Double-Step Image Superimposition Technique for Fabricating a Drilling Guide to Access the Abutment Screw in Implant Prostheses

Loosening of the abutment screw is the most common complication for implant restorations, especially single-tooth replacements.1 When screw loosening occurs in a firmly cemented crown, either the crown should be sectioned or a screw-access hole should be drilled. Although creating a screw-access hole is relatively nondestructive, estimating the position of the hole and the drilling angle are difficult in the narrow intraoral space. This difficulty led to the development of a drilling guide system that provides three-dimensional (3D) information about the abutment screw location.2 Cone beam computed tomography (CBCT) features low radiation and metal artifact reduction compared with conventional computed tomography.3

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