Dentists' Perspective and Experiences Relative to the Accidental Dropping of Implant Drivers and Components Intraorally: A Survey of Practicing Clinicians.

Ingestion or aspiration of dental implant screwdrivers or implant components is potentially life-threatening. There are no reports on the frequency at which dentists drop these devices within the mouth or which components are most problematic. There are few reports on what protective measures clinicians take, where risks exist, and how this problem is managed. A 9-part questionnaire was provided to dentists. Data collected included clinicians' roles, implant surgeons, restorative clinicians, or both-the frequency of dropping implant screwdrivers or components, items considered most problematic. Patient protection and management were also requested. Finally, questions related to how much of a problem clinicians considered this to be and if further solutions and a standardized management protocol should be developed. One hundred twelve dentists voluntarily completed the survey. Of the dentists, 54% restored, 37% restored and surgically placed, and 9% solely placed implants. Twenty-nine percent claimed never to drop components, with 56% dropping an instrument less than 10% of the time. Less than half would suggest patients seek medical advice if a screwdriver or component was accidentally dropped intraorally and was not recovered. Thirty percent never tied floss tethers to screwdrivers, and a similar percentage reported they only sometimes did so. Throat pack protection was reported 51% of the time. Ninety percent considered dropping components an issue, with screwdrivers most problematic. Aspiration or ingestion of implant screwdrivers and components is problematic, with dentists varying their use of protection devices. There is a need to standardize and implement patient protection procedures and management and develop methods to reduce the risk of these potentially life-threatening issues.

Retention of titanium copings to implant-supported fixed dental prostheses.

PURPOSE: The aim of this in vitro study was to assess the effects of using different cements and titanium copings designs on the retention of implant-supported fixed dental prostheses (IFDPs) using a pull-out test. MATERIALS AND METHODS: Fifty zirconia (ZirCAD; Ivoclar Vivadent) and 20 prepolymerized denture acrylic resin (AvaDent) rectangular (36 mm × 12 mm × 8 mm) specimens were milled to mimic the lower left segmental portion of the All-on-Four IFDPs. Cylindrical titanium copings (Variobase; Straumann) (V) were used in 2 prepolymerized denture acrylic resin groups (n = 10) while conical titanium copings (Straumann) (C) were used as a control group for zirconia with 4 groups using cylindrical titanium copings. Before cementation, the outer surfaces of all titanium copings and the intaglio bonding surface of prosthetic specimens were airborne-particle abraded. All specimens were cemented following the manufacturer's recommendations and instructions according to the experimental design. After artificial aging (5000 cycles of 5°C 55°C, dwelling time 20 s; 150 N, 1.5 Hz in a 37°C water bath), all specimens were subjected to retention force testing using a pull-out test using a universal testing machine and a custom fixture with a crosshead speed 5 mm/min. Modes of failure were classified as Type 1, 2, or 3. Retention force values were analyzed by the t-test for the prepolymerized denture acrylic resin specimen groups, and 1-way ANOVA and the Tukey test for the zirconia groups at α = 0.05. RESULTS: Mean and standard deviation retention force values varied from 101.1 ± 67.1 to 509.0 ± 65.2 N for the prepolymerized denture acrylic resin specimen groups. The zirconia groups ranged from 572.8 ± 274.7 to 1416.1 ± 258.0 N. There is no statistically significant difference in retention force values between V and C specimens cementing to zirconia with Panavia SA cement (Kuraray Noritake) (p = 0.587). The retention forces and failure modes were influenced by the cement used (p < 0.05). Modes of failure were predominantly Type 2 (mixed failure) and Type 1 (adhesive fracture from prosthetic materials) except for the quick-set resin group (Type 3, adhesive failure from coping). CONCLUSIONS: When bonding IFDPs onto titanium copings, quick-set resin provided significantly higher retention force for prepolymerized denture acrylic resin prostheses. Conical and cylindrical titanium copings performed similarly when cemented to zirconia with Panavia SA cement under the same protocol. The stability of the bonded interface and retention forces between zirconia prostheses and titanium copings varied from the cement used.

A technique to guide replacement of multiunit abutments supporting an existing implant-supported fixed complete denture.

This article describes a technique for replacing a fractured multiunit abutment (MUA) supporting an existing implant-supported fixed complete denture (ISFCD) with a custom-fabricated abutment alignment device. The angulated MUA threads that receive the prosthetic screw to secure the ISFCD can become stripped, cross-threaded, or, in some patients, the thin metal in this region may fracture. These conditions necessitate the removal and replacement of the angulated MUA. For many clinicians, replacement of the angulated MUA will be a rare and unfamiliar procedure. One of the biggest challenges is to achieve the correct orientation of the replacement angulated MUA hexagon to the supporting implant's internal hexagon. This technique aids the accurate indexing of the current angulated MUA position and replacement with a new angulated MUA without a trial-and-error approach involving multiple insertions and tightening of the abutment screw.

A technique to eliminate subgingival cement adhesion to implant abutments by using polytetrafluoroethylene tape.

Residual excess cement adhered subgingivally to an implant abutment has the potential to cause periimplant mucositis or periimplant disease. This article describes a procedure in which polytetrafluoroethylene (PTFE) tape is used to protect dental cements from adhering to the implant abutment. This technique ensures complete removal of cement from the implant abutment after seating of the crown.