From the Bench of Dr Mark

Reducing the Risk of Implant-Abutment Screw Loosening
By Chandur Wadhwani, BDS,MSD

Key take aways from this article

  • Loosening of the implant/abutment (IA) screw is a common complication in implant dentistry.
  • Issues can range from a straightforward fix, such as retightening the screw, to catastrophic failure and breakage of the joint components.
  • The risk of screw loosening can be greatly reduced by understanding how the screw system works.
  • Using appropriate materials (i.e., components) and tools is crucial.
  • Regularly monitoring the implant restoration allows clinicians to mitigate the forces that act upon it.
  • Three common reasons for screw loosening involve operator error, mechanical misfit, and biological changes within the patient’s stomatological system.
  • When tightening screws, torque-limiting devices are essential to achieving the manufacturer-specified torque value.
  • Torque wrenches must be used and maintained correctly to ensure correct screw torque.
  • The screw’s surface coating dictates the proper screw tightening protocol.
  • Implant restorative occlusal surfaces should be designed with the aim of transmitting force through the long axis of the screw whenever possible to mitigate IA screw loosening.
  • To minimize tooth movement — and thus reduce the risk of screw loosening — clinicians may wish to provide patients with a nightguard.
  • With sufficient knowledge and prudent clinical practice, the risk of IA screw loosening can be minimized.

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