WO2011054477A1

WO2011054477A1 - A system consisting of a screw to be rotated into the bone, a screwing instrument, and a retaining cap

Info

Publication number: WO2011054477A1
Application number: PCT/EP2010/006585
Authority: WO
Inventors: Holger Zipprich; Cornelius Geist
Original assignee: Holger Zipprich; Cornelius Geist
Priority date: 2009-11-05
Filing date: 2010-10-28
Publication date: 2011-05-12
Also published as: DE102009052119A1

Abstract

The invention relates to a system consisting of a screw (S) provided for screwing into the bone, a screwing instrument, also called a blade (K), provided for this purpose, and a retaining cap (EST). The aim of the invention is to simplify handling prior to and during the screwing of the screw. This is achieved in that the preassembled system can be steam-sterilized during the dental surgery and can be screwed directly by hand or automatically with little preparation. According to the invention, the system is characterized in that the screw can be preassembled in a removably connected manner between the cap and the screwing instrument, and thus surrounding the screw. Advantageously, the screw is not surrounded in an air-tight or water-tight manner and/or the screwing instrument is only surrounded by the cap to the extent that the screwing instrument can be inserted into an automatic screwing device without removing the cap, or the hand piece can be fully used on the screwing instrument.

Description

description

A SYSTEM CONSISTING OF A SCREW TO BE TURNED IN THE BONE, ONE

INSERTING INSTRUMENT AND A HOLDING CAP

The invention relates to a simplification in the handling and a risk minimization when screwing in and dealing with screws which are screwed into the bone, preferably in the human jaw.

In orthodontics, the main therapeutic goal is the targeted and controlled movement of teeth. Such a translational or rotational movement of a tooth is only possible by a force is applied to the tooth to the appropriate extent, which can move this against the jaw. This force is then applied over suitable fixing means over comparatively long periods of time on the respective tooth, until it assumes the desired positioning and / or orientation in the oral cavity. However, a suitable support of the force-exerting element in the oral cavity is necessary for targeted application of a tooth with such a suitably chosen force, for example via brackets, wires, rubbers or other suitable force-exerting elements.

Usually, such a support of the force-applying elements is made on a further tooth, for example, two suitably positioned teeth are connected to each other via a clamping element, which is then biased to train. However, such an approach has the disadvantage that it conceptually two teeth are applied symmetrically with forces, but this is actually intended and desired only for one of the teeth. The targeted repositioning of the one tooth is thus inevitably associated with an undesirable or only conditionally acceptable change in position of the other tooth.

CONFIRMATION COPY In order to counteract this, an anchoring via one-piece temporary screws, the so-called orthodontic anchoring screws, can also be carried out, which are temporarily introduced into the jawbone and removed again after the tooth has been displaced. In contrast to dental implant materials, which are designed for permanent integration into the jawbone and the longest possible stable ingrowth, anchoring screws of this type must therefore be introduced in such a way that a later removal from the bone remains possible. In contrast, when using such anchoring screws but necessarily to be noted that during the active therapy phase, ie during the actual application of force of the desired forces in the tooth requiring treatment, a reliable and resilient fit of the respective, provided as counterpoint anchoring screw is essential.

To support prostheses or to fix and / or support other aids, screws are used which are preferably screwed into the bone in the jawbone and project through the skin or mucous membrane to fix it to them or as an abutment for support to use.

In reconstructive surgery, after bone fractures or bone segment transplantation, screws are used to fix these bone segments. For stabilization also plates, usually made of titanium or a titanium alloy are used, which are fastened by screws to the bone. These screws are commonly used as

Osseosyntheseschrauben indicates.

Screws that are screwed into the bone in their application have special storage conditions before screwing into the bone to ensure sterility. With dental implants, these are individually packaged and sterilized by the manufacturer under the purest conditions. This means that each individual implant is in a separate individual packaging and usually only to be opened during surgery, to insert it directly into the bone, usually screwing.

Such a process is particularly necessary if a surface-roughening treatment was carried out as a whole or only partially with the implant or the screw to be introduced into the bone. The rougher a surface is the greater the risk that impurities accumulate on it that are difficult or impossible to remove. Therefore implants that have been heavily roughened are packaged sterile and immediately screwed into the bone after opening the package. If the implants remain free of any roughening process or if only a small degree of roughening is carried out, sterile packaging can be dispensed with by the manufacturer. Such implants or

Screws can be sent to the practitioner without sterilization. The dentist takes over the sterilization and possibly also a previous cleaning of the implants or screws. With orthodontic mini implants, Transgingivalschrauben and Ossteosyntheseschrauben a sterile dispatch of screws from the manufacturer to the practitioner is rarely practiced. Usually, these are packaged cleanly by the manufacturer, but first sterilized by the attending physician. Since it is usually delivered in unclean packaging, usually has to be cleaned before.

Partially the screws are also welded in sterile hoses.

Sterile hoses initially consist of two foils / paper foils welded together in such a way that they form a tube structure. One of the slides is translucent to see what is in it. The other film is permeable to water vapor. Both films are not bacteria permeable. In this tube can be introduced to be sterilized objects. After both ends of the tube are welded, the inside of the tube can be sterilized with steam in a sterilizer.

In most cases, the screws are unpacked at the attending physician and incorporated or sorted into a specially designed and reusable (re-sterilizable) packaging or housing. In these Housing is also often stored the necessary tool for screwing. These cases are called trays. Fig. 1 and Fig. 2 show possible trays in which the screws can be sorted and stored with and without tools or accessories. These trays are sealed in a sterile tube before treatment (before screwing the screws into the bone) and then sterilized.

Fig. 1 shows a Trayboden (TB) in which several mold cavities are present. It is a screwdriver compartment (SDF), a tweezer compartment (PF), an empty compartment (LF) for other utensils and a plurality of screw compartments (SF) which are shown in the section enlargement AA of the area A and partially filled with screws (S). Insertion tool 1 (EDI-1) and 2 (EDI-2) are housed in the designated Formausnehmungen. The Tray Lid (TD) can be moved in the Tray Lid Guide (TDF) to protect the items stored in the tray from falling out.

Fig. 2 shows another tray version with a tray bottom (TB), a screwdriver compartment (SDF), screw compartments (SF) and a

Tray lid guide (TDF).

Orthodontists usually do not work surgically. In principle, however, every orthodontist is entitled to use orthodontic mini-implants in patients. Some orthodontists use the mini implants without prior training and some only after they have attended training. Others, in turn, have their patients place mini implants with other mostly surgical dentists, oral surgeons or oral and maxillofacial surgeons. This concept is referred to as a referral concept. Usually, the orthodontist transfers his patients to the mini-implant placement colleagues and tells them where (lower jaw / upper jaw, oral / vestibular, etc.) he would like to have the mini-implant placed. The screws, the tool and the tray are then either stored by the surgical dentist or surgically attached to the orthodontist for each insertion active dentist. Here it would also be an advantage if the range of screws, tools, accessories and tray are as small as possible.

In a patient session, an orthodontic mini-implant is usually used. The number of mini-implants to be placed can also go up to 4. In most trays there is room for a lot of people

Screws. This is also due to the fact that some manufacturers have very many different screw variants with different screw lengths, diameters, heads etc. in their assortment. For this reason alone, it makes sense to have only a few screw types in a system. All unused screws in the tray, the tool and the entire tray must then be cleaned and re-sterilized, even if only one

Screw was used. The subsequent cleaning and sterilization takes a not inconsiderable amount of time. For this time and the time the tray needs to cool, the tray is blocked and can not be used. If a practitioner has 10 patients in a row with which one or more screws have to be set, he needs several trays in order to be able to do this. Keeping sterilized trays in place will tie up cleaning and sterilizing capacity and, moreover, much capital. The fewer screw types in a system, the fewer tools and special accessories required, the lower the capital commitment and the cleaning and sterilization effort for the practitioner. From this perspective, it would be an advantage if each screw and each tool were individually packaged and only become non-sterile when actually used. It is only important that the practitioner has easy and quick access to all screws, tools and accessories during treatment.

The screws described above are usually manually with a passive screwing tool (eg screwdriver Fig. 3) or a Eindrehinstrument (also called blade Fig. 4), which by an active insertion tool (eg motor-driven angle piece or other motor-driven Eindrehinstrument) in the bone brought in. Fig. 3 Shows a screwdriver. Conventionally, a handle (GR) is rotatably mounted on the hand turn, via which the torque is applied for screwing. The torque is transmitted through a usually interchangeable blade (K) and the molded on the front portion of the blade insert (SE) which possesses a rotary locking mechanism to the screw to be screwed.

In the literature and practice, two different variants are described in the process of screwing.

Version 1 :

Screwing the screws into a preformed into the bone mold cavity, preferably a bore. For this purpose, a screw is required, which has based on the thread in the bone either a self-cutting and or self-forming properties.

Variant 2:

Direct screwing of the screw into the bone without prior action on the bone. For this type of insertion of screws into the bone, it is useful in the design of the screw in addition to the properties described in variant 1 additionally integrate a self-drilling property.

Before screwing the screws into the bone, the screw must be mounted on the driving tool / driver. The insertion instruments have at one end a receptacle for the screw, which a

have rotational locking against the screw. These ratchets are executed on the instrument side as a die and or patrix. In a particularly advantageous embodiment, the plugged screw has an inhibiting and or blocking effect against the falling off of the screw from the screwing instrument. This hamper should be easily separable after screwing in the screw. The side opposite the driver of the screw receptacle side can have different shapes and properties. Usually, the instruments have at least one of the following properties.

• Pick-up or coupling to a motor-driven and manually operated screwing tool (Fig. 4). For example, a picture of an H & W elbow.

• Recording or coupling to a tool with which a manual or manual screwing of the screws into the bone should take place.

• A handle or a design which is suitable for manual recording and a manual or manual screwing of the screws into the bone.

If the driver does not have a handle at the end opposite the screw but a connection for connecting to another screwdriver or screwdriver, it is called a "blade." This blade is then attached to another screwdriver. Screwdriver ".

Before inserting the mini-implants into the jaw, the screw (mini-implant) is placed on the driver (blade, screwdriver, etc.). In the best case, this means that with the screwdriver, the screw from the tray or the sterile packaging must be included. In less favorable cases, either the blade on the insertion tool (screwdriver, H & W angle piece, etc.) must be plugged and then taken the screw from the tray or vice versa. This can be very complicated and cumbersome because the screw for sterility reasons not in the hand (even if gloves are worn) may be taken. If the screw is first taken up with the blade and then coupled to the screwing-in tool there is a risk that the screw detaches from the blade and falls off. Here, a simplification of the recording procedure would be useful to simplify the conditions on the patient before inserting the screw. Any simplification would make the insertion of the screws safer and faster. The aim of the invention is the simplification of the handling and the minimization of risk with respect to the sterility and the secure hold of the screw on the insertion instrument with regard to the preparation of the screwing operation. In addition, the goal was still to reduce the number of components to be re-sterilized, thus minimizing the formation of capital for the practitioner.

The object is achieved by the screw is applied before sterilization on the blade or the screwdriver and is fixed there with an additional component. This component will be referred to as

"One-piece tray" or "holding cap". Subsequently, the blade or the screwdriver can be welded and sterilized separately in a sterile tube. However, the one-piece tray must enclose the screw so that a violation of the sterile tube is prevented.

This procedure offers the following advantages:

• The screws can be applied at rest with a glove on the blade or the screwdriver before the actual treatment.

• Working hours for attaching may be handled by the staff of the dentist

be performed, which is cheaper than if it is performed by the practitioner. In addition, it relieves the practitioner and shortens the treatment time.

• The one-piece tray protects the practitioner, the staff and the patient from accidental injuries to the pointed screw, because the practitioner can, similar to a syringe, only remove the single-coat tray immediately before screwing it in.

• By removing the one-piece tray until just before screwing in, the screw is protected from accidental falling off of the blade or screwdriver.

• If the practitioner uses a blade that needs to be coupled to a screwdriver, H & W elbow, or other finishing tool, the practitioner can hand-manipulate the blade on the one-piece tray and very comfortably, without risk of injury and without risk of contamination due to contact with the screwing tool.

• The complicated and cumbersome recording of the screw from a tray or a sterile packaging is eliminated during the treatment.

• After screwing in, the dentist only needs to clean and sterilize the tools he actually used.

This one-piece tray or this holding cap can be attached with different mechanical methods. The attachment method should be carried out expediently with a detachable connection. A releasable connection is defined as a connection which can be disassembled without destroying a component of the connection system. In this case, the compound itself is intended primarily to prevent inadvertent disconnection, disengagement or disintegration of the components involved in the system due to gravity or forces caused by transport, sterilization, assembly to other tools or other movements or activities in dealing with The connection system should be performed and should not explicitly lead to the connection being disconnected. Particularly favorable methods for the detachable connection are:

1. snap closure

2. Jamming over a conical self-locking

3. Jamming via a parallel-walled escapement

4. Bayonet lock

5. Screw

With regard to the simple handling of the entire system, it would be favorable to use a method which can apply or remove the holding cap by means of a linear movement. This is only possible with methods 1, 2, and 3. Method 1 describes the method used in the syringe cap of syringes. However, the requirement for the system is lower. With the retaining cap described here, the screw must be held at a defined position in the insertion instrument. The accuracy in the Positioning of the retaining cap is not optimal due to the conical attachment method.

A parallel-walled inhibition has the disadvantage that the haptic signal, which receives the person when plugging in is only an end stop. Slips in the meantime, the screw, there is a risk that this can only be detected optically and not haptically.

Particularly favorable is a snap closure. Over this one gets the haptic information of the latching, which is at the same time the proof for the correct seat of the screw.

Fig. 4 shows a blade coupleable to an elbow with a screw insert into which a screw head can be inserted and secured against twisting by means of a rotary ratchet, and thus in some e.g. Bone can be screwed in. From the right, the angle piece connection (WSA), the blade shank (KS) and the screw insert (SE) are located. The screw insert (SE) is externally provided with 2 cylindrical areas (ZB-1 and ZB-2), a conical area (KB) and a groove (N). About the two cylindrical areas (ZB-1 and ZB-2) can be made a releasable connection in the form of a cylindrical escapement. The conical section (KB) provides a releasable connection as a conical self-locking feature. The groove (N) allows due to its undercut a snap closure in which a tab can engage.

The exploded view of a variant with a snap closure is shown in Fig. 5. Fig. 5 shows the blade (K), the screw (S) and the one-piece trench (EST) with integrated milled slots (EF) which allow for resilient expansion of the flaps (L) during assembly to allow the blade (K) to fit into the one-piece tray (EST) can penetrate. The restoring forces of the tabs (L) allow the tabs in the groove of the blade (K). The engagement of the tabs provides a haptic feedback and provides information as to whether the one-piece tray in the blade is properly engaged and continues to provide information about the correct fit of the screw in the overall system. Fig. 6 shows a screw with the threaded portions 1 and 2 (GB-1 and GB-2), a non-threaded screw shank (S-Sch), a screw head (SK) with integrated screw plate (ST) is executed.

Fig. 7 shows the cross-sectional view of the one-piece tray (EST), the screw (S) and the blade (K) in the assembled state. In this embodiment, the screw head located on the screw head of the blade (K) and the

Einstücktray (EFT) so enclosed that the screw S is secured against movements in the axial blade direction as long as the detachable connection between Einstücktray (EST) and blade (K) is not dissolved or destroyed. For improved steam sterilizability, the opening 1 (Ö-1) on the

One-piece tray (EST) and the ventilation hole (BEB) attached to the blade (K). In steam sterilization, it is important that the hot water vapor can reach as many surfaces as possible to thermally sterilize it. A few places that are not perfectly accessible can also be heated sufficiently high enough by the thermal conductivity of the components to be sterilized, and thus also sterilized.

Fig. 8 shows an alternative embodiment of the one-piece tray / the holding cap with a snap closure. The outer shape of the one-piece tray initially corresponds approximately to a pipe. The four millings (EF-1 - EF-4) result in four tabs (L-1 - L-4) which have a spring effect. The material thickness, the milling width, the milling length, the number of millings and the material of the one-piece tray can be used to influence and adjust the spring action of the straps. The milled grooves (EF-1 - EF-4) additionally provide improved steam sterilizability as they behave like an orifice or bore in terms of steam sterilizability. A single tray or the holding cap can with a screw, and both with a blade (ie, a screwdriver, which has a connection to a powered screwing tool) and with instruments that allow manual insertion and or here not further listed insertion or insertion instruments according to the invention Form system. When tuning the system, it is important to note the following parameters.

1. The overlap of the rotary locking mechanism between the screw and the insertion instrument (blade, screwdriver, etc.) must be large enough to allow the screw to be screwed in without additional effort after removing the retaining cap. In this case, the axial play of the screw to the insertion instrument must be smaller than the length / overlap of the rotary locking mechanism between the screw and the insertion instrument

2. Holes or openings in the one-piece tray / holding cap and / or the insertion instrument must be designed so that a water vapor sterilization is ensured, advantageously the cover of the screw through the retaining cap goes so far that no risk of injury (patient, practitioner , involved persons, sterile hose, etc.) goes through the screw, ie that the screw does not protrude from the retaining cap / Einstücktray at any point.

Advantageously, the area of the one-piece tray is averted

Eindrehinstrumentes not surrounded by the one-piece tray or sheathed. This results in the advantage that the driver can be inserted directly and completely into a driven screwing tool either directly or without removal of the one-piece tray (for example a blade) and possibly locked in it. If the insertion instrument is a manual insertion instrument (eg a screwdriver), the entire area required by the turning hand should not be encased or enclosed by the one-piece tray / retaining cap so that the system can be removed from the sterile hose using a screwdriver one hand, the retaining cap can be removed and then the screw can be screwed without grasping.

To simplify the application, another cap which encloses the remaining area of the insertion instrument is possible but possibly disturbing (sectional view Fig. 9 with two caps). Should a freestanding area, ie a portion of the insertion aid not enclosed or encased in the one-piece tray, Mentes pose a risk of injury to persons and or the sterile hose, it is advantageous with the help of a second protective / holding cap to cover this area. Fig. 9 shows such a system, consisting of the original system [screw (S), Eindrehinstrument eg blade (K) and the Einstücktray (EST)] and an additional cap (ZK) the at least one further area of the Eindrehinstrumentes but advantageously the entire Eindrahinstrument sheathed or encloses. Fig. 9 shows the tabs (L-2 and L-4) which can be seen on the retaining cap. The additional cap also contains tabs (L-5, L-6) which fulfill the function of a releasable connection between the retaining cap and the additional cap. After unpacking the system from the sterile tubing, the extra cap (ZK) can be removed by holding the one-piece tray without the components of the remaining system falling apart. Subsequently, for example, in the case of a blade, the designated area of the blade can be introduced into a driven pinning instrument and, under certain circumstances, locked therein. It is important that there is a detachable connection between the one-piece tray and the additional cap.

The releasable connection between the screw in the insertion instrument (blade, screwdriver, etc.) and or the one-piece tray and the auxiliary cap may be made with the following principles. Conical escapement, parallel escapement, snap lock, balls which by spring action (e.g., by means of O-ring) in the undercuts e.g. Intervene holes or other variants that will not be discussed here

As material for the one-piece tray or the holding cap are basically all materials that do not have too high elasticity. It must be prevented that the one-piece tray or the retaining cap is deformed so much in the area of normal use that a risk of injury from the screw can go out. In order to ensure the Dampfstenlisierbarkeit it makes sense to use a metal or plastic. The metal for the one-piece tray should be chosen so that it will not withstand the chemical and / or electrochemical corrosion either before, during, and / or after contact with the screw and / or the instrument before, during and / or after steam sterilization can come. For this purpose, titanium or alloys would include the titanium as the main ingredient or as an ingredient or alloys containing iron, chromium, cobalt, molybdenum, zirconium, tantalum as the main ingredient or at least as an ingredient. If the one-piece tray or the holding cap is made of plastic, it must be ensured that the plastic is steam-sterilizable and remains dimensionally stable at the temperature of the steam sterilizer (about 50 °) and does not contain any toxic or

Releases harmful substances. Preferably, some POM materials are suitable, but PEEK is particularly suitable. A combination of metal and plastic is also conceivable. If the elastic inherent force of the material of which the one-piece tray or the holding cap is made is not sufficient to maintain the escapement with the screw and the insertion instrument, an additional component of metal, plastic, silicone, rubber, etc. may be advantageous be used.

To secure and improve the sterilizability in steam sterilizer, it is advantageous to avoid a tight seal between the Einstücktray or the retaining cap, the screw and the Einbringinstrument. Furthermore, it is favorable for one to provide the Einbringinstrument and the other Einstücktray or the retaining cap with holes to favor the contact between the water vapor and the screw, the Einbringinstrument and Einstücktray or the retaining cap. The holes, milled holes or openings on the one-piece tray or the holding cap and the insertion instrument are shown in Fig. 4, Fig. 5, Fig. 7, Fig. 8 and Fig. 9. The holes fulfill the purpose that a vacuum or a vacuum can be formed by the steam sterilizer in all openings and form recesses and then all areas can be wetted with water vapor in order to actually sterilize all surfaces of the components.

The system described here consists of a screw, a retaining cap and a driver. This has made handling easier, minimizing the risk of injury to persons and the sterile hose, and minimizing risk of screw contamination when handling the screw. The assembly finds a meaningful way in the treatment- the doctor instead of steam sterilization. If screws are used where there is a high risk of contamination and or should the handling be further improved, an even more advantageous variation of a system component is possible. Is introduced in addition to the releasable connection between the driver and the retaining cap, a second releasable connection between the retaining cap and the screw, which is effective only when not inserted Eindrehinstrument, consequently when inserting the Eindrehinstrumentes is disabled and advantageously by the detachable connection between Driver and screw is replaced, but when removing the driver prevents the detachable connection between the screw and the retaining cap is effective again, a pre-assembly of two components of the system is possible. Consequently, the subsystem comprising the screw and the retaining cap can be plugged onto the insertion instrument or the insertion instrument can be inserted into the retaining cap which contains the screw, then the retaining cap can be removed without the screw detaching from the insertion instrument. This is achieved by first a releasable connection between the screw and retaining cap prevents the screw can be omitted from the retaining cap. By introducing the Eindrehinstrumentes the releasable connection between the screw and retaining cap is overridden and replaced by at least one detachable connection, namely the between the screw and the Eindrehinstrument, advantageously additionally by a detachable connection between the Eindrehinstrument and the retaining cap. Upon removal of the retaining cap, the releasable connection between the retaining cap and the driver is disabled without re-activating the releasable connection between the screw and the retaining cap. All that remains now is the detachable connection between the screw and the insertion instrument, which is required to screw the screw into the bone without the risk of it falling off the insertion instrument. There is now the additional advantage that the manufacturer can mount the already cleaned screws in the holding cap or in the one-piece tray. The practitioner receives this subsystem consisting of the retaining cap and the screw by means of a detachable connection In the retaining cap is secured against falling out, he has two possible and favorable procedures.

1. He can sterilize the subsystem consisting of screw and retaining cap directly and then attach the screw to avoid contamination on the retaining cap without touching a screwing on instrument and thus form the system of the invention, apply and screw the screw.

2. He can mount the subsystem consisting of screw and retaining cap directly on a Eindrehinstrument and thus form the system of the invention, then sterilize it, apply and screw the screw.

Both variants have the advantage that no component which is in direct contact with the patient during the treatment (screw, screw insert on the screw-in piece, etc.) has to be touched with the hands and / or another instrument (for example tweezers). This is called a no-touch system. This concept of the no-touch system can be maintained very easily and without further aids (for example with tweezers).

The execution of the additional releasable connection which is to be effective between the screw and the retaining cap can be performed by a conical escapement, parallel escapement, a snap closure, a releasable lock also by means of additional components such as spring elements, rubber elements, balls, rods, etc.

LIST OF REFERENCE NUMBERS

A range of holes / inserts / compartments for

screw

AA magnification of A

S screw

SF screw compartment

TDF tray lid guide

EDI-1 driver-1 in compartment for EDI-1

EDI-2 driver-2 in compartment for EDI-2

LF Empty compartment for more utensils

TD tray lid

TB tray floor

SDF screwdriver compartment

PF tweezer compartment

SE screw insert

K blade

HDS hand turning piece

GR handle

ZB-1 Cylindrical area 1

ZB-2 Cylindrical Sphere-1

BEB ventilation hole

KB Conic area

KS blade shaft

WSA elbow connector

N groove

EST one-piece tray or holding cap

EF milling

GB-1 threaded area 1

GB-2 threaded area 2

S-Sch screw shaft

SK screw head ST screw plate

Ö-1 opening 1

Ö-2 opening 2

L tab

L-1 - L-6 tab 1 to tab 6

EF-1 - EF-4 Milling 1 to Milling 4

ZEF-1 additional milling 1

ZEF-2 additional milling 2

ZK additional cap

Claims

claims

1. A system consisting of a retaining cap (EST) or a plurality of retaining caps which are made of a metallic material or of a plastic, a screw provided for insertion into a bone (S), which by means of a first releasable connection with an instrument (K) wherein the instrument is at least twice the length of the screw and wherein the retaining cap surrounds at least the thread of the screw, and is characterized in that it is connected to the instrument by means of a second releasable connection and thus the screw between itself and stored the instrument and the instrument is not completely enclosed by the first holding cap.

2. A system according to claim 1, wherein the instrument has either a handle having at least three times the length of the screw or a connection to another insertion instrument or a connection for an H & W elbow.

3. A system according to claim 1, wherein the screw is not trapped in air and / or water vapor.

4. A system according to claim 1, wherein the retaining cap which surrounds the insertion instrument to which it has a releasable connection only partially.

5. A system according to claim 1 wherein the releasable connection comprises a

Snap closure has.

6. A system according to claim 1, wherein the releasable connection has a conical escapement.

A system according to claim 1, wherein the releasable connection

has parallel-walled inhibition.

8. A system according to claim 1, wherein the releasable connection comprises a screw connection.

A system according to claim 1, wherein the releasable connection comprises a combination of at least two variants of claims 5-8.

10. A system according to claim 1, wherein the releasable connection comprises a bayonet closure.