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

This scoping review mapped the literature on alternative techniques for removing fractured screws from dental implants. Following the five-step methodological framework by Arksey and O'Malley and the Joanna Briggs Institute Manual for Evidence Synthesis, the study adhered to the PRISMA-ScR checklist. The protocol was registered in the Open Science Framework (). Two independent reviewers searched MEDLINE (PubMed), Web of Science, Embase, and ClinicalTrials.gov in December 2024 using the terms "dental implants" AND ("screw retrieval" OR "fractured screw" OR "screw removal" OR "screw fragment"), including gray literature and reference lists. Among the 47 included studies, six were in vitro, one in silico, twenty-six clinical case reports, and fourteen technical descriptions. The main removal approaches identified were: (1) manual instruments; (2) ultrasonic devices; (3) mechanical or rescue kits; (4) rotary or drilling methods; and (5) customized alternatives such as laser welding, hollow screw modification, and guided drilling. No single method proved superior. The choice of technique depends on clinical conditions, fracture type, and implant preservation. Conservative, low-risk approaches should be attempted before invasive methods. Overall, prevention, torque control, and periodic maintenance remain the most effective strategies to avoid screw fractures. .