Unfortunately dental implant abutment screws come in all different shapes and sizes. Because of that, there are many, many different screws that hold them together. There are also so many different instrument adapters to tighten and loosen dental implant components.
It would be nice if there was a universally accepted system for dental implants so that if a patient moves from France to Burbank, California there would be no problem in finding a dentist that could work on the implant.
For most modern, well done dental implants, screw loosening is a thing of the past. But what is increasingly common is using the same implant for another crown or bridge. You may have had for a single tooth crown dental implant to later be used as a connecter to a bridge if you lost a tooth behind or in front of it.
Dental implant screwdrivers come in all shapes and sizes. We have hexes, slots, torques, and many other types. What size is it? Is it a size .035 ,.048 or is it .050 or .062 or .017 slot? What is the shaft length? Is the abutment torqued with a nut driver because it is a solid abutment without a hole? When you see all these tiny parts in a box they all look alike! Yikes!
The list goes on and on.
The problem is often a lack of organization in an average general dental office. The dentist perhaps does not practice implant dentistry often and is just handed a box of screwdrivers and left to figure it out until something fits. If it “kind of fits” but if it doesn’t fit perfectly the screw gets stripped!! The screwdriver also gets rounded out on the corners. After the stripped screwdriver gets sterilized it gets used on another patient and potentially can strip that screw too.
Worse yet, the implant doesn’t get tightened down fully but it is believed that it is screwed down all the way. What ends up happening is the dental implant crown or bridge becomes loose on the abutment level. The crown usually doesn’t come out when that happens, it’s just wobbles and causes gum irritation, pain and bone loss if it is left for too long.
A loose screw will also fracture leaving the broken part stuck inside. It isn’t a lot of fun to dig out!
I use a variety of dental implant systems. I use a universally accepted internally hexed implant that has a .050 hex screw. This is not a proprietary screw like some other implant systems and will make it easy for you should you have a problem in the future or just need to build on your dental implant. An example of building on your dental implant would be a patient that has 4 front teeth implants and they are losing all of their back teeth. The back teeth could be extracted, dental implants placed and a Prettau full arch zirconia screw retained bridge could be connected to the new and old implants.
I find that the wrong screwdriver problem happens more often when the surgical part of the dental implant is being done by one person, and the crown bridge or implant overdenture is being done by another dentist. This leads to a mismatch of parts sometimes if the dentist team or staff is not well aligned with each other.
These custom angulated abutments I made are held in by screws.
My recommendation would be to just make a note somewhere of the type and style of implant screw you have should you ever need it. If your situation is complex I would highly suggest seeing a dental implant specialist for the best results. Their staff should be equally knowledgeable and are a key part of your implant success!
Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry