Background: Cold welded cover screw is a rare mechanical complication. There is barely any literature on the etiology and removal techniques for the same. However, it can pose a serious problem and the screw needs to be removed, without damaging the internal threads of the implant, to initiate the prosthetic phase of implant therapy.
Aim: The aim of this paper is to report our experience with the retrieval of cold welded dental implant cover screw.
Case description: The present situation illustrates a new technique to retrieve a cold welded cover screw.
Conclusion: Removing a cold welded cover-screw from an implant can be difficult. There is no method of screw removal that can be universally applied. In this particular case, the screw was successfully removed using the prescribed technique. Therefore, this new technique may be used when removing a cold welded coverscrew from the implant.
Clinical significance: This technique is cost-effective, simple, and applicable to all available dental implant systems and can be effectively incorporated into the clinical situations in which the cold welded screws are not retrievable by conventional techniques.
Jokstad A, Braegger U, Brunski JB, Carr AB, Naert I, Wennerberg A. Quality of dental implants. Int Dent J 2003;53: 409-443.
Satterthwaite J, Rickman L. Retrieval of a fractured abutment screw thread from an implant: a case report. Br Dent J 2008;204:177-180.
Balshi TJ. An analysis and management of fractured implants: a clinical report. Int J Oral Maxillofac Implants 1996;11:660-666.
Nergiz I, Schmage P, Shahin R. Removal of a fractured implant abutment screw: a clinical report. J Prosthet Dent 2004;91: 513-517.
Healing abutment Does Not Unscrew: safest way to remove it without damaging the Implant Threads? Available from: www.osseonews.com
Removing a cover screw on nobel biocare replace select implant any ideas. Available from: www.osseonews.com
Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA, Berger M. Patients with prior fracture have an increased risk of future fractures: a summary of literature and statistical synthesis. J Bone Miner Res 2000;15:721-739.
Gourlay ML, Brown SA. Clinical consideration in post menopausal osteoporosis. Arch Intern Med 2004;164:603-613.
Cheng ML, Gupta V. Post menopausal osteoporosis. Indian J EndocrinolMetab 2013;17(2):240-244.
Tyndall DA, Rathore S. Cone-beam CT diagnostic applications: Caries, periodontal bone assessment, and endodontic application. Dent Clin North Am 2008;52(4):825-841.
Koh KJ, Kim KA. Utility of the computed tomography indices on cone beam computed tomography images in the diagnosis of osteoporosis in women. Imaging Sci Dent 2011;41:101-106.
Dutra V, Yang J, Devlin H, Susin C. Radiomorphometric indices and their relation to gender, age and dental status. Oral Surg Oral Med Oral Pathol Oral RadiolEndod 2005;99:479-484.
Devlin H, et al. Diagnosing osteoporosis by using dental panoramic radiographs: the Osteodent project. Oral Surg Oral Med Oral Pathol Oral RadiolEndod 2007;104:821-828.
Taguchi A, Suei Y, Ohtsuka M, Otani K, Tanimoto K, Ohtaki M. Usefulness of panoramic radiography in the diagnosis of postmenopausal osteoporosis in women. Width and morphology of inferior cortex of the mandible. DentomaxillofacRadiol 1996;25:263-267.
Devlin H, Horner K. Mandibular radiomorphometric indices in the diagnosis of reduced skeletal bone mineral density. Osteoporos Int 2002;13:373-378.
Halling A, Personn, Berglund J, Johansson O, Renvert S. Comparison between Klemetti index and heel DXA BMD measurement in the diagnosis of reduced skeletal bone mineral density in the elderly. Osteoporos Int 2005;16:999-1003.
Brown JP, Josse RG. Clinical practise guidelines for the diagnosis and management of osteoporosis in Canada. Can Med Assoc J 2002;167:S135.
Sagsveen M, Farmer JE, Prentice A, et al. Gonadotrophinreleasing hormone analogues for endometriosis: bone mineral density. Cochrane Database Syst Rev 2003;4.
Cundy T, Ames R, Home A, Clearwater J, Roberts H, Gamble G, Reid IR. A randomized controlled trial of estrogen replacement therapy in long-term users of depot medroxyprogesterone acetate. J ClinEndocrinolMetab 2003;88:78.
Liu SL, Lebrun CM. Effect of oral contraceptives and hormone replacement therapy on bone mineral density in premenopausal and perimenopausal women: a systematic review. Br J Sports Med 2006; 40:11-24.
Manz MC. Factors associated with radiographic vertical bone loss around implants placed in a clinical study. Ann Periodontol 2000 Dec;5(1):137-151.
Araujo MG, Lindhe J. Dimensional ridge alterations following tooth extraction: an experimental study in the dog. J Clin Periodontol 2005 Feb;32(2):212-218.
Yamada S, Heymann D, Bouler JM, Daculsi G. Osteoclastic resorption of calcium phosphate ceramics with different hydroxyapatite/beta-tricalcium phosphate ratios. Biomater 1997 Aug;18(15):1037-1041.
Wiltfang J, Merter HA, Rupprechs SKA, et al. Degradation charactertics of alpha and beta tri-calcium-phosphate (TCP) in minipigs. J Biomed Mater Res 2002;63(2):115-121.
Vaccaro AR. The role of the osteoconductive scaffold in synthetic bone graft. Orthoblue J 2002 May;25(5 suppl):S571-578.
Ortega-Martínez J, Pérez-Pascual T. Immediate implants following tooth extraction: a systematic review. Med Oral Pathol Oral Cir Bucal 2012;17(2):251-261.
Tabata LF, Rocha EP, Barao VA, Assuncao WG. Platform switching: biomechanical evaluation using threedimensional finite element analysis. Int J Oral and Maxillofac Implants 2011;26(3):482-491.
Natali AN, Pavan PG, Ruggero AL. Analysis of boneimplant interaction phenomena by using a numerical approach. Clin Oral Implants Res 2006;17(1):67-74.
Tang CB, Liul SY, Zhou GX, Yu JH, Zhang GD, Bao YD, Wang QJ. Nonlinear finite element analysis of three implant– abutment interface designs. Int J Oral Sci 2012 Jun;4(2):101-108.
Raoofi S, Khademi M, Amid R, Kadkhodazadeh M, Movahhedi MR. Comparison of the effect of three abutment implant connections on stress distribution at the internal surface of dental implants. J Dent Res Dent Clin Dent Prospects 2013;7(3):132-139.
Hansson S. Implant abutment interface: biomechanical study of flat top versus conical. Clin Implant Dent Relat Res 2000;2(1):33-41.
Chu CM, Huang HL, Hsu JT, Fuh LJ. Influences of internal tapered abutment designs on bone stresses around a dental implant: threedimensional finite element method with statistical evaluation. J Periodontol 2012 Jan;83(1):111-118.
Alkan I, Sertgöz A, Ekici B. Influence of occlusal forces on stress distribution in preloaded dental implant screws. J Prosthet Dent 2004 Apr;91(4):319-325.
Theoharidou A, Petridis HP, Tzannas K, Garefis P. Abutment screw loosening in singleimplant restorations: a systematic review. Int J Oral Maxillofac Implants 2008;23(4):691-690.
Segundo RM, Oshima HM, da Silva IN, Burnett LH Jr, Mota EG, Silva LL. Stress distribution of an internal connection implant pros theses set: a 3D finite element analysis. Stomatol 2009; 11(2):55-59.
Rubin CT, Lanyon LE. Limb mechanics as a function of speed and gait : a study of functional strains in the radius and tibia of horse and dog. J Exp Biol 1982 Dec;101:187-211.
Natali AN, Pavan PG, Ruggero AL. Analysis of boneimplant interaction phenomena by using a numerical approach. Clin Oral Implants Res 2006 Feb;17(1):67-74.
Quaresma SE, Cury PR, Sendyk WR, Sendyk C. A finite element analysis of two different dental implants: stress distribution in the prosthesis, abutment, implant, and supporting bone. J Oral Implantol 2008;34(1):1-6.
Hansson S. A conical implantabutment interface at the level of the marginal bone improves the distribution of stresses in the supporting bone. An axisymmetric finite element analysis. Clin Oral Implants Res 2003 Jun;14(3):286-293.
Lin CL, Chang SH, Chang WJ, Kuo YC. Factorial analysis of variables influencing mechanical characteristics of a single tooth implant placed in the maxilla using finite element analysis and the statisticsbased Taguchi method. Eur J Oral Sci 2007 Oct;115(5):408-416.
Pessoa RS, Vaz LG, Marcantonio E Jr, Vander Sloten J, Duyck J, Jaecques SV. Biomechanical evaluation of platform switching in different implant protocols: computed tomographybased three-dimensional finite element analysis. Int J Oral Maxillofac Implants 2010 SepOct; 25(5):911-919.
Hansson S. The implant neck: smooth or provided with retention elements. A biomechanical approach. Clin Oral Implant Res 1999 Oct;10(5):394-405.
Kitoh M, Matsushita Y, Yamane S, et al. The stress distribution of the hydroxyapatite implant under the vertical load by the two-dimensional finite element method. J Oral Implantol 1988; 14(1):65-71.
Meijer HJA, Starnians FIM, Steen WHA, Bosman F. A threedimensional, finite element analysis of bone around dental implants in an edentulous human mandible. Arch Oral Biol 1993 Jun;38(6):491-496.
Omori M, Sato Y, Kitagawa N, Shimura Y, Ito M. A biomechanical investigation of mandibular molar implants: reproducibility and validity of a finite element analysis model. Int J Implant Dentist 2015;1(10):2-13.
Implant Dentistry—The Most Promising Discipline of Dentistry. Implant Complications Ma Angeles Sánchez Garcés, Jaume Escoda-Francolí and Cosme Gay-Escoda University of Barcelona, Faculty of Dentistry, Spain.
Mendonca G, Mendonca DB, Fernandes Neto AJ, Neves FD. Use of distraction osteogenesis for repositioning of an osseointegrated implant: a case report. Int J Oral Maxillofac Implants 2008;23(3):551-555.
Georgiev T, Nogalchev K. Local complications occuring during dental implantation. J Int Med Assoc Bulgaria 2010;16(4):35-37.
Elie E. Daou Stud attachments for the mandibular implant retained overdentures: Prosthetic complications. A literature review. Remov able Prosthodontics Department, School of Dentistry, Lebanese University, Beirut, Lebanon The Saudi Dental Journal (2013). Available at: http://dx.doi.org/10.1016/j. sdentj.2012.12.003
Steigmann M. Aesthetic flap design for correction of buccal fenestration defects, practical procedures and aesthetic dentistry: PPAD 2008;20(8):487-493.
Chrcanovic BR, Custodio AL. Mandibular fractures associated with endo steal implants, oral and maxillofacial surgery 2009;13 (4):231-238.
Misch CE, Resnik R. Mandibular nerve neurosensory impairment after dental implant surgery: management and protocol. Implant Dentistry 2010;19(5):378-386.
Wittneben JG, Millen C, Bragger U. Clinical performance of screw-versus cement-retained fixed implant-supported reconstructions—a systematic review. Int J Oral Maxillofac Implants 2014;29(Suppl):84-98.
Moghadam HG, Cols Y, Histomorphometric evaluation of bone regeneration using allogenic and alloplastic bone substitutes. J Oral Maxillofac Surg 2004 Feb;62(2):202-13.
Revie Leziy SS, Miller BA. Guided implant surgery and the use of osteotomes for rehabilitation of the maxilla. Pract Proced Aesthet Dent 2006 Jun;18(5):293-95.
Pereira CC, Gealh WC, Nogueira LM, Garcia IR JR, Okamoto R. Piezosurgey applied to implant dentistry: Clinical and biological aspects. J Oral Implantol 2012 Jan 4[Epub ahead of print].
Viña-Almunia J, Maestre-Ferrín L, Alegre-Domingo T, Peñarrocha-Diago MA. Survival of implants placed with the osteotome technique: An update. Med Oral Patol Oral Cir Bucal 2012;17(5):e765-68.
Piano S. A simple way to plan implant positioning: the ‘Stechnique’. Eur J Esthet Dent Autumn; 2011;6(3):328-41.
Kfir E, Goldestein M, Abramovitz I, Mazor Z, Kfir V, Kaluski E. The effects of sinus membrane pathology on bone augmentation and procedural outcome using minimal invasive antral membrane balloon elevation. J Oral Implantol 2012 Mar
[Epub ahead of print].
Kaneko T, Masuda I, Horie N, Shimoyama T. New bone formation in nongrafted sinus lifting with space-maintaining management: A novel technique using a titanium bone fixation device. J Oral Maxillofac Surg 2012Mar;70(3):e217-24.
Crespi R, Capparè P, Gherlone E. Osteotome sinus floor elevation and simultaneous implant placement in grafted biomaterial sockets: 3 years of follow-up. J Periodontol 2010 Mar;81(3):344-49.
Brägger U, Gerber C, Joss A, Haenni S, Meier A, Hashorva E, Lang NP. Patterns of tissue remodeling after placement of ITI dental implants using an osteotome technique: A longitudinal radiographic case cohort study. Clin Oral Implants Res 2004 Apr;15(2):158-66.
Lindgren C, Mordenfeld A, Hallman M. A prospective 1-year clinical and radiographic study of implants placed after maxillary sinus floor augmentation with synthetic biphasic calcium phosphate or deproteinized bovine bone. Clin Implant Dent Relat Res 2012 Mar;14(1):41-50.
Guyot M, Dubuc O, Richard NP, Dutour O. Comparison between direct clinical and digital photogrammetric measurements in patients with 22q11 microdeletion. Int J Oral Maxillofac Surg 2003 June;32(3):246-52.
Jemt LT. Photogrammetric measurements of implant positions. Description of a technique to determine the fit between implants and superstructures. Clin Oral Implants Res 2003;5(1):30-36.
Summers RB. The osteotome technique: Part 3. Less invasive methods of elevating the sinus floor. Compendium 1994;15: 702-04.
Taschieri S, Corbella S, Saita M, Tsesis I, Del Fabbro M. Osteotome-mediated sinus lift without grafting material: A review of literature and a technique proposal. Hindawi Publishing Corporation. Int J Dent 2012, Article ID 849093, 9 pages.
Taschieri S, Corbella S, Del Fabbro M. Use of plasma rich in growth factor for Schneiderian membrane management during maxillary sinus augmentation procedure. J Oral Implantol 2012;38(5):621-27.
Mol A, Van de Stel APF. Application of digital image analysis in dental radiography for the description of periapical bone lesions: A preliminary study. (Special tissue in dentistry) Trans Biomed Eng 1991;38:357-59.
Palioto DB. Sato S. Computer assisted image analysis methods for evaluation of periodontal wound healing. Braz Dent J 2001;12(3):167-72.
Ganz SD. Cone beam computed tomography-assisted treatment planning concepts. Dent Clin North Am 2011 Jul;55(3):515-36.
Peck JN, Conte GJ. Radiologic techniques using CBCT and 3-D treatment planning for implant placement. J Calif Dent Assoc 2008 Apr;36(4):287-90.
Fienitz T, Schwarz F, Ritter L, Dreiseidler T, Becker J, Rothamel D. Accuracy of cone beam computed tomography in assessing peri-implant bone defect regeneration: A histologically controlled study in dogs. Clin Oral Implants Res 2012Jul;23(7):882-87.
Leziy SS, Miller BA. Guided implant surgery and the use of osteotomes for rehabilitation of the maxilla. Pract Proced Aesthet Dent 2006 Jun;18(5):293-95.
Beretta M, Cicciù M, Bramanti E, Maiorana C. Schneider membrane elevation in presence of sinus septa: Anatomic features and surgical management. Hindawi Publishing Corporation. Int J Dent 2012;Article ID 261905, 6 pages.
Ganz SD. Computer-aided design/computer-aided manufacturing applications using CT and cone beam CT scanning technology. Dent Clin North Am 2008 Oct;52(4):777-808.
Chung S, McCullagh A, Irinakis T. Immediate loading in the maxillary arch: Evidence-based guidelines to improve success rates: A review. J Oral Implantol 2011 Oct; 37(5):610-17.
Bertassoni LE, Marshall GW. Papain-gel degrades intact nonmineralized type I collagen fibrils. Scanning 2009 Nov- Dec;31(6):253-258.
Moon SE, Kim HY, Cha JD. Synergistic effect between clove oil and its major compounds and antibiotics against oral bacteria. Arch Oral Biol 2011 Sep;56(9):907-916.
Pinto E, Vale-Silva L, Cavaleiro C, Salgueiro L. Antifungal activity of the clove essential oil from Syzygium aromaticumon, candida, aspergillus and dermatophyte species. J Med Microbiol 2009 Nov;58(Pt 11):1454-1462.
Olajide OA, Makinde JM, Awe SO. Evaluation of the pharmacological properties of nutmeg oil in rats and mice. Pharma Biol 2000;38(5):385-390.
Thanoon SZ, Al-Refai AS, Kamal A. Antibacterial effect and healing potential of nutmeg oil for chemically induced oral ulcerations in rabbits. Zanco J Med Sci 2013;17(2): 393-399.
Mitwally MF, Casper RF. Use of an aromatase inhibitor for induction of ovulation in patients with an inadequate response to clomiphene citrate. Fertil Steril 2001;75:305-09.
Sammour A, Bijan MM, Tan SL, Tulandi T. Prospective randomised trial comparing the effects of letrazole (LE) and clomiphene citrate (CC) on follicular development, endometrial thickness and pregnancy rate in patients undergoing superovulation prior to intrauterine insemination (IUI). Fertil Steril 2001;76(Suppl 1):S110.
Mitwally MF, Casper RF. Single-dose administration of an aromatase inhibitor for ovarian stimulation. Fertil Steril 2005;83:229-31.
Fisher SA, Reid RL, Van Vugt DA, Casper RF. A randomized double-blind comparison of the effects of clomiphene citrate and the aromatase inhibitor letrozole on ovulatory function in normal women. Fertil Steril 2002;78:280-85.
Fatemi HM, Kalibianakis E, Tournaye H, Camus M, Van Steirteghem AC, Devroey P. Clomiphene citrate vs letrozole for ovarian stimulation: A pilot study. Reprod Biomed Online 2003;7:543-46.
Hu Y, Cortvrindt R, Smitz J. Effects of aromatase inhibition on in vitro follicle and oocyte development analyzed by early preantral mouse follicle culture. Mol Reprod Dev 2002;61: 549-59.
Shetty G, Krishnamurthy H, Krishnamurthy HN, Bhatnagar S, Moudgal NR. Effect of estrogen deprivation on the reproductive physiology of male and female primates. J Steroid Biochem Mol Biol 1997;61:157-66.
Mitwally MF, Casper RF. Aromatase inhibition reduces gonadotrophin dose required for controlled ovarian stimulation in women with unexplained infertility. Hum Reprod 2003;18:1588-97.
Mitwally MF, Casper RF. Aromatase inhibition improves ovarian response to follicle-stimulating hormone in poor responders. Fertil Steril 2002;77:776-80.
Goswami SK, Das T, Chattopadhyay R, Sawhney V, Kumar J, Chaudhury K, Chakravarty BN, Kabir SN. A randomized single blind controlled trial of letrozole as a low-cost IVF protocol in women with poor ovarian response: A preliminary report. Hum Reprod 2004;19:2031-35.
Newkirk KM, Chandler HL, Parent AE, et al. Ultraviolet radiation-induced corneal degeneration in 129 mice. Toxicol Pathol 2007;35:819-26.
Pettenati MJ, Sweatt AJ, Lantz P, et al. The human cornea has a high incidence of acquired chromosome abnormalities. Hum Genet 1997;101:26-29.
Snibson GR. Collagen cross-linking: A new treatment paradigm in corneal disease—a review. Clin Experiment Ophthalmol 2010;38:141-53.
Spoerl E, Raiskup-Wolf F, Kuhlisch E, Pillunat LE. Cigarette smoking is negatively associated with keratoconus. J Refract Surg 2008;24:S737-40.
Rabinowitz YS, Nesburn AB, McDonnell PJ. Videokeratography of the fellow eye in unilateral keratoconus. Ophthalmology 1993;100:181-86.
Goodrich DW, Lee WH. The molecular genetics of retinoblastoma. Cancer Surv 1990;9:529-54.
Moodaley LC, Woodward EG, Liu CS, Buckley RJ. Life expectancy in keratoconus. Br J Ophthalmol 1992;76:590-91.
Honein MA, Dawson AL, Petersen EE, Jones AM, Lee EH, Yazdy MM, Ahmad N, Macdonald J, Evert N, Bingham A, et al. Birth defects among fetuses and infants of US women with evidence of possible Zika virus infection during pregnancy. JAMA 2017 Jan 3;317(1):59-68.
Chervenak FA, Jeanty P, Cantraine F, Chitkara U, Venus I, Berkowitz RL, Hobbins JC. The diagnosis of fetal microcephaly. Am J Obstet Gynecol 1984 Jul 1;149(5):512-517.
Papageorghiou AT, Thilaganathan B, Bilardo CM, Ngu A, Malinger G, Herrera M, Salomon LJ, Riley LE, Copel JA. ISUOG Interim Guidance on ultrasound for Zika virus infection in pregnancy: information for healthcare professionals. Ultrasound Obstet Gynecol 2016 Apr;47(4):530-532.
Chibueze EC, Parsons AJ, Lopes KD, Yo T, Swa T, Nagata C, Horita N, Morisaki N, Balogun OO, Dagvadorj A, et al. Diagnostic accuracy of ultrasound scanning for prenatal microcephaly in the context of Zika virus infection: a systematic review and meta-analysis. Sci Rep 2017 May 23;7(1):2310.
Cordeiro MT. Zika virus: laboratory diagnosis. In: Zika in focus. Springer International Publishing; 2017. pp. 59-62.
Mlakar J, Korva M, Tul N, Popović M, Poljšak-Prijatelj M, Mraz J, Kolenc M, Resman Rus K, Vesnaver Vipotnik T, Fabjan Vodušek V, et al. Zika virus associated with microcephaly. N Engl J Med 2016 Mar 10;374(10):951-958.
Zare Mehrjardi M, Keshavarz E, Poretti A, Hazin AN. Neuroimaging findings of Zika virus infection: a review article. Jpn J Radiol 2016 Dec;34(12):765-770.
Oliveira Melo AS, Malinger G, Ximenes R, Szejnfeld PO, Alves Sampaio S, Bispo de Filippis AM. Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: tip of the iceberg? Ultrasound Obstet Gynecol 2016 Jan;47(1):6-7.
Brasil P, Pereira JP Jr, Moreira ME, Ribeiro Nogueira RM, Damasceno L, Wakimoto M, Rabello RS, Valderramos SG, Halai UA, Salles TS, et al. Zika virus infection in pregnant women in Rio de Janeiro. N Engl J Med 2016 Dec 15;375(24):2321-2334.