Screw Fracture Overview

Problem & Impact:

Fractured implant screws, while uncommon, pose a significant mechanical complication. They often follow screw loosening or biomechanical overload, sometimes leading to complex retrieval or even implant removal.

Main Causes:

Fatigue fracture from repeated micro-movements, inadequate preload or torque, prosthetic misfit, excessive occlusal loading, parafunctional habits, and suboptimal screw design or materials are leading contributors.

Materials/Fractography:

Recent analyses show most fractures exhibit fatigue patterns, influenced by clinical loading and variations in screw geometry or titanium-alloy quality.

Retrieval & Management:

Stepwise protocols start with conservative retrieval (direct access, reverse torque), then ultrasonic/micro-drilling kits. Implant replacement may be needed if retrieval fails or the connection is damaged.

Emerging Methods:

Minimally invasive techniques (silicone holders, micro-brushes, ultrasonic tips) show promise but are supported mainly by case reports.

References:

Raju S et al. J Indian Prosthodont Soc. 2023;23(1):12–22.

Martínez-Alcaraz P et al. J Prosthet Dent. 2024;132(2):177–185.

Chowdhary R et al. J Osseointegration. 2023;15(1):47–54.

Nayana P et al. J Indian Prosthodont Soc. 2022;22(3):215–222.

Soleimani M et al. Clin Case Rep. 2024;12(2):e9621.

Chowdhary R et al. J Prosthodont Res. 2024;68(3):231–239.

Al-Omari WM et al. J Osseointegration. 2024;16(2):90–101.

Aboushelib MN et al. Int J Prosthodont. 2023;36(1):55–62.

Jang JH et al. Clin Implant Dent Relat Res. 2023;25(1):75–84.

Petrescu R et al. Int J Prosthodont. 2023;36(5):510–517.