Hand Instruments for Diagnostic & IMR Recovery Cases

This reference guide assumes familiarity with the diagnostic algorithm case Types used to differentiate the various nuances of retrieving fractured screw fragments. This diagnostic protocol can be reviewed in a separate document in this resources section.

When confronted with a fractured screw IMR case, the first step is always obtaining accurate data. Verifying and refining this diagnosis clinically is the next step toward resolving the case. To be as accurate as possible, the site is first evaluated with hand instruments under microscopic visualization. The three hand instruments used, both in this diagnostic process and subsequently when retrieving mobile fractured screws, are included in all basic instrument setups. These instruments are described below and in the case of the modified endodontic spoon excavator, the modification steps are described as well.

1. Mouth Mirror

Any mouth mirror will work but the best I have found, which are still economic, are Crystal HD mirrors from Zirc Dental Products. When photographing a case off of a mirror, these mirrors reflect significantly more light than a typical mouth mirror. In photographic language, it translates to about 2 exposure stops.

2. Endodontic Explorer

I’m not totally specific in this case, but this explorer does need to be as long as possible to reach down into an implant. The instruments used today are from Hu-Friedy: EXDG16

3. Modified Endodontic Excavator

The endodontic spoon excavator is an additional instrument to assist in rotating a mobile screw fragment.  It is slightly more efficient in transferring torque to the screw fragment than the endodontic explorer. I use both interchangeably and the determination is made whether a screw fragment is mobile or not, as a differentiating factor in determining the course of treatment approaches.

Preparing the spoon excavator

The stock endodontic spoon excavator is modified with three grinds using a diamond disc to take it to a slightly curved sharp point.  The stock instrument used today is a Hu-Friedy: EXC32L6.  The instrument modifications are described below.

Modification  grinds

For more information on the history of IMR, interested parties can contact us or visit our History of IMR page to learn more about Implant Mechanical Rescue Dentistry.

Contact Dr. Mastrovich and the Mastrovich Dental Team for more information on our Implant Mechanical Rescue services.