DENTAL TECHNIQUE

Clinical assessment of fractured implant abutment screws: The

Bernese silicone replica technique
Kensuke Igarashi, DDS, PhDa and Kelvin I. Afrashtehfar, DDS, MScb

With implant dentistry increas- ABSTRACT

ingly associated with satisfactory
Fractured implant abutment screws can be retrieved with repair or rescue devices. However,
long-term clinical and patient- whether the screw was completely retrieved or the inner implant body was damaged may be
1,2
centered outcomes, implant uncertain. A silicone replica technique was recently implemented in Bern and may be the most
complications have also inc- predictable method available at the moment for clinically assessing the internal implant body. This
reased.3-5 Mechanical compli- technique is straightforward and precise and may help dentists determine the internal implant
cations include a 3.9% incidence condition when managing a fractured screw. (J Prosthet Dent 2017;-:---)
of fractured implant abutments
screws and a 6.7% incidence of loosened implant abut- elastomeric impression material such as polyvinyl
ments screws,4 with loosening often being the precursor to siloxane18 or vinylsiloxanether.19
6
a fractured screw. Consequently, completely retrieving
the fractured abutment screws without damaging the TECHNIQUE
implant is a clinical challenge.7-12 Using a dental exca-
vator13 or ultrasonic scaler14 may be the most straight- 1. After retrieving the fractured abutment screw with
forward methods; however, they may not always be the repair device (RSS; Straumann AG), rinse
successful, and a repair or rescue device for the retrieval of thoroughly with 10 mL of saline from a disposable
fractured implant abutment screws may be necessary.15 syringe (Omnifix; B. Braun Medical Inc) with a
Although these devices may remove the fractured screws stainless steel 25-gauge irrigating needle (ProRinse;
by drilling and hand tapping into the implant body, the Dentsply Sirona).
condition of the internal implant body may be impossible 2. Air-dry the inner implant fixture using a 3-way sy-
to observe clearly, even with magnification. Moreover, the ringe and clean with a microbrush (Microbrush;
presence of fragments of the fractured screw in the depth Microbrush Intl).
of the implant screw hole may prevent seating of the new 3. Insert the intraoral tip of an impression cartridge
abutment and may not be perceived by the clinician. (Identium Light; Kettenbach GmbH & Co KG) as
Prosthesis misfit may cause a new mechanical complica- deeply as possible inside the implant body
tion16 in addition to periimplant soft tissue damage and (Fig. 1).
marginal bone loss.17 A reliable method of evaluating the 4. Inject the light-body impression material until it
internal implant condition is needed. extrudes from the implant shoulder. As the tip is
This article describes the Bernese silicone replica withdrawn, keep injecting material until excess
technique developed for a precise assessment of the in- material is approximately 5 mm coronally from the
ternal implant condition. This dental technique uses an shoulder of the implant (Figs. 2, 3).

Materials provided by the Department of Reconstructive Dentistry & Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
a
Postdoctoral Fellow, Department of Reconstructive Dentistry & Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland; and
Assistant Professor, Department of Life Science Dentistry, The Nippon Dental University, Niigata, Japan.
b
Fellow, Advanced Studies in Oral Implantology, Department of Reconstructive Dentistry & Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.

THE JOURNAL OF PROSTHETIC DENTISTRY 1

2 Volume
Figure 1. Intraoral tip for light-body silicone Figure 2. Extrusion of excess impression material.
inserted in implant.
Figure 4. Interproximal wooden wedge inserted.
5. Insert an interproximal wooden wedge (Polydentia
SA) held in cotton pliers (Tweezers College Liq-
uidSteel; Carl Martin GmbH) as deeply as possible
into the middle of the impression in 1 motion to
avoid introducing air bubbles (Fig. 4).
6. Allow the impression material to polymerize and
remove the internal implant negative pattern by
carefully turning the external excess in a counter-
clockwise direction (Fig. 5).
7. Compare the removed pattern (left) with a control
silicone pattern (right) (Fig. 6). The control silicone
pattern should be prepared beforehand from an
undamaged dental implant.
DISCUSSION
This dental technique describes the steps needed to
assess the internal implant condition after using a repair
device (Supplementary Video). The authors are unaware
of previous reports on the internal implant condition
after retrieving a fractured abutment screw. Knowing the
THE JOURNAL OF PROSTHETIC DENTISTRY
- Issue -
Figure 3. Extruded excess impression material.
Figure 5. Impression pattern removal.
internal implant state as precisely as possible is essential
to determining whether the dental implant can be
salvaged for a future prosthesis. This straightforward
method can clinically assess the condition of an internal
implant. Additionally, the Bernese silicone replica tech-
nique is safe and inexpensive.
Few techniques are available for evaluating the
complete removal of a fractured abutment screw after
using a repair device. For example, there are workshops
in which participants are instructed to assess the suc-
cess of retrieving a fractured abutment screw by
inserting an impression post. If the impression post is
completely inserted, then the screw removal procedure
is considered successful. Our group, however, has
shown that this test is unreliable because the apical
portion of the impression screw does not reach the
bottom of the implant screw hole. Therefore, a consis-
tent method of determining complete removal of the
fractured abutment screw is needed. Impression making
has been associated with 2 clinical reports of fractured
screw removal,20,21 but the purpose was finding a
Igarashi and Afrashtehfar
- 2017
Figure 6. Internal implant condition comparison. Removed fractured
screw (left) and control (right) negative patterns.
prosthetic solution, not to assess the internal implant
condition.
This technique may not be suitable for all clinical
scenarios. For example, when silicone is subjected to
more than the recommended 25 C storage temperature,
the material sets faster, and the silicone pattern may
distort.22 In another scenario, when internal implant
screw threads have been severely damaged, the silicone
pattern may engage undercuts and be torn on removal.23
Moreover, a pattern of an undamaged implant from the
same manufacturer may not always be available, for
example, if no undamaged implant is stored and if the
patient has only 1 implant of that type.
SUMMARY
This technique assesses the internal implant condition
after fractured abutment screw retrieval with a repair
device and a silicone impression. This method can be
considered straightforward and precise.
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Corresponding author:
Dr Kelvin Ian Afrashtehfar
Department of Reconstructive Dentistry & Gerodontology
School of Dental Medicine, Faculty of Medicine
University of Bern
Rm C305, Freiburgstrasse 7
3010 Berne
SWITZERLAND
Email: kelvin.afrashtehfar@zmk.unibe.ch
Acknowledgments
The authors thank the scientific illustrator, Ms Bernadette Rawyler, Department of
Multimedia and Computer Science for her assistance in the elaboration of the video.
K.I. thanks The Nippon Dental University School of Life Dentistry at Niigata for
supporting the postdoctoral education. K.I.A. thanks the International Team of
Implantology (ITI; Basel, Switzerland) for the educational support.
Copyright © 2017 by the Editorial Council for The Journal of Prosthetic Dentistry.
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