Journal of Oral Implantology August 2013 - (Page 475)

CASE REPORT Ultrasonic Oscillations for Conservative Retrieval of a Rare Fracture of Implant Healing Abutment Sudhir Bhandari, MDS* Narinder Aggarwal, BDS Sonika Bakshi, MBA, BDS Dental implants can be rendered useless because of complications related to implant components such as the fracture of abutment screw and prosthetic retaining screw. Removal of such fractured fragments is therefore deemed necessary for the sake of prosthetic restoration. This case report presents a rare incident of healing abutment fracture and details the stepwise and probably the most conservative clinical technique using ultrasonic oscillations for retrieval of fractured screw fragment without affecting the internal surface of the implant. The management was based on the fact that the screw, being an inclined plane, will unthread when subjected to continuous vibrations. Key Words: healing abutment, screw fracture, ultrasonic oscillations INTRODUCTION D espite being predictable and with a documented high success rate, mechanical, biological, and technical complications do occur in dental implant–related treatments.1,2 Implant components, especially abutment screws and prosthetic retaining screws, fracture in response to myriad factors (alone or in combination), ranging from fatigue due to biomechanical overload, repeated screw loosening and tightening, improper placement techniques, nonpassive fit or improper use of the prosthesis, and manufacturing errors.3–8 Retrieval of fractured screws is considered difficult and generally poses a challenge for the clinician to remove them without damaging the internal surface of implants. An abutment screw fractured above the head of the implant can be removed by holding it with hemostats. Screw fracture within the body of implant can be retrieved either by the use of a self-made screwdriver6 or using the special service set available for the Post Graduate Institute of Medical Education and Research, Chandigarh, India. * Corresponding author, DOI: 10.1563/AAID-JOI-D-11-00126 specific implant system (IMZ TwinPlus Repair Set K 3.3, Dentsply Friadent, Mannheim, Germany).7 The objective of these systems is to use a removal wedge to engage the broken screw via a slot drilled into the top surface of the broken screw and then applying a reverse torque. Use of endodontic instruments has also been reported to retrieve the thread that had fractured away from the body of the screw.8 When the fractured screw fragment is not retrievable, the implant could be salvaged by modifying the screw hole and fabricating a postsupported crown.9 Following is a case report describing a rare incident of healing abutment fracture (3.4 mm/GH 2, Friadent GMBH, Mannheim, Germany) and the utility of a piezoelectric ultrasonic scaler (EMS Minipiezon, Electromedical Systems SA, Nyon, Switzerland) in conservatively retrieving the fractured screw fragment. CASE REPORT A 64-year-old woman in good general health sought care for a dislodged healing abutment with respect to an implant placed in the right maxillary second premolar for 2 days. Intraoral examination showed that the right maxillary first and second Journal of Oral Implantology 475

Table of Contents for the Digital Edition of Journal of Oral Implantology August 2013

Literary Responsibility—Everyone Has a Role to Play
Rehabilitation of Surgically Relocated Integrated Dental Implants With and Without Bone Morphogenesis Protein-2
Marginal Fit of Implant-Supported All-Ceramic Zirconia Frameworks
Influence of the Implant Diameter With Different Sizes of Hexagon: Analysis by 3-Dimensional Finite Element Method
Autologous Dental Pulp Stem Cells in Regeneration of Defect Created in Canine Periodontal Tissue
Histologic and Biomechanical Evaluation of 2 Resorbable-Blasting Media Implant Surfaces at Early Implantation Times
Efficacy of Guided Bone Regeneration Using Composite Bone Graft and Resorbable Collagen Membrane in Seibert’s Class I Ridge Defects: Radiological Evaluation
Minimal Iliac Bone Harvesting in Sinus Lift Surgery
Functional Load in Oblique Bicortical Implants: Parasinusal Implants and Palatine Implants
Ultrasonic Oscillations for Conservative Retrieval of a Rare Fracture of Implant Healing Abutment
Craniofacial Implant-Retained Auricular Prosthesis: A Case Report
Gingival Conditioning in an Implant-Supported Prosthesis: A Clinical Report
An Early Loaded Implant-Supported Mandibular Complete Arch Fixed Prosthesis in a Young Completely Edentulous Patient: A Case Report
Computer Guided Surgery for Implant Placement and Dental Rehabilitation in a Patient Undergoing Sub-Total Mandibulectomy and Microvascular Free Flap Reconstruction
Guided Bone Regeneration for Socket Preservation in Molar Extraction Sites: Histomorphometric and 3D Computerized Tomography Analysis
Osseointegration of Dental Implants and Osteonecrosis of the Jaw in Patients Treated With Bisphosphonate Therapy: A Systematic Review
Review of Current Literature

Journal of Oral Implantology August 2013