactorylong-term clinical and patient-centered outcomes,1,2 implantcomplications have also inc-reased.3-5 Mechanical compli-cations include a 3.9% incidenceof fractured implant abutments
screws and a 6.7% incidence of loosened implant abut-ments screws,4 with loosening often being the precursor toa fractured screw.6 Consequently, completely retrievingthe fractured abutment screws without damaging theimplant is a clinical challenge.7-12 Using a dental exca-vator13 or ultrasonic scaler14 may be the most straight-forward methods; however, they may not always besuccessful, and a repair or rescue device for the retrieval offractured implant abutment screws may be necessary.15Although these devices may remove the fractured screwsby drilling and hand tapping into the implant body, thecondition of the internal implant body may be impossibleto observe clearly, even with magnification. Moreover, thepresence of fragments of the fractured screw in the depthof the implant screw hole may prevent seating of the newabutment and may not be perceived by the clinician.Prosthesis misfit may cause a new mechanical complica-tion16 in addition to peri-implant soft tissue damage andmarginal bone loss.17 A reliable method of evaluating theinternal implant condition is needed.
This article describes the Bernese silicone replicatechnique developed for a precise assessment of the in-ternal implant condition. This dental technique uses an
vided by the Department of Reconstructive Dentistry & Gerodontology, Scl Fellow, Department of Reconstructive Dentistry & Gerodontology, Schoolfessor, Department of Life Science Dentistry, The Nippon Dental Universitnced Studies in Oral Implantology, Department of Reconstructive Dentistry &
L OF PROSTHETIC DENTISTRY
elastomeric impression material such as polyvinylsiloxane18 or vinylsiloxanether.19
TECHNIQUE
1. After retrieving the fractured abutment screw withthe repair device (RSS; Straumann AG), rinsethoroughly with 10 mL of saline from a disposablesyringe (Omnifix; B. Braun Medical Inc) with astainless steel 25-gauge irrigating needle (ProRinse;Dentsply Sirona).
2. Air-dry the inner implant fixture using a 3-way sy-ringe and clean with a microbrush (Microbrush;Microbrush Intl).
3. Insert the intraoral tip of an impression cartridge(Identium Light; Kettenbach GmbH & Co KG) asdeeply as possible inside the implant body(Fig. 1).
4. Inject the light-body impression material until itextrudes from the implant shoulder. As the tip iswithdrawn, keep injecting material until excessmaterial is approximately 5 mm coronally from theshoulder of the implant (Figs. 2, 3).
hool of Dental Medicine, University of Bern, Bern, Switzerland.of Dental Medicine, University of Bern, Bern, Switzerland; andy, Niigata, Japan.Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
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Figure 1. Intraoral tip for light-bodysilicone inserted in implant.
ure 2. Extrusion of excess impression material.
Figure 4. Interproximal wooden wedge in
Figure 3. Extruded excess impression material.
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Fig
serted. Figure 5. Impression pattern removal.
5. Insert an interproximal wooden wedge (PolydentiaSA) held in cotton pliers (Tweezers College Liq-uidSteel; Carl Martin GmbH) as deeply as possibleinto the middle of the impression in 1 motion toavoid introducing air bubbles (Fig. 4).
6. Allow the impression material to polymerize andremove the internal implant negative pattern bycarefully turning the external excess in a counter-clockwise direction (Fig. 5).
7. Compare the removed pattern (left) with a controlsilicone pattern (right) (Fig. 6). The control siliconepattern should be prepared beforehand from anundamaged dental implant.
DISCUSSION
This dental technique describes the steps needed toassess the internal implant condition after using a repairdevice (Supplementary Video). The authors are unawareof previous reports on the internal implant conditionafter retrieving a fractured abutment screw. Knowing the
internal implant state as precisely as possible is essentialto determining whether the dental implant can besalvaged for a future prosthesis. This straightforwardmethod can clinically assess the condition of an internalimplant. Additionally, the Bernese silicone replica tech-nique is safe and inexpensive.
Few techniques are available for evaluating thecomplete removal of a fractured abutment screw afterusing a repair device. For example, there are workshopsin which participants are instructed to assess the suc-cess of retrieving a fractured abutment screw byinserting an impression post. If the impression post iscompletely inserted, then the screw removal procedureis considered successful. Our group, however, hasshown that this test is unreliable because the apicalportion of the impression screw does not reach thebottom of the implant screw hole. Therefore, a consis-tent method of determining complete removal of thefractured abutment screw is needed. Impression makinghas been associated with 2 clinical reports of fracturedscrew removal,20,21 but the purpose was finding a
Igarashi and Afrashtehfar
Figure 6. Internal implant condition comparison. Removed fracturedscrew (left) and control (right) negative patterns.
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prosthetic solution, not to assess the internal implantcondition.
This technique may not be suitable for all clinicalscenarios. For example, when silicone is subjected tomore than the recommended 25�C storage temperature,the material sets faster, and the silicone pattern maydistort.22 In another scenario, when internal implantscrew threads have been severely damaged, the siliconepattern may engage undercuts and be torn on removal.23
Moreover, a pattern of an undamaged implant from thesame manufacturer may not always be available, forexample, if no undamaged implant is stored and if thepatient has only 1 implant of that type.
SUMMARY
This technique assesses the internal implant conditionafter fractured abutment screw retrieval with a repairdevice and a silicone impression. This method can beconsidered straightforward and precise.
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Corresponding author:Dr Kelvin Ian AfrashtehfarDepartment of Reconstructive Dentistry & GerodontologySchool of Dental Medicine, Faculty of MedicineUniversity of BernRm C305, Freiburgstrasse 73010 BerneSWITZERLANDEmail: [email protected]
AcknowledgmentsThe authors thank the scientific illustrator, Ms Bernadette Rawyler, Department ofMultimedia and Computer Science for her assistance in the elaboration of the video.K.I. thanks The Nippon Dental University School of Life Dentistry at Niigata forsupporting the postdoctoral education. K.I.A. thanks the International Team ofImplantology (ITI; Basel, Switzerland) for the educational support.
Copyright © 2017 by the Editorial Council for The Journal of Prosthetic Dentistry.
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