A New Device to Prevent Aspiration or Swallowing of Implant

Screwdrivers
Marc Appelbaum, DDS
Department of Restorative Dentistry, Rutgers School of Dental Medicine, Newark, NJ

Keywords Abstract
Eliminates throat packs and floss; safety
device; tethered harness.
The screwdriver harness is potentially a life-saving device. It allows the clinician to
work intraorally with a handheld screwdriver without the concern of unintentionally
Correspondence
losing contact with the driver, risking the possibility of aspiration or swallowing by
Dr. Marc Appelbaum, Department of the patient.
Restorative Dentistry, Rutgers School of
Dental Medicine,110 Bergen St., Newark, NJ
07101. E-mail:
landmappelbaum@hotmail.com

The author denies any conflicts of interest

related to this study.

Accepted August 9, 2018

doi: 10.1111/jopr.12982

The comorbidities of swallowing or aspirating dental prosthe- pharyngeal tissues is arbitrary. Some practitioners subscribe to
ses or instruments during routine intraoral dental procedures do a length equal to the distance from the nose to the mid chest,
not receive adequate attention in the dental literature. With the with no evidence to support their decision. Manual and electric
introduction of implant dentistry and the use of small-machined drivers will eliminate the need for handheld screwdrivers; how-
parts and devices, the incidence of a practitioner unintentionally ever, when the driver is engaged in these instruments, it may
dropping a device in the oral cavity has increased. The liter- limit their intraoral access.
ature documents numerous instances of implant drivers being These problems are not limited to the novice dental student
aspirated or swallowed, thus requiring surgical intervention.1-7 or practitioner just beginning to introduce implant dentistry
This problem is magnified by the small size of the instruments, into a clinical practice. This issue is of concern to all clinicians
and when coated with saliva, with patients in a supine or semi- working with implants.
supine, position, the chances of loss of control are enhanced. The placement of a rubber dam during endodontic proce-
Screwdrivers are required during dental implant procedures dures and nonimplant restorative dental procedures is an ef-
to either loosen or tighten prefabricated or custom implant fective barrier to prevent swallowing or aspiration; however,
abutments to the dental implant. Unfortunately, access with the dam cannot be placed in many clinical situations when
the screwdriver using two hands (required to stabilize and restoring dental implants. Additionally, many patients have a
turn the driver) in many areas of the mouth can be difficult, pronounced gag reflex, which makes the packing of the throat
causing the dentist to lose dexterity and drop the instrument. with gauze difficult or impossible. Pre-warning patients to be
When this occurs, this dental procedure may become a medical alert for the possibility of a driver dropped on the tongue or
emergency.8 The manufacturers of these drivers and clinicians in the throat can only make the patient more apprehensive
have recommended the use of dental floss inserted into a hole and often does nothing to improve their reflex, especially in
in the driver or around the head as a solution for their retrieval.9 the older adult patient who may already have a compromised
Any clinician who has used this floss technique knows all too gag reflex.
well that there are inherent difficulties. Either the floss becomes A prototype implant harness was fabricated from polylac-
entangled around the clinician’s finger, making it difficult to tic acid (PLA) using 3D printing (Ultimaker, Geldermalsen,
turn the driver, or the floss slips off the head of the screw- Netherlands). The device consists of the following components:
driver. The length of floss that the practitioner tethers to his/her head assembly, magnet, adjustable collar, flexible tether, and
finger that would allow retrieval without laceration to the oral- finger ring. The initial design demonstrated the feasibility and

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C 2018 by the American College of Prosthodontists 1
Screwdriver Harness Appelbaum

Figure 1 Initial design concept for housing, tether, and finger loop.

Figure 3 Schematic of how measurements were made on various

implant screwdrivers.

Figure 4 Central housing that accommodates driver heads of various

diameters.

was a concern. If it is too short, operator dexterity would be

compromised, if it is too long and requires retrieving, unneces-
sary soft tissue trauma would likely occur.
The final design of the screwdriver harness consists of a
central seating housing that will accommodate driver heads of
various diameters and driver shafts of all the lengths presently
on the market (Fig 4). The housing is of rigid plastic that will
Figure 2 Initial 3D printed prototype of device. stabilize the driver while at the same time allow for easy access
to turn the driver clockwise or counterclockwise.
practicality of a device to prevent the loss of physical contact
with the screwdriver in the oral cavity (Figs 1 and 2).
Technique
The prototype incorporated a magnet to both retain the head 1. Screwdriver head is inserted firmly into the device
of the driver in place as well as to stabilize it when the adjustable housing.
collar is tightened. The limitations of this design included the 2. The strap with its oblong slits and “living hinge” is placed
rigid nature of the adjustable collar, tether, and finger ring. over the shank of the driver and fastened to the locking
Additionally, the head assembly and magnet would not accom- device.
modate and stabilize all the numerous sizes and nonmagnetic 3. The screwdriver is now secured (Fig 5).
nature of some of the screwdrivers. 4. The dentist engages the finger ring, placing it over the
Working with the design engineers at Catalyst Product De- pinky.
velopment, Indianapolis, IN, several design prototypes were 5. With the flick of a finger, the locking mechanism can be
examined with regards to universal applicability, ease of use, disengaged.
material fatigue, minimally intrusive dimensions, and steriliz-
ability. Digital calipers were used to measure 7 of the most Discussion
commonly used implant screwdrivers at various points (Fig 3).
This information was used to design the housing to accommo- The simplicity of the device negates the necessity of the fingers
date and stabilize the heads of the drivers. The length of tether of one hand to stabilize the screwdriver and the fingers of the

2 Journal of Prosthodontics 0 (2018) 1–3 

C 2018 by the American College of Prosthodontists
Appelbaum Screwdriver Harness

are a real possibility. The use of dental floss ligated to the

driver or packing the throat with gauze have drawbacks and
limitations. This screwdriver harness will significantly reduce
the possibility of an implant screwdriver creating an unintended
medical emergency.

References
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