A New Device to Prevent Aspiration or Swallowing of Implant

Screwdrivers
Marc Appelbaum, DDS
Department of Restorative Dentistry, Rutgers School of Dental Medicine, Newark, NJ

Keywords Abstract
Eliminates throat packs and floss; safety
device; tethered harness.
The screwdriver harness is potentially a life-saving device. It allows the clinician to
work intraorally with a handheld screwdriver without the concern of unintentionally
Correspondence
losing contact with the driver, risking the possibility of aspiration or swallowing by
Dr. Marc Appelbaum, Department of the patient.
Restorative Dentistry, Rutgers School of
Dental Medicine,110 Bergen St., Newark, NJ
07101. E-mail:
landmappelbaum@hotmail.com

The author denies any conflicts of interest

related to this study.

Accepted August 9, 2018

doi: 10.1111/jopr.12982

The comorbidities of swallowing or aspirating dental prosthe-
ses or instruments during routine intraoral dental procedures do
not receive adequate attention in the dental literature. With the
introduction of implant dentistry and the use of small-machined
parts and devices, the incidence of a practitioner unintentionally
dropping a device in the oral cavity has increased. The liter-
ature documents numerous instances of implant drivers being
aspirated or swallowed, thus requiring surgical intervention.1-7
This problem is magnified by the small size of the instruments,
and when coated with saliva, with patients in a supine or semi-
supine, position, the chances of loss of control are enhanced.
Screwdrivers are required during dental implant procedures
to either loosen or tighten prefabricated or custom implant
abutments to the dental implant. Unfortunately, access with
the screwdriver using two hands (required to stabilize and
turn the driver) in many areas of the mouth can be difficult,
causing the dentist to lose dexterity and drop the instrument.
When this occurs, this dental procedure may become a medical
emergency.8 The manufacturers of these drivers and clinicians
have recommended the use of dental floss inserted into a hole
in the driver or around the head as a solution for their retrieval.9
Any clinician who has used this floss technique knows all too
well that there are inherent difficulties. Either the floss becomes
entangled around the clinician’s finger, making it difficult to
turn the driver, or the floss slips off the head of the screw-
driver. The length of floss that the practitioner tethers to his/her
finger that would allow retrieval without laceration to the oral-
pharyngeal tissues is arbitrary. Some practitioners subscribe to
a length equal to the distance from the nose to the mid chest,
with no evidence to support their decision. Manual and electric
drivers will eliminate the need for handheld screwdrivers; how-
ever, when the driver is engaged in these instruments, it may
limit their intraoral access.
These problems are not limited to the novice dental student
or practitioner just beginning to introduce implant dentistry
into a clinical practice. This issue is of concern to all clinicians
working with implants.
The placement of a rubber dam during endodontic proce-
dures and nonimplant restorative dental procedures is an ef-
fective barrier to prevent swallowing or aspiration; however,
the dam cannot be placed in many clinical situations when
restoring dental implants. Additionally, many patients have a
pronounced gag reflex, which makes the packing of the throat
with gauze difficult or impossible. Pre-warning patients to be
alert for the possibility of a driver dropped on the tongue or
in the throat can only make the patient more apprehensive
and often does nothing to improve their reflex, especially in
the older adult patient who may already have a compromised
gag reflex.
A prototype implant harness was fabricated from polylac-
tic acid (PLA) using 3D printing (Ultimaker, Geldermalsen,
Netherlands). The device consists of the following components:
head assembly, magnet, adjustable collar, flexible tether, and
finger ring. The initial design demonstrated the feasibility and

Journal of Prosthodontics 0 (2018) 1–3 

C 2018 by the American College of Prosthodontists 1
Screwdriver Harness
Figure 1 Initial design concept for housing, tether, and finger loop.
Figure 2 Initial 3D printed prototype of device.
practicality of a device to prevent the loss of physical contact
with the screwdriver in the oral cavity (Figs 1 and 2).
The prototype incorporated a magnet to both retain the head
of the driver in place as well as to stabilize it when the adjustable
collar is tightened. The limitations of this design included the
rigid nature of the adjustable collar, tether, and finger ring.
Additionally, the head assembly and magnet would not accom-
modate and stabilize all the numerous sizes and nonmagnetic
nature of some of the screwdrivers.
Working with the design engineers at Catalyst Product De-
velopment, Indianapolis, IN, several design prototypes were
examined with regards to universal applicability, ease of use,
material fatigue, minimally intrusive dimensions, and steriliz-
ability. Digital calipers were used to measure 7 of the most
commonly used implant screwdrivers at various points (Fig 3).
This information was used to design the housing to accommo-
date and stabilize the heads of the drivers. The length of tether
2 Journal of Prosthodontics 0 (2018) 1–3 
Appelbaum
Figure 3 Schematic of how measurements were made on various
implant screwdrivers.
Figure 4 Central housing that accommodates driver heads of various
diameters.
was a concern. If it is too short, operator dexterity would be
compromised, if it is too long and requires retrieving, unneces-
sary soft tissue trauma would likely occur.
The final design of the screwdriver harness consists of a
central seating housing that will accommodate driver heads of
various diameters and driver shafts of all the lengths presently
on the market (Fig 4). The housing is of rigid plastic that will
stabilize the driver while at the same time allow for easy access
to turn the driver clockwise or counterclockwise.
Technique
1. Screwdriver head is inserted firmly into the device
housing.
2. The strap with its oblong slits and “living hinge” is placed
over the shank of the driver and fastened to the locking
device.
3. The screwdriver is now secured (Fig 5).
4. The dentist engages the finger ring, placing it over the
pinky.
5. With the flick of a finger, the locking mechanism can be
disengaged.
Discussion
The simplicity of the device negates the necessity of the fingers
of one hand to stabilize the screwdriver and the fingers of the
C 2018 by the American College of Prosthodontists
Appelbaum
Figure 5 Screwdrivers of two diameters secured within new device
(strap not firmly tightened).
other hand to turn it. Now only one hand is required to do both
functions. The housing only adds 2 mm to the height of the
driver. This significantly facilitates working in any area of the
mouth, especially in the posterior regions and in the mouths of
those individuals with a limited inter-arch space. The harness
provides better retention than dental floss and does not get
entangled with each turn of the driver. The need for packing the
throat with gauze is eliminated. This device is disposable and
meant for one-time use.
There are inherent challenges to using implant drivers in
the oral cavity. The ramifications of accidentally losing grip
of the driver can have life-threatening consequences. The need
for a device to stabilize the screwdriver during placement or
removal of abutments, bars, or prostheses, and tether the driver
to prevent aspiration or swallowing is of the highest priority
in patient management during implant treatment. Even in the
hands of the most-experienced practitioners, adverse outcomes
Journal of Prosthodontics 0 (2018) 1–3 
C 2018 by the American College of Prosthodontists
Screwdriver Harness
are a real possibility. The use of dental floss ligated to the
driver or packing the throat with gauze have drawbacks and
limitations. This screwdriver harness will significantly reduce
the possibility of an implant screwdriver creating an unintended
medical emergency.
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