How to remove the fractured screw inside dental implants? A scoping review

Area of Science:

• Dental Implantology
• Biomaterials Engineering
• Surgical Techniques

Background:

• Fractured screws are a complication in dental implant procedures.
• Effective removal techniques are crucial for successful implant outcomes and patient well-being.

Purpose of the Study:

• To comprehensively map and review existing literature on alternative techniques for fractured screw retrieval from dental implants.
• To synthesize information on various removal approaches and their applicability.

Main Methods:

• A scoping review methodology following Arksey and O'Malley framework and Joanna Briggs Institute guidelines.
• Systematic literature search across major databases (MEDLINE, Web of Science, Embase, ClinicalTrials.gov) with specific keywords.
• Inclusion of 47 studies encompassing in vitro, in silico, case reports, and technical descriptions.

Main Results:

• Identified five main categories of screw removal approaches: manual instruments, ultrasonic devices, mechanical kits, rotary/drilling methods, and customized techniques (e.g., laser welding).
• No single method demonstrated superiority; technique selection is contingent upon clinical context, fracture characteristics, and the need for implant preservation.
• Conservative, lower-risk methods are recommended before resorting to more invasive procedures.

Conclusions:

• The choice of fractured screw retrieval technique requires careful consideration of individual clinical scenarios.
• Preventive measures, including proper torque control during placement and regular maintenance, are paramount in avoiding screw fractures.
• Further research may be needed to compare the efficacy and safety of different retrieval methods.