Implant Abutment Screw Rescue Techniques: A Comprehensive Review

International Journal of Dental Science and Innovative Research (IJDSIR) IJDSIR : Dental Publication Service Available Online at:www.ijdsir.com Volume – 8, Issue – 3, June – 2025, Page No. : 30 - 35 Corresponding Author: Dr.Smita Khalikar, ijdsir, Volume – 8 Issue - 3, Page No. : 30 - 35 Page30 ISSN: 2581-5989 PubMed - National Library of Medicine - ID: 101738774 Implant Abutment Screw Rescue Techniques: A Comprehensive Review 1Dr. Smita Khalikar, 2Dr. Kishor Mahale, 3Dr. Sonali Khedkar, 4Dr. Sharayu Bangar, 5Dr. Vilas Rajguru, 6Dr. Sonali Mahajan, 7Dr. Ulhas Tandale 1-7Government Dental College And Hospital, Chhatrapati Sambhajinaga. Corresponding Author: Dr. Smita Khalikar Citation of this Article: Dr.Smita Khalikar, Dr. Kishor Mahale, Dr.Sonali Khedkar, Dr. Sharayu Bangar, Dr. Vilas Rajguru, Dr. Sonali Mahajan, Dr. Ulhas Tandale, “Implant Abutment Screw Rescue Techniques: A Comprehensive Review”, IJDSIRJune – 2025, Volume – 8, Issue – 3, P. No. 30 – 35. Copyright: © 2025, Dr.Smita Khalikar, et al. This is an open access journal and article distributed under the terms of the creative common’s attribution non-commercial License. Which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given, and the new creations are licensed under the identical terms. Type of Publication: Review Article Conflicts of Interest: Nil Abstract The fracture of implant abutment screws presents a significant challenge in implant prosthodontics, potentially compromising the integrity of the implant system. The retrieval of fractured screws requires precise techniques to prevent damage to the implant body. Various retrieval methods range from manual approaches using explorers and ultrasonic scalers to advanced techniques involving customized drill guides and rotary instruments. This review provides a comprehensive overview of the available techniques for retrieving fractured abutment screws, analyzing their effectiveness, advantages, limitations, and clinical applications. Keywords: Bruxism, Slow Jiggling Motion, Polymerization Introduction The long-term success of dental implants relies on the structural integrity of the implant-abutment complex. Abutment screw fractures, though relatively uncommon, pose significant clinical challenges that require careful management. Several factors contribute to these fractures, including mechanical overload, material fatigue, improper prosthetic design, and ill-fitting components. The retrieval of fractured screws is crucial to preserving the integrity of the implant and ensuring the longevity of the prosthesis. Various techniques have been developed, each with distinct indications and limitations. This review explores the causes of abutment screw fractures and examines the various retrieval methods reported in the literature. Causes of Abutment Screw Fracture A] Biomechanical Overload7: Excessive occlusal forces, particularly from bruxism and parafunctional habits, can place excessive stress on implant components, leading to screw loosening and fracture. B] Ill-Fitting Prosthetic Components: Inadequate seating of the abutment or misaligned prosthetic structures can create internal stress, increasing the risk of screw breakage7. Dr.Smita Khalikar, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page31 Page31 Page31 Page31 Page31 Page31 Page31 Page31 Page31 Page31 Page31 Page31 Page31 Page31 Page31 Page31 Page31 Page31 Page31 C] Peri-Implant Bone Loss7: Severe bone loss around an implant alters load distribution, causing micromovements that accelerate screw fatigue and failure. D] Metal Fatigue8: Repeated stress cycles from mastication lead to material fatigue, causing the screw to break at its weakest point. E] Non-Passive Fit of Prosthetic Structures7: A prosthesis that does not fit passively exerts uneven forces on the implant-abutment interface, leading to screw failure over time. F] Inadequate Treatment Planning8: Poor implant positioning, insufficient number of implants, or incorrect occlusal force distribution can increase the likelihood of screw fractures. Screw Retrieval Techniques A] Manual Retrieval Techniques  Explorers and Hand Instruments2: Simple retrieval attempts can be made using sharp explorers or hand scalers to engage and rotate the broken screw. When the fragment is accessible, instruments like probes or spoon excavators can aid in removal.  Ultrasonic Scalers2: The application of ultrasonic vibrations helps loosen the screw fragment without damaging the internal implant threads. This minimally invasive approach preserves implant integrity. B] Specialized Retrieval Kits and Techniques  Screw Removal Kits: Commercially available kits, such as fragment forks and screw extractors, are designed for specific implant systems and facilitate efficient retrieval of broken screws, like nobelbiocare, osstem implant system1  Customized Drill Guides1: The customized drill guide was fabricated using an implant impression coping that could specifically fit to the internal structure of the implant fixture1. To be able to maintain the bur position at the center of the coping, the impression coping modified using autopolymerizing acrylic resin. The channel of the impression coping filled with autopolymerizing acrylic resin, and when the resin reached the dough stage, a #329 bur inserted. The bur moved back and forth until the resin completed polymerization. The central access hole with a depth of 0.5 mm was made with a #329 bur on top of the broken screw, and the reverse tap drill was used in a contra-angle handpiece with a counter-clockwise and fracture screw and abutment is removed1 Figure 1: Figure 2: Figure 3: Figure 4: Dr.Smita Khalikar, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page32 Page32 Page32 Page32 Page32 Page32 Page32 Page32 Page32 Page32 Page32 Page32 Page32 Page32 Page32 Page32 Page32 Page32 Page32  Reverse-Tapping Rotary Instruments7: These instruments engage the central hole of the fractured screw, allowing controlled counter-clockwise removal. Figure 5: Figure 6: C] Conservative Approaches Using Prefabricated or Modified Components  Hollow Abutment Screws4: Pre-designed abutments with central access holes facilitate retrieval in case of screw fracture4. Figure 7: Figure 8:  Self-Made Screwdrivers5:- Existing dental burs and instruments can be modified to create custom screwdrivers tailored to the specific retrieval scenario. Figure 9: Figure 10:  Modified round-tip scissors used to retrieve the fractured titanium abutment8:- Modify the tips of a pair of round-tip scissors with a cutting disk so that they can be inserted inside the dental implant and have a retentive feature with a notched outer edge. The approximate size of the tips should be less than the diameter of abutment screw, which is 2.3 mm, and the depth of the notch should be less than 1 mm. Use a dental implant analog to customize the size of the tips Insert into wedge fractured abutment and removed in slow jiggling motion Figure 11: Figure 12: Dr.Smita Khalikar, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page33 Page33 Page33 Page33 Page33 Page33 Page33 Page33 Page33 Page33 Page33 Page33 Page33 Page33 Page33 Page33 Page33 Page33 Page33  Plastic Mixing Tips for Retrieval9: Innovative use of plastic mixing tips can engage and rotate the broken screw without damaging the implant body9. Figure 13: Figure 14:  Retrieval of a fractured abutment screw thread from an implant3:-The screw-thread of the abutment screw which fractured away from the body of the screw and retained within the implant removed with the help of endodontic fiel3. Figure 15: Figure 16: Figure 17: Screwdriver fashioned from a needle10:-A straightforward and cost effective method for removing a screw fractured above or level with the implant platform by using a custom screwdriver fashioned from a hypodermic needle Figure 18: Figure 19: D] Surgical and Last-Resort Methods6  Flap Elevation for Direct Access: When conservative methods fail, raising a soft tissue flap improves visibility and control during retrieval6.  Re-tapping the Implant Threads: If retrieval damages the internal threads, re-tapping tools help restore implant function by reforming the screw channels6.  Implant Removal and Replacement: In cases where retrieval is unsuccessful or damages the implant, explain to the patient and replacement may be necessary6. Figure 20: Dr.Smita Khalikar, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page34 Page34 Page34 Page34 Page34 Page34 Page34 Page34 Page34 Page34 Page34 Page34 Page34 Page34 Page34 Page34 Page34 Page34 Page34 Clinical Considerations and Future Directions A] Accurate Treatment Planning8  Conduct thorough pre-treatment assessments to identify risk factors, such as bruxism and heavy occlusal loads.  Ensure proper implant placement and angulation to evenly distribute occlusal forces.  Recommend protective devices like night guards to mitigate parafunctional forces. B] Appropriate Component Selection7  Select compatible abutments and prosthetic components suited to the clinical scenario.  Consider using titanium abutments, which exhibit greater fracture resistance than zirconia abutments. C] Achieving Optimal Preload7  Follow manufacturer-recommended torque specifications for abutment screws to achieve appropriate preload and prevent screw loosening. D] Ensuring Passive Fit of Prosthesis7  Fabricate prosthetic components with a passive fit to minimize undue stress on implant components and reduce the risk of screw fractures. E] Regular Maintenance and Monitoring7  Schedule periodic examinations to assess implant and prosthetic component integrity.  Educate patients on maintaining optimal oral hygiene and reporting any abnormal sensations or mobility. F] Patient Education7  Advise patients to avoid excessive chewing forces on implant-supported restorations.  Stress the importance of attending follow-up appointments for early detection and intervention in case of complications. By implementing these preventive measures, clinicians can significantly reduce the incidence of implant abutment screw fractures and enhance the longevity of implant-supported restorations. Conclusion The retrieval of fractured abutment screws is a critical aspect of implant prosthodontics, requiring a combination of manual dexterity, specialized tools, and innovative approaches. The choice of retrieval technique depends on the location and extent of the fracture, accessibility, and clinician expertise. A methodical approach, beginning with conservative techniques and progressing to advanced methods as needed, increases the success rate of screw retrieval while minimizing implant damage. Ongoing research and technological advancements continue to improve the predictability and efficiency of screw retrieval procedures, ensuring better clinical outcomes in implant dentistry. References 1. Yoon JH, Lee H, Kim MY. Safe removal of a broken abutment screw with customized drill guide and rotary instrument: A clinical report. J Prosthodont. 2015;00:1–4. 2. Chen JH, Cho SH. An accessory technique for the intraoral removal of a fractured implant abutment screw. J Prosthet Dent. 2018. 3. Satterthwaite J, Rickman L. Retrieval of a fractured abutment screw thread from an implant: A case report. Br Dent J. 2008;204(4):177–80 4. Sim BK, Kim B, Kim MJ, Jeong GH, Ju KW, Shin YJ, et al. Hollow abutment screw design for easy retrieval in case of screw fracture in a dental implant system. J Healthc Eng. 2017;2017:4842072. 5. Williamson RT, Robinson FG. Retrieval technique for fractured implant screws. J Prosthet Dent. 2001 6. Maalhagh-Fard A, Jacobs LC. Retrieval of a stripped abutment screw: A clinical report. J Prosthet Dent. 2010;104(4):212–5. Dr.Smita Khalikar, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page35 Page35 Page35 Page35 Page35 Page35 Page35 Page35 Page35 Page35 Page35 Page35 Page35 Page35 Page35 Page35 Page35 Page35 Page35 7. Carneiro TAPN, Prudente MS, Pessoa RS, Mendonça G, Neves FD. A conservative approach to retrieve a fractured abutment screw – Case report. J Prosthodont Res. 2015. 8. Lee JH, Park JH, Park CJ, Cho LR. Technique to retrieve implant abutment fragments. J Prosthet Dent. 2015 9. Sane VD, Nair VS, Khandelwal S, Sane RV. A clinical tip for conservative retrieval of fractured abutment screw. J Indian Prosthodont Society. 2023;23(4):398–400. 10. Yang C-H, Wu AY-J. A technique to retrieve a fractured implant abutment screw by using a screwdriver fashioned from a needle. J Prosthet Dent. 2019;121(4):709-710.