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Uploaded byShimaa Hussein Kotb
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Retrieval of Fractured Abutment Screw of Dental Implant.

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Retrieval of Fractured Abutment Screw of Dental Implant Dr. Shimaa kotb • Assistant lecturer of Oral Medicine, Periodontology, Oral Diagnosis& Dental Radiology • Sphinx university • Member RCSI, RCSEng, RCSEd, RCPSG • -MFDS Examiner RCPSG • International specialty Advisor RCSEng • Examiner Oral Medicine RCSEd. International Conference Of Dentistry and Oral Health . London 2025
Outlines Objective / Aim Dental implant Dental implant problems Signs of implant failure Mechanical Failure Etiology Factor influencing abutment screw loosening Decision making tree Rational of treatment plan Conclusion References
Retrieval of Fractured Abutment Screw of Dental Implant One of most tricky task that requires precise methods to handle effectively.
Dental Implant Dental implants marks a significant milestone in modern dentistry, offering effective solution for tooth replacement.
Failure Of Dental Implant Primary Failure Early Osseointegration Failure Pt Factor/surgical tech factor) Secondary Failure Late Biological Failure (peri-implantitis / Recession) Mechanical Failure (prosthetic complication
Mechanical Failure Technical complication (Prosthetic components) Abutment micromovement Fracture screw abutment  Screw loosening (incidence 25% of pt.)  Screw Fracture (Incidence 0.35%- 0.6%)
Fracture screw abutment Serious mechanical problem Challenging situation to clinician Retrieval is a must to preserve implant integrity Main target: Using “Non-invasive retrieval tech” a top priority level of fracture determines ease of retrieval
Fracture screw abutment Inadequate treatment plan Inadequate design Component misfit Technical problems Occlusal overload Immediate loading / parafunctional habits Insufficent screw tightening Etiology “a multifactorial Factors”
Factors influencing abutment screw loosening Screw length (deep internal connection allow proper screw length usage.) Angulation of Abutment (Angulated show greater screw loosening) Implant Diameter ) more-wider, more-risky) Lateral force (lateral force increase risk of screw loosening)
Outcomes of screw loosening Biological complication at implant abutment interface permit Bacterial leakage through interface) Peri-implant bone loss Mechanical issues Implant fracture Implant failure
Why Management of abutment screw fracture a challenging ?? the preloading and occlusal loading could wedge the fractured abutment into the implant and this require a high pull-out force. Saliva, blood, and the limited visibility make difficult accessibility. The lack of clarity in treatment paths can cause confusion. Decision trees are helpful in dealing with scenarios of all levels of complexity.
Evaluate the Patient condition Clinical assessment Radiographic interpretation Proper Treatment plan
1.Proper Clinical assessment 2.Identify Cause 3.Reduce subsequent Complication/ Recurrence
Rationale of treatment plan Retrieve the screw. ( Mean saving the implant). Failure Retrieval ( lost implant & for sure remove the implant )
Rationale of work begin with the conservative approach. Retrieval Instead of depending on expensive commercial retrieval systems Rely on the commonly available instruments in Dental practice
Technique for Retrieval of Abutment Screw Assess location of the fractured abutment, either clinically and radiographically Determining fracture part is above or below the implant head.
If the broken screw is visible and above the implant body using a hemostat or sharp explorer to the fragment in counterclockwise direction to retrieve it
Abutment screw fractures below implant platform, Ultrasonic tip used counterclockwise under copious irrigation to avoid thermal damage to the surrounding bone. If fracture screw still difficult to remove, cotton swab employed to extract the fragment. Oblique fractures in cotton swab help wedging the screw within the oblique part of the wooden swab.
If the fractured abutment screw still not possible to remove, so must go to another option. Burs or drills mounted on a handpiece in counter-clockwise rotation. Access points or grooves created on occlusal aspect of fragment for mechanical interlocking of scaler tip. If implant’s screw damaged irreversible and patient unwilling to sacrifice the implant, so better to fabricate a custom cast post and core.
Advantage Safe, gentle Technique Less risky Non-Invasive conservative Cost effective
Consume time Heat generation Don’t depend on clinician experience Unpredictable results
ITI® DENTAL IMPLANT SYSTEM (INSTITUT STRAUMANN AG, SWITZERLAN D), IMZ® TWIN PLUS IMPLANT SYSTEM1 (DENTSPLY FRIADENT, GERMANY), SCREW REMOVAL KIT REPLACE (NOBEL BIOCARE ,Y ORBA LINDA, CALIFORNIA, USA), SCREW REMOVAL KIT (BIOMET 3I , FLORIDA, USA31). Available implant repair kits including:
Conclusion  Implant fractures is a serious complication that contribute to implant failure. Therefore, prevention is crucial and relies on accurate diagnosis, appropriate case selection, meticulous treatment planning, and regular maintenance.  The retrieval of a fractured screw is a challenging scenarios.  A decision-making tree serves as a useful tool that guide the clinicians in managing different abutment screw fractures scenarios.
Recommendation  • Retightening implant screws: 10 minutes after the initial torque application. • Mechanical torque gauges should be used instead of hand drivers for consistently tightening of implant components to the recommended torque values. • The use of sealers to fill gaps between screws and implant threads, as well as adhesives to increase frictional resistance, has been suggested to minimize screw loosening.
* According to the decision tree, methods employed to grasp the broken screw. * Determined by the location of the fracture abutment – above or below the head of the implant. Decision tree
References ▪ Peitsinis, Panagiotis Rafail, et al. "Optimizing Implant Placement Timing and Loading Protocols for Successful Functional and Esthetic Outcomes: A Narrative Literature Review." Journal of Clinical Medicine 14.5 (2025): 1442. ▪ Pereira, Rafael & Sabri, Hamoun & Nava, Paolo & Alrmali, Abdusalam & Wang, Hom-Lay. Treatment Strategies for Peri‐Implant Mucositis: The Final Stop for Preventing Peri‐Implantitis. International Journal of Dentistry. 2025. ▪ Abdelfattah MY. Different mechanical complications of implant prosthodontics. Int J Dent Res. 2014;2(6):190-6. ▪ Nayana P, Nayak SS, Chatterjee A, Sivaraman K, Srikanth G, Singh C. Retrieval of fractured implant abutment screws: a narrative review. Journal of International Society of Preventive and Community Dentistry. 2022 1;12(3):287-94. ▪ Kotb, S. Retrieval of Fractured Abutment Screw of Dental Implant. Case Report. Preprints 2025, 2025050669.
Retrieval of Fractured Abutment Screw of Dental Implant.