Which retrieval technique offers the highest success rate for fractured dental implant abutment screws while preserving implant integrity?

Abstract

A Commentary on

Arshad M, Doust Mohammadi M, Habibzadeh S, et al.

The efficacy of techniques for managing fractured dental implant abutment screws: A systematic review and meta-analysis. Journal of Evidence-Based Dental Practice. 2026:102226.

Design

Systematic review and meta-analysis synthesizing evidence from 53 studies (31 case reports, 14 technique papers, 7 in vitro studies, 1 finite element analysis) involving 576 dental implants with fractured abutment screws. The review evaluated multiple retrieval strategies and stratified outcomes by implant configuration, fracture location, and technique category.

Case selection

Fractured abutment screws in dental implants, regardless of loading status. Studies were included if they reported retrieval techniques (manual exploratory instruments, ultrasonic devices, mechanical modification approaches, or custom methods) and success rates for fragment removal.

Data analysis

Pooled success proportions were calculated with 95% confidence intervals using random-effects modeling. Subgroup analyses compared external versus internal implant connections, fracture locations (coronal, within implant body, mixed, or apical), and technique categories (ultrasonic, instrument modification, screw modification with retrieval kits, and manual methods alone). Heterogeneity was quantified using I² statistics, and publication bias was assessed through Begg and Egger tests and funnel plots.

Results

Overall in vitro retrieval success was 86% (95% CI: 0.75–0.94; I² = 88%). External implant connections achieved 100% retrieval success, compared with 80% for internal connections (P = 0.01). Screws fractured within the implant body had significantly higher success (95%; 95% CI: 0.90–0.99; I² = 40%) than mixed or deeper fractures (67%; 95% CI: 0.47–0.84; I² = 92%; P < 0.01). By technique, ultrasonic methods had the highest success at 97% (95% CI: 0.81–1.00; I² = 2%), followed by instrument modification combined with manual instruments at 96% (95% CI: 0.86–1.00; I² = 45%), screw modification with retrieval instruments at 82% (95% CI: 0.65–0.95; I² = 91%), and manual instruments alone at 71% (95% CI: 0.61–0.80; I² = 0%).

Conclusions

Fractured abutment screw retrieval success depends on fracture accessibility, implant connection type, and fracture depth. A stepwise strategy beginning with conservative techniques appears justified before advancing to more invasive or instrument-modifying approaches.