This is certainly anxiety inducing and all I have ever done is go sloth slow. I will usually start with a small spot on the lingual and lightly advance until I see a cement line. At that point I will start searching for the teflon. I would be very interested to know what others are doing. Ive recently heard of green teflon being used as a means to both identify ASC screws and to help locate screw access in cemented cases.

Unfortunately, no magic to this procedure. It definitely helps to go slow and I use a flat tapered diamond but or a diamond chamfer bur. Definitely, looking at multiple X-rays to have your best access location is helpful but it just takes that along with patience. Also, if it’s not your crown you may not be fortunate to find teflon, it may just be disintegrated cotton or worse filling material on the screw so patience and good vision are important.

If screw is stripped there are kits out there that may help to remove it, Salvin is one of many companies that have tools like that if needed but hopefully that won’t be the case. Sorry I don’t have a magic pill for ya but typically it’s not as bad or as hard as your expect just a little Tedious

Take a small field CBCT. You can sometimes tell where the screw access is from the CBCT and it’s especially helpful if the screw access is NOT lingual. Cemented restorations make sense for aesthetics if the screw access is coming out the facial! So there’s a very good chance that screw access on the cemented restoration is not in the cinculum position

Update on this guys, after finding the screw, (the CBCT Gilbert was a great idea), I could not get it to turn. Sent to a prosthodontist who stated either composite or cement get around the screw and he had to drill it out. There has to be an easier way, hopefully some day.