Transalveolar screws and the incidence of dental damage: a prospective study

The incidence of screw/tooth contact in the placement of transalveolar screws was prospectively studied. The clinical significance of such contact when it occurred was assessed. Patients with fractures of the mandible requiring intra- or post-operative control of their occlusion with transalveolar screws were entered into the study. Following screw removal, contact was assessed radiographically and all teeth adjacent to screws were tested for vitality. Any contacts were judged to be minor if less than 50% of the diameter of the screw hole impinged on a tooth root or major if this was more than 50%. Fifty-four male and one female patients completed the study. There were 232 screws placed in these patients adjacent to 440 teeth. Twenty-six screws (11.2%) had major contacts and 37 (15.9%) had minor contacts. Seventeen teeth tested as non-vital with electronic pulp testing but of these only 6 showed any impingement by screws. Two screws were associated with complications in two patients. Screw/tooth contact does occur using transalveolar screws, however, the incidence of clinically significant damage appears to be very low.