Journal of Oral Implantology December 2014 - (Page 733)

Retrieval of a Separated Implant Screwdriver Fragment Ashwin R. Mysore, BDS* Meena A. Aras, MDS Vidya Chitre, MDS INTRODUCTION T he use of dental implants for replacement of a single missing tooth is a wellestablished treatment modality.1,2 The procedure of implant placement and restoration has been conventionally divided into surgical and prosthetic phases. Each phase requires specialized instrumentation and trained operators. The main prosthetic procedures for a straightforward, single-implant rehabilitation are abutment connection, impression, abutment modifications if needed, followed by trial and delivery of the prosthesis. Even with precautionary measures, some complications may occur during implant therapy. Various classifications have been proposed to categorize these complications.3-5 Although prosthetic complications are given some consideration, detailed intraoperative and procedural complications during the prosthetic phase have not been considered in most classifications. Although instrument breakage or separation has been mentioned under the classification of surgical complications,6 there is no classification that considers such a complication during the prosthetic phase. Numerous instruments are used during the prosthetic phase of implant therapy. One such instrument is the screwdriver used to tighten the screw that holds the abutment and implant together. It is mandatory to use the implant screwdriver in conjunction with a calibrated torque wrench, as it has been shown that even experienced operators tighten the screws to only 30%- 50% of the prescribed torque when using handheld screwdrivers and that a torque wrench application also reduces microbial leakage.7,8 This case report describes an intraoperative complication that arose due to the separation of the tip of a screwdriver in the screw access channel Department of Prosthodontics, Goa Dental College and Hospital, Bambolim, Goa, India. * Corresponding author, e-mail: DOI: 10.1563/AAID-JOI-D-12-00128 of the abutment. This features a lesser-reported complication due to instrumentation failure and operator error. It also describes the technique that was used to retrieve it so that the procedure of rehabilitation could be completed successfully. DESCRIPTION OF THE CASE A 39-year-old man reported to the Department of Prosthodonics, Goa Dental College and Hospital, with a request for the replacement of a missing lower molar No. 31. After a detailed clinical and radiographic examination, a single implant-supported crown was decided upon as the ideal treatment plan for the replacement of the tooth No. 31. A 2-stage protocol was selected for the implant treatment. At the next appointment, implant (GS II, Osstem, Seoul, South Korea) placement was done under antibiotic cover. The fixture measured 5.5 mm in diameter and 11.5 mm in length. The surgical procedures were carried out according to the manufacturer's instructions. The surgical site was closed with sutures, and the patient was dismissed with postoperative home care instructions. A week later, the sutures were removed, and the surgical site demonstrated good healing. The patient was asked to report back to the department after 3 months. After the completion of 3 months, following a radiologic evaluation, second-stage surgery was performed and a healing abutment was placed. The healing abutment was left for a period of 3 weeks, after which the abutment connection was planned. During the abutment connection and tightening using the torque wrench, the tip of the screwdriver (1.2 S, Osstem) separated and remained wedged inside the screw access hole in the abutment (Figure 1). The reason for the separation was overtightening. A radiograph revealed that approximately 2.5 mm of the tip had separated from the instrument and had remained embedded in the screw access channel (Figure 2a). The fragment had to be

Table of Contents for the Digital Edition of Journal of Oral Implantology December 2014

Effect of Splinting in Accuracy of Two Implant Impression Techniques
Assessment of the Stress Transmitted to Dental Implants Connected to Screw-Retained Bars Using Different Casting Techniques
Retentiveness of Various Luting Agents Used With Implant-Supported Prosthesis: An In Vitro Study
Role of rhBMP-2 and rhBMP-7 in the Metabolism and Differentiation of Osteoblast-Like Cells Cultured on Chemically Modified Titanium Surfaces
Coated vs Uncoated Implants: Bone Defect Configurations After Progressive Peri-implantitis in Dogs
Why Guided When Freehand Is Easier, Quicker, and Less Costly?
Advanced Platelet-Rich Fibrin: A New Concept for Cell-Based Tissue Engineering by Means of Inflammatory Cells
Flapless Alveolar Ridge Preservation Utilizing the ‘‘Socket-Plug’’ Technique: Clinical Technique and Review of the Literature
Implants Placed in the Nasopalatine Canal to Rehabilitate Severely Atrophic Maxillae: A Retrospective Study With Long Follow-up
Severe Mandibular Atrophy Treated With a Subperiosteal Implant and Simultaneous Graft With rhBMP-2 and Mineralized Allograft: A Case Report
Full-Mouth Rehabilitation of a Patient With Ectodermal Dysplasia With Dental Implants
The 2-Visit CAD-CAM Implant-Retained Overdenture: A Clinical Report
Assessment of Implant-Related Treatment With Edited Three-Dimensional Reconstructed Images From Cone-Beam Computerized Tomography: A Technical Note
Retrieval of a Separated Implant Screwdriver Fragment
Correction of Esthetic Complications of a Malpositioned Implant: A Case Letter
Fixed Partial Denture Treatment With Mini Dental Implants
Replacement of an Implant and Prosthesis in the Premaxilla Due to a Malposition and Prosthetic Failure: A Clinical Case Letter
A New Restorative Technique for the Perishing Implant Due to Abutment Screw Fracture
Fit of CAD/CAM Implant Frameworks: A Comprehensive Review

Journal of Oral Implantology December 2014