By Dr. Lee Ann Brady
Managing the screw access holes is one of the challenges I run into with implant
dentistry. We all hope to fill them once and then never have to get to the head of the
screw again, but this is dentistry after all and that would be unrealistic. In the last 6
months I have partnered with two patients to replace implant supported hybrid
prostheses, and had to remove and replace the old restoration at every
appointment managing the access holes.
Placing the cotton is pretty easy...
removing them is not so easy
I was taught to use a cotton pellet to cover the screw, then fill the top of the hole above that. Placing the cotton is pretty easy, you create long hotdog shaped pieces if cotton and then condense them into the access hole. Removing them however is not so easy, Some people pack the cotton tightly and others place less, but either way we are left trying to grab on to and tease the cotton out with instruments like an explorer or endo file.
I have recently stopped using cotton Pellets
Based on the suggestion of the oral surgeon that I work with I have (recently) stopped using cotton pellets and started using plumbers tape. This white Teflon tape is available at any hardware store, and I have it in my office as I use it as a matrix when seating veneers and inlays to protect adjacent teeth and preps. I cut off an inch to an inch and a half piece of the plumbers tape. Grab one end with a cotton pliers and using the tips of the pliers pack it in over the screw access hole. It is tacky so it sticks to itself and forms a mass inside the access hole. When it is time to take it back out once you get the tip of the explorer into the end the whole piece feeds right out in an instant.
Read more classic tips and tricks from Dr. Brady here and here!