Login now to access Regular content available to all registered users.
Abstract
Discussion Forum (0)
The following report summarises the fourth paper presented during the Things we stopped in our practice due to failures session, at the EAO's 25th annual Scientific Meeting in Paris, 2016.
In this session, four different issues were addressed: immediate implant placement; prosthodontic rehabilitation of edentulous jaws; immediate CAD/CAM restorations; and cemented fixed restorations. These different topics have a common denominator: they are all clinical protocols that have been subject to a change of opinion due to failures.
After a period when the majority of implant restorations were screw-retained, cemented retention on simplified abutments became more popular again. Cementation is widely used by prosthodontists because of its simplicity; capacity for hermetic sealing; passive fit; and favourable aesthetic appearance.
However, cement-retained restorations are often associated with mucositis and peri-implantitis, due to open margins and cement excesses (Figure 1). Cement-retained crowns with a poor marginal fit can cause significantly more crestal bone loss – even in tissue-level implants – than well-fitting crowns after a mean of 3 years (Chen et al. 2013). Increased incidences of inflammation are found in cases where there is an excess of cement around the restoration (Korsch et al. 2015). This is especially the case in aesthetic areas, where the abutment finishing line is generally lower and cement excess may be displaced subgingivally, where it is difficult to remove (Linkevicius et al. 2011; Linkevicius et al. 2013).
Figure 1
Fact 1. Various techniques have been developed to avoid the excess of cement, such as dual cord application in the sulcus; venting the crown; or using a practice abutment. These techniques have been demonstrated in vitro (Begum et al. 2014), but currently lack definitive conclusions
Fact 2. A high number of cemented restorations exhibit excess cement in the peri-implant sulcus (Kosrch et al. 2015)
Fact 3. Excess cement has been associated with signs of peri-implant disease 81% of cases (Wilson et al. 2009)
Fact 4. The frequency of undetected excess depends on the type of cement used, and is significantly greater in methacrylate cements than in ZOE cements (Korsch et al. 2014)
Fact 5. Removal of excess cement is difficult. Well-trained clinicians were only successfully able to remove excesses of ZOE cement from models (Behr et al. 2014)
Fact 6. The retentiveness of luting agents varies (Garg et al. 2014)
Fact 7. The retentiveness of provisional luting agents is less predictable (Schiessl et al. 2013)
Fact 8. The interface between abutment, cement and suprastructure in the subgingival region is a critical area, offering ideal conditions for the formation of biofilms near the crestal alveolar bone. Higher levels of bacteria accumulating on cement lines have been demonstrated in vivo than on machined titanium surfaces (Papavasileiou et al. 2015)
A comparison of the clinical performance of screw- and cement-retention reveals no significant differences. However, screw-retained reconstructions exhibit fewer technical and biological complications overall than cement-retained ones (Wittneben et al. 2013; Wittneben et al. 2014). Technical complications are partially dependent on the systems used.
Fact 9. Occlusal discontinuity of access holes in screw-retained crowns may affect their resistance
Fact 10. Screw retention has the potential for reintervention (Figure 2)
Figure 2
The speaker recommended that we forget cementation, even though screw-retained reconstructions are more technically complex. For example, a passive fit is crucial for preventing mechanical problems in reconstructions on multiple abutments, and it is advisable to convert conicaconnections to flat non-locking ones in order to facilitate passivity (Figure 3).
Figure 3
Begum Z, Sonika R, Pratik C. Effect of different cementation techniques on retained excess cement and uniaxial retention of the implant-supported prosthesis: an in vitro study. Int J Oral Maxillofac Implants. 2014 Nov-Dec;29(6):1333–7. doi: 10.11607/jomi.3724. Epub 2014 Aug 20.
Behr M, Spitzer A, Preis V, Weng D, Gosau M, Rosentritt M. The extent of luting agent remnants on titanium and zirconia abutment analogs after scaling. Int J Oral Maxillofac Implants. 2014 Sep–Oct;29(5):1185–92. doi: 10.11607/jomi.3523.
Chen CJ, Papaspyridakos P, Guze K, Singh M, Weber HP, Gallucci GO. Effect of misfit of cement-retained implant single crowns on crestal bone changes. Int J Prosthodont. 2013 Mar–Apr;26(2):135–7. doi: 10.11607/ijp.3137.
Garg P, Pujari M, Prithviraj DR, Khare S. Retentiveness of various luting agents used with implant-supported prosthesis: an in vitro study. J Oral Implantol. 2014 Dec;40(6):649–54. doi: 10.1563/AAID-JOI-D-12-00008.
Korsch M, Robra BP, Walther W. Cement-associated signs of inflammation: retrospective analysis of the effect of excess cement on peri-implant tissue. Int J Prosthodont. 2015 Jan–Feb;28(1):11–8. doi: 10.11607/ijp.4043.
Korsch M, Walther W. Peri-Implantitis Associated with Type of Cement: A Retrospective Analysis of Different Types of Cement and Their Clinical Correlation to the Peri-Implant Tissue. Clin Implant Dent Relat Res. 2015 Oct;17 Suppl 2:e434–43. doi: 10.1111/cid.12265. Epub 2014 Sep 2.
Linkevicius T, Vindasiute E, Puisys A, Peciuliene V. The influence of margin location on the amount of undetected cement excess after delivery of cement-retained implant restorations. Clin Oral Implants Res. 2011 Dec;22(12):1379–84. doi: 10.1111/j.1600-0501.2010.02119.x. Epub 2011 Mar 8.
Linkevicius T, Puisys A, Vindasiute E, Linkeviciene L, Apse P. Does residual cement around implant-supported restorations cause peri-implant disease? A retrospective case analysis. Clin Oral Implants Res. 2013 Nov;24(11):1179–84. doi: 10.1111/j.1600-0501.2012.02570.x. Epub 2012 Aug 8.
Papavasileiou D, Behr M, Gosau M, Gerlach T, Buergers R. Peri-implant Biofilm Formation on Luting Agents Used for Cementing Implant-Supported Fixed Restorations: A Preliminary In Vivo Study. Int J Prosthodont. 2015 Jul–Aug;28(4):371–3. doi: 10.11607/ijp.4100.
Schiessl C, Schaefer L, Winter C, Fuerst J, Rosentritt M, Zeman F, Behr M. Factors determining the retentiveness of luting agents used with metal- and ceramic-based implant components. Clin Oral Investig. 2013 May;17(4):1179–90. doi: 10.1007/s00784-012-0798-x. Epub 2012 Jul 31.
Wilson TG Jr. The positive relationship between excess cement and peri-implant disease: a prospective clinical endoscopic study. J Periodontol. 2009 Sep;80(9):1388–92. doi: 10.1902/jop.2009.090115
Wittneben JG, Buser D, Salvi GE, Bürgin W, Hicklin S, Brägger U. Complication and failure rates with implant-supported fixed dental prostheses and single crowns: a 10-year retrospective study. Clin Implant Dent Relat Res. 2014 Jun;16(3):356–64. doi: 10.1111/cid.12066. Epub 2013 Apr 2.
Wittneben JG, Millen C, Brägger U. Clinical performance of screw- versus cement-retained fixed implant-supported reconstructions--a systematic review. Int J Oral Maxillofac Implants. 2014;29 Suppl:84–98. doi: 10.11607/jomi.2014suppl.g2.1.
This summary was prepared by the EAO Congress Scientific Report rapporteurs and approved by the speaker.
View the full publication at: www.eao.org
In this session, four different issues were addressed: immediate implant placement; prosthodontic rehabilitation of edentulous jaws; immediate CAD/CAM restorations; and cemented fixed restorations. These different topics have a common denominator: they are all clinical protocols that have been subject to a change of opinion due to failures.
Cement-retained restorations
Facts that make us think
After a period when the majority of implant restorations were screw-retained, cemented retention on simplified abutments became more popular again. Cementation is widely used by prosthodontists because of its simplicity; capacity for hermetic sealing; passive fit; and favourable aesthetic appearance.
However, cement-retained restorations are often associated with mucositis and peri-implantitis, due to open margins and cement excesses (Figure 1). Cement-retained crowns with a poor marginal fit can cause significantly more crestal bone loss – even in tissue-level implants – than well-fitting crowns after a mean of 3 years (Chen et al. 2013). Increased incidences of inflammation are found in cases where there is an excess of cement around the restoration (Korsch et al. 2015). This is especially the case in aesthetic areas, where the abutment finishing line is generally lower and cement excess may be displaced subgingivally, where it is difficult to remove (Linkevicius et al. 2011; Linkevicius et al. 2013).
Facts associated with intraoral cementation
Fact 1. Various techniques have been developed to avoid the excess of cement, such as dual cord application in the sulcus; venting the crown; or using a practice abutment. These techniques have been demonstrated in vitro (Begum et al. 2014), but currently lack definitive conclusions
Fact 2. A high number of cemented restorations exhibit excess cement in the peri-implant sulcus (Kosrch et al. 2015)
Fact 3. Excess cement has been associated with signs of peri-implant disease 81% of cases (Wilson et al. 2009)
Fact 4. The frequency of undetected excess depends on the type of cement used, and is significantly greater in methacrylate cements than in ZOE cements (Korsch et al. 2014)
Fact 5. Removal of excess cement is difficult. Well-trained clinicians were only successfully able to remove excesses of ZOE cement from models (Behr et al. 2014)
Fact 6. The retentiveness of luting agents varies (Garg et al. 2014)
Fact 7. The retentiveness of provisional luting agents is less predictable (Schiessl et al. 2013)
Fact 8. The interface between abutment, cement and suprastructure in the subgingival region is a critical area, offering ideal conditions for the formation of biofilms near the crestal alveolar bone. Higher levels of bacteria accumulating on cement lines have been demonstrated in vivo than on machined titanium surfaces (Papavasileiou et al. 2015)
To conclude: forget cementation
A comparison of the clinical performance of screw- and cement-retention reveals no significant differences. However, screw-retained reconstructions exhibit fewer technical and biological complications overall than cement-retained ones (Wittneben et al. 2013; Wittneben et al. 2014). Technical complications are partially dependent on the systems used.
Fact 9. Occlusal discontinuity of access holes in screw-retained crowns may affect their resistance
Fact 10. Screw retention has the potential for reintervention (Figure 2)
The speaker recommended that we forget cementation, even though screw-retained reconstructions are more technically complex. For example, a passive fit is crucial for preventing mechanical problems in reconstructions on multiple abutments, and it is advisable to convert conicaconnections to flat non-locking ones in order to facilitate passivity (Figure 3).
References
Begum Z, Sonika R, Pratik C. Effect of different cementation techniques on retained excess cement and uniaxial retention of the implant-supported prosthesis: an in vitro study. Int J Oral Maxillofac Implants. 2014 Nov-Dec;29(6):1333–7. doi: 10.11607/jomi.3724. Epub 2014 Aug 20.
Behr M, Spitzer A, Preis V, Weng D, Gosau M, Rosentritt M. The extent of luting agent remnants on titanium and zirconia abutment analogs after scaling. Int J Oral Maxillofac Implants. 2014 Sep–Oct;29(5):1185–92. doi: 10.11607/jomi.3523.
Chen CJ, Papaspyridakos P, Guze K, Singh M, Weber HP, Gallucci GO. Effect of misfit of cement-retained implant single crowns on crestal bone changes. Int J Prosthodont. 2013 Mar–Apr;26(2):135–7. doi: 10.11607/ijp.3137.
Garg P, Pujari M, Prithviraj DR, Khare S. Retentiveness of various luting agents used with implant-supported prosthesis: an in vitro study. J Oral Implantol. 2014 Dec;40(6):649–54. doi: 10.1563/AAID-JOI-D-12-00008.
Korsch M, Robra BP, Walther W. Cement-associated signs of inflammation: retrospective analysis of the effect of excess cement on peri-implant tissue. Int J Prosthodont. 2015 Jan–Feb;28(1):11–8. doi: 10.11607/ijp.4043.
Korsch M, Walther W. Peri-Implantitis Associated with Type of Cement: A Retrospective Analysis of Different Types of Cement and Their Clinical Correlation to the Peri-Implant Tissue. Clin Implant Dent Relat Res. 2015 Oct;17 Suppl 2:e434–43. doi: 10.1111/cid.12265. Epub 2014 Sep 2.
Linkevicius T, Vindasiute E, Puisys A, Peciuliene V. The influence of margin location on the amount of undetected cement excess after delivery of cement-retained implant restorations. Clin Oral Implants Res. 2011 Dec;22(12):1379–84. doi: 10.1111/j.1600-0501.2010.02119.x. Epub 2011 Mar 8.
Linkevicius T, Puisys A, Vindasiute E, Linkeviciene L, Apse P. Does residual cement around implant-supported restorations cause peri-implant disease? A retrospective case analysis. Clin Oral Implants Res. 2013 Nov;24(11):1179–84. doi: 10.1111/j.1600-0501.2012.02570.x. Epub 2012 Aug 8.
Papavasileiou D, Behr M, Gosau M, Gerlach T, Buergers R. Peri-implant Biofilm Formation on Luting Agents Used for Cementing Implant-Supported Fixed Restorations: A Preliminary In Vivo Study. Int J Prosthodont. 2015 Jul–Aug;28(4):371–3. doi: 10.11607/ijp.4100.
Schiessl C, Schaefer L, Winter C, Fuerst J, Rosentritt M, Zeman F, Behr M. Factors determining the retentiveness of luting agents used with metal- and ceramic-based implant components. Clin Oral Investig. 2013 May;17(4):1179–90. doi: 10.1007/s00784-012-0798-x. Epub 2012 Jul 31.
Wilson TG Jr. The positive relationship between excess cement and peri-implant disease: a prospective clinical endoscopic study. J Periodontol. 2009 Sep;80(9):1388–92. doi: 10.1902/jop.2009.090115
Wittneben JG, Buser D, Salvi GE, Bürgin W, Hicklin S, Brägger U. Complication and failure rates with implant-supported fixed dental prostheses and single crowns: a 10-year retrospective study. Clin Implant Dent Relat Res. 2014 Jun;16(3):356–64. doi: 10.1111/cid.12066. Epub 2013 Apr 2.
Wittneben JG, Millen C, Brägger U. Clinical performance of screw- versus cement-retained fixed implant-supported reconstructions--a systematic review. Int J Oral Maxillofac Implants. 2014;29 Suppl:84–98. doi: 10.11607/jomi.2014suppl.g2.1.
This summary was prepared by the EAO Congress Scientific Report rapporteurs and approved by the speaker.
View the full publication at: www.eao.org
The following report summarises the fourth paper presented during the Things we stopped in our practice due to failures session, at the EAO's 25th annual Scientific Meeting in Paris, 2016.
In this session, four different issues were addressed: immediate implant placement; prosthodontic rehabilitation of edentulous jaws; immediate CAD/CAM restorations; and cemented fixed restorations. These different topics have a common denominator: they are all clinical protocols that have been subject to a change of opinion due to failures.
After a period when the majority of implant restorations were screw-retained, cemented retention on simplified abutments became more popular again. Cementation is widely used by prosthodontists because of its simplicity; capacity for hermetic sealing; passive fit; and favourable aesthetic appearance.
However, cement-retained restorations are often associated with mucositis and peri-implantitis, due to open margins and cement excesses (Figure 1). Cement-retained crowns with a poor marginal fit can cause significantly more crestal bone loss – even in tissue-level implants – than well-fitting crowns after a mean of 3 years (Chen et al. 2013). Increased incidences of inflammation are found in cases where there is an excess of cement around the restoration (Korsch et al. 2015). This is especially the case in aesthetic areas, where the abutment finishing line is generally lower and cement excess may be displaced subgingivally, where it is difficult to remove (Linkevicius et al. 2011; Linkevicius et al. 2013).
Figure 1
Fact 1. Various techniques have been developed to avoid the excess of cement, such as dual cord application in the sulcus; venting the crown; or using a practice abutment. These techniques have been demonstrated in vitro (Begum et al. 2014), but currently lack definitive conclusions
Fact 2. A high number of cemented restorations exhibit excess cement in the peri-implant sulcus (Kosrch et al. 2015)
Fact 3. Excess cement has been associated with signs of peri-implant disease 81% of cases (Wilson et al. 2009)
Fact 4. The frequency of undetected excess depends on the type of cement used, and is significantly greater in methacrylate cements than in ZOE cements (Korsch et al. 2014)
Fact 5. Removal of excess cement is difficult. Well-trained clinicians were only successfully able to remove excesses of ZOE cement from models (Behr et al. 2014)
Fact 6. The retentiveness of luting agents varies (Garg et al. 2014)
Fact 7. The retentiveness of provisional luting agents is less predictable (Schiessl et al. 2013)
Fact 8. The interface between abutment, cement and suprastructure in the subgingival region is a critical area, offering ideal conditions for the formation of biofilms near the crestal alveolar bone. Higher levels of bacteria accumulating on cement lines have been demonstrated in vivo than on machined titanium surfaces (Papavasileiou et al. 2015)
A comparison of the clinical performance of screw- and cement-retention reveals no significant differences. However, screw-retained reconstructions exhibit fewer technical and biological complications overall than cement-retained ones (Wittneben et al. 2013; Wittneben et al. 2014). Technical complications are partially dependent on the systems used.
Fact 9. Occlusal discontinuity of access holes in screw-retained crowns may affect their resistance
Fact 10. Screw retention has the potential for reintervention (Figure 2)
Figure 2
The speaker recommended that we forget cementation, even though screw-retained reconstructions are more technically complex. For example, a passive fit is crucial for preventing mechanical problems in reconstructions on multiple abutments, and it is advisable to convert conicaconnections to flat non-locking ones in order to facilitate passivity (Figure 3).
Figure 3
Begum Z, Sonika R, Pratik C. Effect of different cementation techniques on retained excess cement and uniaxial retention of the implant-supported prosthesis: an in vitro study. Int J Oral Maxillofac Implants. 2014 Nov-Dec;29(6):1333–7. doi: 10.11607/jomi.3724. Epub 2014 Aug 20.
Behr M, Spitzer A, Preis V, Weng D, Gosau M, Rosentritt M. The extent of luting agent remnants on titanium and zirconia abutment analogs after scaling. Int J Oral Maxillofac Implants. 2014 Sep–Oct;29(5):1185–92. doi: 10.11607/jomi.3523.
Chen CJ, Papaspyridakos P, Guze K, Singh M, Weber HP, Gallucci GO. Effect of misfit of cement-retained implant single crowns on crestal bone changes. Int J Prosthodont. 2013 Mar–Apr;26(2):135–7. doi: 10.11607/ijp.3137.
Garg P, Pujari M, Prithviraj DR, Khare S. Retentiveness of various luting agents used with implant-supported prosthesis: an in vitro study. J Oral Implantol. 2014 Dec;40(6):649–54. doi: 10.1563/AAID-JOI-D-12-00008.
Korsch M, Robra BP, Walther W. Cement-associated signs of inflammation: retrospective analysis of the effect of excess cement on peri-implant tissue. Int J Prosthodont. 2015 Jan–Feb;28(1):11–8. doi: 10.11607/ijp.4043.
Korsch M, Walther W. Peri-Implantitis Associated with Type of Cement: A Retrospective Analysis of Different Types of Cement and Their Clinical Correlation to the Peri-Implant Tissue. Clin Implant Dent Relat Res. 2015 Oct;17 Suppl 2:e434–43. doi: 10.1111/cid.12265. Epub 2014 Sep 2.
Linkevicius T, Vindasiute E, Puisys A, Peciuliene V. The influence of margin location on the amount of undetected cement excess after delivery of cement-retained implant restorations. Clin Oral Implants Res. 2011 Dec;22(12):1379–84. doi: 10.1111/j.1600-0501.2010.02119.x. Epub 2011 Mar 8.
Linkevicius T, Puisys A, Vindasiute E, Linkeviciene L, Apse P. Does residual cement around implant-supported restorations cause peri-implant disease? A retrospective case analysis. Clin Oral Implants Res. 2013 Nov;24(11):1179–84. doi: 10.1111/j.1600-0501.2012.02570.x. Epub 2012 Aug 8.
Papavasileiou D, Behr M, Gosau M, Gerlach T, Buergers R. Peri-implant Biofilm Formation on Luting Agents Used for Cementing Implant-Supported Fixed Restorations: A Preliminary In Vivo Study. Int J Prosthodont. 2015 Jul–Aug;28(4):371–3. doi: 10.11607/ijp.4100.
Schiessl C, Schaefer L, Winter C, Fuerst J, Rosentritt M, Zeman F, Behr M. Factors determining the retentiveness of luting agents used with metal- and ceramic-based implant components. Clin Oral Investig. 2013 May;17(4):1179–90. doi: 10.1007/s00784-012-0798-x. Epub 2012 Jul 31.
Wilson TG Jr. The positive relationship between excess cement and peri-implant disease: a prospective clinical endoscopic study. J Periodontol. 2009 Sep;80(9):1388–92. doi: 10.1902/jop.2009.090115
Wittneben JG, Buser D, Salvi GE, Bürgin W, Hicklin S, Brägger U. Complication and failure rates with implant-supported fixed dental prostheses and single crowns: a 10-year retrospective study. Clin Implant Dent Relat Res. 2014 Jun;16(3):356–64. doi: 10.1111/cid.12066. Epub 2013 Apr 2.
Wittneben JG, Millen C, Brägger U. Clinical performance of screw- versus cement-retained fixed implant-supported reconstructions--a systematic review. Int J Oral Maxillofac Implants. 2014;29 Suppl:84–98. doi: 10.11607/jomi.2014suppl.g2.1.
This summary was prepared by the EAO Congress Scientific Report rapporteurs and approved by the speaker.
View the full publication at: www.eao.org
In this session, four different issues were addressed: immediate implant placement; prosthodontic rehabilitation of edentulous jaws; immediate CAD/CAM restorations; and cemented fixed restorations. These different topics have a common denominator: they are all clinical protocols that have been subject to a change of opinion due to failures.
Cement-retained restorations
Facts that make us think
After a period when the majority of implant restorations were screw-retained, cemented retention on simplified abutments became more popular again. Cementation is widely used by prosthodontists because of its simplicity; capacity for hermetic sealing; passive fit; and favourable aesthetic appearance.
However, cement-retained restorations are often associated with mucositis and peri-implantitis, due to open margins and cement excesses (Figure 1). Cement-retained crowns with a poor marginal fit can cause significantly more crestal bone loss – even in tissue-level implants – than well-fitting crowns after a mean of 3 years (Chen et al. 2013). Increased incidences of inflammation are found in cases where there is an excess of cement around the restoration (Korsch et al. 2015). This is especially the case in aesthetic areas, where the abutment finishing line is generally lower and cement excess may be displaced subgingivally, where it is difficult to remove (Linkevicius et al. 2011; Linkevicius et al. 2013).
Facts associated with intraoral cementation
Fact 1. Various techniques have been developed to avoid the excess of cement, such as dual cord application in the sulcus; venting the crown; or using a practice abutment. These techniques have been demonstrated in vitro (Begum et al. 2014), but currently lack definitive conclusions
Fact 2. A high number of cemented restorations exhibit excess cement in the peri-implant sulcus (Kosrch et al. 2015)
Fact 3. Excess cement has been associated with signs of peri-implant disease 81% of cases (Wilson et al. 2009)
Fact 4. The frequency of undetected excess depends on the type of cement used, and is significantly greater in methacrylate cements than in ZOE cements (Korsch et al. 2014)
Fact 5. Removal of excess cement is difficult. Well-trained clinicians were only successfully able to remove excesses of ZOE cement from models (Behr et al. 2014)
Fact 6. The retentiveness of luting agents varies (Garg et al. 2014)
Fact 7. The retentiveness of provisional luting agents is less predictable (Schiessl et al. 2013)
Fact 8. The interface between abutment, cement and suprastructure in the subgingival region is a critical area, offering ideal conditions for the formation of biofilms near the crestal alveolar bone. Higher levels of bacteria accumulating on cement lines have been demonstrated in vivo than on machined titanium surfaces (Papavasileiou et al. 2015)
To conclude: forget cementation
A comparison of the clinical performance of screw- and cement-retention reveals no significant differences. However, screw-retained reconstructions exhibit fewer technical and biological complications overall than cement-retained ones (Wittneben et al. 2013; Wittneben et al. 2014). Technical complications are partially dependent on the systems used.
Fact 9. Occlusal discontinuity of access holes in screw-retained crowns may affect their resistance
Fact 10. Screw retention has the potential for reintervention (Figure 2)
The speaker recommended that we forget cementation, even though screw-retained reconstructions are more technically complex. For example, a passive fit is crucial for preventing mechanical problems in reconstructions on multiple abutments, and it is advisable to convert conicaconnections to flat non-locking ones in order to facilitate passivity (Figure 3).
References
Begum Z, Sonika R, Pratik C. Effect of different cementation techniques on retained excess cement and uniaxial retention of the implant-supported prosthesis: an in vitro study. Int J Oral Maxillofac Implants. 2014 Nov-Dec;29(6):1333–7. doi: 10.11607/jomi.3724. Epub 2014 Aug 20.
Behr M, Spitzer A, Preis V, Weng D, Gosau M, Rosentritt M. The extent of luting agent remnants on titanium and zirconia abutment analogs after scaling. Int J Oral Maxillofac Implants. 2014 Sep–Oct;29(5):1185–92. doi: 10.11607/jomi.3523.
Chen CJ, Papaspyridakos P, Guze K, Singh M, Weber HP, Gallucci GO. Effect of misfit of cement-retained implant single crowns on crestal bone changes. Int J Prosthodont. 2013 Mar–Apr;26(2):135–7. doi: 10.11607/ijp.3137.
Garg P, Pujari M, Prithviraj DR, Khare S. Retentiveness of various luting agents used with implant-supported prosthesis: an in vitro study. J Oral Implantol. 2014 Dec;40(6):649–54. doi: 10.1563/AAID-JOI-D-12-00008.
Korsch M, Robra BP, Walther W. Cement-associated signs of inflammation: retrospective analysis of the effect of excess cement on peri-implant tissue. Int J Prosthodont. 2015 Jan–Feb;28(1):11–8. doi: 10.11607/ijp.4043.
Korsch M, Walther W. Peri-Implantitis Associated with Type of Cement: A Retrospective Analysis of Different Types of Cement and Their Clinical Correlation to the Peri-Implant Tissue. Clin Implant Dent Relat Res. 2015 Oct;17 Suppl 2:e434–43. doi: 10.1111/cid.12265. Epub 2014 Sep 2.
Linkevicius T, Vindasiute E, Puisys A, Peciuliene V. The influence of margin location on the amount of undetected cement excess after delivery of cement-retained implant restorations. Clin Oral Implants Res. 2011 Dec;22(12):1379–84. doi: 10.1111/j.1600-0501.2010.02119.x. Epub 2011 Mar 8.
Linkevicius T, Puisys A, Vindasiute E, Linkeviciene L, Apse P. Does residual cement around implant-supported restorations cause peri-implant disease? A retrospective case analysis. Clin Oral Implants Res. 2013 Nov;24(11):1179–84. doi: 10.1111/j.1600-0501.2012.02570.x. Epub 2012 Aug 8.
Papavasileiou D, Behr M, Gosau M, Gerlach T, Buergers R. Peri-implant Biofilm Formation on Luting Agents Used for Cementing Implant-Supported Fixed Restorations: A Preliminary In Vivo Study. Int J Prosthodont. 2015 Jul–Aug;28(4):371–3. doi: 10.11607/ijp.4100.
Schiessl C, Schaefer L, Winter C, Fuerst J, Rosentritt M, Zeman F, Behr M. Factors determining the retentiveness of luting agents used with metal- and ceramic-based implant components. Clin Oral Investig. 2013 May;17(4):1179–90. doi: 10.1007/s00784-012-0798-x. Epub 2012 Jul 31.
Wilson TG Jr. The positive relationship between excess cement and peri-implant disease: a prospective clinical endoscopic study. J Periodontol. 2009 Sep;80(9):1388–92. doi: 10.1902/jop.2009.090115
Wittneben JG, Buser D, Salvi GE, Bürgin W, Hicklin S, Brägger U. Complication and failure rates with implant-supported fixed dental prostheses and single crowns: a 10-year retrospective study. Clin Implant Dent Relat Res. 2014 Jun;16(3):356–64. doi: 10.1111/cid.12066. Epub 2013 Apr 2.
Wittneben JG, Millen C, Brägger U. Clinical performance of screw- versus cement-retained fixed implant-supported reconstructions--a systematic review. Int J Oral Maxillofac Implants. 2014;29 Suppl:84–98. doi: 10.11607/jomi.2014suppl.g2.1.
This summary was prepared by the EAO Congress Scientific Report rapporteurs and approved by the speaker.
View the full publication at: www.eao.org
Cement-retained restorations
Dr. Konrad Meyenberg
Abstract
Discussion Forum (0)
The following report summarises the fourth paper presented during the Things we stopped in our practice due to failures session, at the EAO's 25th annual Scientific Meeting in Paris, 2016.
In this session, four different issues were addressed: immediate implant placement; prosthodontic rehabilitation of edentulous jaws; immediate CAD/CAM restorations; and cemented fixed restorations. These different topics have a common denominator: they are all clinical protocols that have been subject to a change of opinion due to failures.
After a period when the majority of implant restorations were screw-retained, cemented retention on simplified abutments became more popular again. Cementation is widely used by prosthodontists because of its simplicity; capacity for hermetic sealing; passive fit; and favourable aesthetic appearance.
However, cement-retained restorations are often associated with mucositis and peri-implantitis, due to open margins and cement excesses (Figure 1). Cement-retained crowns with a poor marginal fit can cause significantly more crestal bone loss – even in tissue-level implants – than well-fitting crowns after a mean of 3 years (Chen et al. 2013). Increased incidences of inflammation are found in cases where there is an excess of cement around the restoration (Korsch et al. 2015). This is especially the case in aesthetic areas, where the abutment finishing line is generally lower and cement excess may be displaced subgingivally, where it is difficult to remove (Linkevicius et al. 2011; Linkevicius et al. 2013).
Figure 1
Fact 1. Various techniques have been developed to avoid the excess of cement, such as dual cord application in the sulcus; venting the crown; or using a practice abutment. These techniques have been demonstrated in vitro (Begum et al. 2014), but currently lack definitive conclusions
Fact 2. A high number of cemented restorations exhibit excess cement in the peri-implant sulcus (Kosrch et al. 2015)
Fact 3. Excess cement has been associated with signs of peri-implant disease 81% of cases (Wilson et al. 2009)
Fact 4. The frequency of undetected excess depends on the type of cement used, and is significantly greater in methacrylate cements than in ZOE cements (Korsch et al. 2014)
Fact 5. Removal of excess cement is difficult. Well-trained clinicians were only successfully able to remove excesses of ZOE cement from models (Behr et al. 2014)
Fact 6. The retentiveness of luting agents varies (Garg et al. 2014)
Fact 7. The retentiveness of provisional luting agents is less predictable (Schiessl et al. 2013)
Fact 8. The interface between abutment, cement and suprastructure in the subgingival region is a critical area, offering ideal conditions for the formation of biofilms near the crestal alveolar bone. Higher levels of bacteria accumulating on cement lines have been demonstrated in vivo than on machined titanium surfaces (Papavasileiou et al. 2015)
A comparison of the clinical performance of screw- and cement-retention reveals no significant differences. However, screw-retained reconstructions exhibit fewer technical and biological complications overall than cement-retained ones (Wittneben et al. 2013; Wittneben et al. 2014). Technical complications are partially dependent on the systems used.
Fact 9. Occlusal discontinuity of access holes in screw-retained crowns may affect their resistance
Fact 10. Screw retention has the potential for reintervention (Figure 2)
Figure 2
The speaker recommended that we forget cementation, even though screw-retained reconstructions are more technically complex. For example, a passive fit is crucial for preventing mechanical problems in reconstructions on multiple abutments, and it is advisable to convert conicaconnections to flat non-locking ones in order to facilitate passivity (Figure 3).
Figure 3
Begum Z, Sonika R, Pratik C. Effect of different cementation techniques on retained excess cement and uniaxial retention of the implant-supported prosthesis: an in vitro study. Int J Oral Maxillofac Implants. 2014 Nov-Dec;29(6):1333–7. doi: 10.11607/jomi.3724. Epub 2014 Aug 20.
Behr M, Spitzer A, Preis V, Weng D, Gosau M, Rosentritt M. The extent of luting agent remnants on titanium and zirconia abutment analogs after scaling. Int J Oral Maxillofac Implants. 2014 Sep–Oct;29(5):1185–92. doi: 10.11607/jomi.3523.
Chen CJ, Papaspyridakos P, Guze K, Singh M, Weber HP, Gallucci GO. Effect of misfit of cement-retained implant single crowns on crestal bone changes. Int J Prosthodont. 2013 Mar–Apr;26(2):135–7. doi: 10.11607/ijp.3137.
Garg P, Pujari M, Prithviraj DR, Khare S. Retentiveness of various luting agents used with implant-supported prosthesis: an in vitro study. J Oral Implantol. 2014 Dec;40(6):649–54. doi: 10.1563/AAID-JOI-D-12-00008.
Korsch M, Robra BP, Walther W. Cement-associated signs of inflammation: retrospective analysis of the effect of excess cement on peri-implant tissue. Int J Prosthodont. 2015 Jan–Feb;28(1):11–8. doi: 10.11607/ijp.4043.
Korsch M, Walther W. Peri-Implantitis Associated with Type of Cement: A Retrospective Analysis of Different Types of Cement and Their Clinical Correlation to the Peri-Implant Tissue. Clin Implant Dent Relat Res. 2015 Oct;17 Suppl 2:e434–43. doi: 10.1111/cid.12265. Epub 2014 Sep 2.
Linkevicius T, Vindasiute E, Puisys A, Peciuliene V. The influence of margin location on the amount of undetected cement excess after delivery of cement-retained implant restorations. Clin Oral Implants Res. 2011 Dec;22(12):1379–84. doi: 10.1111/j.1600-0501.2010.02119.x. Epub 2011 Mar 8.
Linkevicius T, Puisys A, Vindasiute E, Linkeviciene L, Apse P. Does residual cement around implant-supported restorations cause peri-implant disease? A retrospective case analysis. Clin Oral Implants Res. 2013 Nov;24(11):1179–84. doi: 10.1111/j.1600-0501.2012.02570.x. Epub 2012 Aug 8.
Papavasileiou D, Behr M, Gosau M, Gerlach T, Buergers R. Peri-implant Biofilm Formation on Luting Agents Used for Cementing Implant-Supported Fixed Restorations: A Preliminary In Vivo Study. Int J Prosthodont. 2015 Jul–Aug;28(4):371–3. doi: 10.11607/ijp.4100.
Schiessl C, Schaefer L, Winter C, Fuerst J, Rosentritt M, Zeman F, Behr M. Factors determining the retentiveness of luting agents used with metal- and ceramic-based implant components. Clin Oral Investig. 2013 May;17(4):1179–90. doi: 10.1007/s00784-012-0798-x. Epub 2012 Jul 31.
Wilson TG Jr. The positive relationship between excess cement and peri-implant disease: a prospective clinical endoscopic study. J Periodontol. 2009 Sep;80(9):1388–92. doi: 10.1902/jop.2009.090115
Wittneben JG, Buser D, Salvi GE, Bürgin W, Hicklin S, Brägger U. Complication and failure rates with implant-supported fixed dental prostheses and single crowns: a 10-year retrospective study. Clin Implant Dent Relat Res. 2014 Jun;16(3):356–64. doi: 10.1111/cid.12066. Epub 2013 Apr 2.
Wittneben JG, Millen C, Brägger U. Clinical performance of screw- versus cement-retained fixed implant-supported reconstructions--a systematic review. Int J Oral Maxillofac Implants. 2014;29 Suppl:84–98. doi: 10.11607/jomi.2014suppl.g2.1.
This summary was prepared by the EAO Congress Scientific Report rapporteurs and approved by the speaker.
View the full publication at: www.eao.org
In this session, four different issues were addressed: immediate implant placement; prosthodontic rehabilitation of edentulous jaws; immediate CAD/CAM restorations; and cemented fixed restorations. These different topics have a common denominator: they are all clinical protocols that have been subject to a change of opinion due to failures.
Cement-retained restorations
Facts that make us think
After a period when the majority of implant restorations were screw-retained, cemented retention on simplified abutments became more popular again. Cementation is widely used by prosthodontists because of its simplicity; capacity for hermetic sealing; passive fit; and favourable aesthetic appearance.
However, cement-retained restorations are often associated with mucositis and peri-implantitis, due to open margins and cement excesses (Figure 1). Cement-retained crowns with a poor marginal fit can cause significantly more crestal bone loss – even in tissue-level implants – than well-fitting crowns after a mean of 3 years (Chen et al. 2013). Increased incidences of inflammation are found in cases where there is an excess of cement around the restoration (Korsch et al. 2015). This is especially the case in aesthetic areas, where the abutment finishing line is generally lower and cement excess may be displaced subgingivally, where it is difficult to remove (Linkevicius et al. 2011; Linkevicius et al. 2013).
Facts associated with intraoral cementation
Fact 1. Various techniques have been developed to avoid the excess of cement, such as dual cord application in the sulcus; venting the crown; or using a practice abutment. These techniques have been demonstrated in vitro (Begum et al. 2014), but currently lack definitive conclusions
Fact 2. A high number of cemented restorations exhibit excess cement in the peri-implant sulcus (Kosrch et al. 2015)
Fact 3. Excess cement has been associated with signs of peri-implant disease 81% of cases (Wilson et al. 2009)
Fact 4. The frequency of undetected excess depends on the type of cement used, and is significantly greater in methacrylate cements than in ZOE cements (Korsch et al. 2014)
Fact 5. Removal of excess cement is difficult. Well-trained clinicians were only successfully able to remove excesses of ZOE cement from models (Behr et al. 2014)
Fact 6. The retentiveness of luting agents varies (Garg et al. 2014)
Fact 7. The retentiveness of provisional luting agents is less predictable (Schiessl et al. 2013)
Fact 8. The interface between abutment, cement and suprastructure in the subgingival region is a critical area, offering ideal conditions for the formation of biofilms near the crestal alveolar bone. Higher levels of bacteria accumulating on cement lines have been demonstrated in vivo than on machined titanium surfaces (Papavasileiou et al. 2015)
To conclude: forget cementation
A comparison of the clinical performance of screw- and cement-retention reveals no significant differences. However, screw-retained reconstructions exhibit fewer technical and biological complications overall than cement-retained ones (Wittneben et al. 2013; Wittneben et al. 2014). Technical complications are partially dependent on the systems used.
Fact 9. Occlusal discontinuity of access holes in screw-retained crowns may affect their resistance
Fact 10. Screw retention has the potential for reintervention (Figure 2)
The speaker recommended that we forget cementation, even though screw-retained reconstructions are more technically complex. For example, a passive fit is crucial for preventing mechanical problems in reconstructions on multiple abutments, and it is advisable to convert conicaconnections to flat non-locking ones in order to facilitate passivity (Figure 3).
References
Begum Z, Sonika R, Pratik C. Effect of different cementation techniques on retained excess cement and uniaxial retention of the implant-supported prosthesis: an in vitro study. Int J Oral Maxillofac Implants. 2014 Nov-Dec;29(6):1333–7. doi: 10.11607/jomi.3724. Epub 2014 Aug 20.
Behr M, Spitzer A, Preis V, Weng D, Gosau M, Rosentritt M. The extent of luting agent remnants on titanium and zirconia abutment analogs after scaling. Int J Oral Maxillofac Implants. 2014 Sep–Oct;29(5):1185–92. doi: 10.11607/jomi.3523.
Chen CJ, Papaspyridakos P, Guze K, Singh M, Weber HP, Gallucci GO. Effect of misfit of cement-retained implant single crowns on crestal bone changes. Int J Prosthodont. 2013 Mar–Apr;26(2):135–7. doi: 10.11607/ijp.3137.
Garg P, Pujari M, Prithviraj DR, Khare S. Retentiveness of various luting agents used with implant-supported prosthesis: an in vitro study. J Oral Implantol. 2014 Dec;40(6):649–54. doi: 10.1563/AAID-JOI-D-12-00008.
Korsch M, Robra BP, Walther W. Cement-associated signs of inflammation: retrospective analysis of the effect of excess cement on peri-implant tissue. Int J Prosthodont. 2015 Jan–Feb;28(1):11–8. doi: 10.11607/ijp.4043.
Korsch M, Walther W. Peri-Implantitis Associated with Type of Cement: A Retrospective Analysis of Different Types of Cement and Their Clinical Correlation to the Peri-Implant Tissue. Clin Implant Dent Relat Res. 2015 Oct;17 Suppl 2:e434–43. doi: 10.1111/cid.12265. Epub 2014 Sep 2.
Linkevicius T, Vindasiute E, Puisys A, Peciuliene V. The influence of margin location on the amount of undetected cement excess after delivery of cement-retained implant restorations. Clin Oral Implants Res. 2011 Dec;22(12):1379–84. doi: 10.1111/j.1600-0501.2010.02119.x. Epub 2011 Mar 8.
Linkevicius T, Puisys A, Vindasiute E, Linkeviciene L, Apse P. Does residual cement around implant-supported restorations cause peri-implant disease? A retrospective case analysis. Clin Oral Implants Res. 2013 Nov;24(11):1179–84. doi: 10.1111/j.1600-0501.2012.02570.x. Epub 2012 Aug 8.
Papavasileiou D, Behr M, Gosau M, Gerlach T, Buergers R. Peri-implant Biofilm Formation on Luting Agents Used for Cementing Implant-Supported Fixed Restorations: A Preliminary In Vivo Study. Int J Prosthodont. 2015 Jul–Aug;28(4):371–3. doi: 10.11607/ijp.4100.
Schiessl C, Schaefer L, Winter C, Fuerst J, Rosentritt M, Zeman F, Behr M. Factors determining the retentiveness of luting agents used with metal- and ceramic-based implant components. Clin Oral Investig. 2013 May;17(4):1179–90. doi: 10.1007/s00784-012-0798-x. Epub 2012 Jul 31.
Wilson TG Jr. The positive relationship between excess cement and peri-implant disease: a prospective clinical endoscopic study. J Periodontol. 2009 Sep;80(9):1388–92. doi: 10.1902/jop.2009.090115
Wittneben JG, Buser D, Salvi GE, Bürgin W, Hicklin S, Brägger U. Complication and failure rates with implant-supported fixed dental prostheses and single crowns: a 10-year retrospective study. Clin Implant Dent Relat Res. 2014 Jun;16(3):356–64. doi: 10.1111/cid.12066. Epub 2013 Apr 2.
Wittneben JG, Millen C, Brägger U. Clinical performance of screw- versus cement-retained fixed implant-supported reconstructions--a systematic review. Int J Oral Maxillofac Implants. 2014;29 Suppl:84–98. doi: 10.11607/jomi.2014suppl.g2.1.
This summary was prepared by the EAO Congress Scientific Report rapporteurs and approved by the speaker.
View the full publication at: www.eao.org
The following report summarises the fourth paper presented during the Things we stopped in our practice due to failures session, at the EAO's 25th annual Scientific Meeting in Paris, 2016.
In this session, four different issues were addressed: immediate implant placement; prosthodontic rehabilitation of edentulous jaws; immediate CAD/CAM restorations; and cemented fixed restorations. These different topics have a common denominator: they are all clinical protocols that have been subject to a change of opinion due to failures.
After a period when the majority of implant restorations were screw-retained, cemented retention on simplified abutments became more popular again. Cementation is widely used by prosthodontists because of its simplicity; capacity for hermetic sealing; passive fit; and favourable aesthetic appearance.
However, cement-retained restorations are often associated with mucositis and peri-implantitis, due to open margins and cement excesses (Figure 1). Cement-retained crowns with a poor marginal fit can cause significantly more crestal bone loss – even in tissue-level implants – than well-fitting crowns after a mean of 3 years (Chen et al. 2013). Increased incidences of inflammation are found in cases where there is an excess of cement around the restoration (Korsch et al. 2015). This is especially the case in aesthetic areas, where the abutment finishing line is generally lower and cement excess may be displaced subgingivally, where it is difficult to remove (Linkevicius et al. 2011; Linkevicius et al. 2013).
Figure 1
Fact 1. Various techniques have been developed to avoid the excess of cement, such as dual cord application in the sulcus; venting the crown; or using a practice abutment. These techniques have been demonstrated in vitro (Begum et al. 2014), but currently lack definitive conclusions
Fact 2. A high number of cemented restorations exhibit excess cement in the peri-implant sulcus (Kosrch et al. 2015)
Fact 3. Excess cement has been associated with signs of peri-implant disease 81% of cases (Wilson et al. 2009)
Fact 4. The frequency of undetected excess depends on the type of cement used, and is significantly greater in methacrylate cements than in ZOE cements (Korsch et al. 2014)
Fact 5. Removal of excess cement is difficult. Well-trained clinicians were only successfully able to remove excesses of ZOE cement from models (Behr et al. 2014)
Fact 6. The retentiveness of luting agents varies (Garg et al. 2014)
Fact 7. The retentiveness of provisional luting agents is less predictable (Schiessl et al. 2013)
Fact 8. The interface between abutment, cement and suprastructure in the subgingival region is a critical area, offering ideal conditions for the formation of biofilms near the crestal alveolar bone. Higher levels of bacteria accumulating on cement lines have been demonstrated in vivo than on machined titanium surfaces (Papavasileiou et al. 2015)
A comparison of the clinical performance of screw- and cement-retention reveals no significant differences. However, screw-retained reconstructions exhibit fewer technical and biological complications overall than cement-retained ones (Wittneben et al. 2013; Wittneben et al. 2014). Technical complications are partially dependent on the systems used.
Fact 9. Occlusal discontinuity of access holes in screw-retained crowns may affect their resistance
Fact 10. Screw retention has the potential for reintervention (Figure 2)
Figure 2
The speaker recommended that we forget cementation, even though screw-retained reconstructions are more technically complex. For example, a passive fit is crucial for preventing mechanical problems in reconstructions on multiple abutments, and it is advisable to convert conicaconnections to flat non-locking ones in order to facilitate passivity (Figure 3).
Figure 3
Begum Z, Sonika R, Pratik C. Effect of different cementation techniques on retained excess cement and uniaxial retention of the implant-supported prosthesis: an in vitro study. Int J Oral Maxillofac Implants. 2014 Nov-Dec;29(6):1333–7. doi: 10.11607/jomi.3724. Epub 2014 Aug 20.
Behr M, Spitzer A, Preis V, Weng D, Gosau M, Rosentritt M. The extent of luting agent remnants on titanium and zirconia abutment analogs after scaling. Int J Oral Maxillofac Implants. 2014 Sep–Oct;29(5):1185–92. doi: 10.11607/jomi.3523.
Chen CJ, Papaspyridakos P, Guze K, Singh M, Weber HP, Gallucci GO. Effect of misfit of cement-retained implant single crowns on crestal bone changes. Int J Prosthodont. 2013 Mar–Apr;26(2):135–7. doi: 10.11607/ijp.3137.
Garg P, Pujari M, Prithviraj DR, Khare S. Retentiveness of various luting agents used with implant-supported prosthesis: an in vitro study. J Oral Implantol. 2014 Dec;40(6):649–54. doi: 10.1563/AAID-JOI-D-12-00008.
Korsch M, Robra BP, Walther W. Cement-associated signs of inflammation: retrospective analysis of the effect of excess cement on peri-implant tissue. Int J Prosthodont. 2015 Jan–Feb;28(1):11–8. doi: 10.11607/ijp.4043.
Korsch M, Walther W. Peri-Implantitis Associated with Type of Cement: A Retrospective Analysis of Different Types of Cement and Their Clinical Correlation to the Peri-Implant Tissue. Clin Implant Dent Relat Res. 2015 Oct;17 Suppl 2:e434–43. doi: 10.1111/cid.12265. Epub 2014 Sep 2.
Linkevicius T, Vindasiute E, Puisys A, Peciuliene V. The influence of margin location on the amount of undetected cement excess after delivery of cement-retained implant restorations. Clin Oral Implants Res. 2011 Dec;22(12):1379–84. doi: 10.1111/j.1600-0501.2010.02119.x. Epub 2011 Mar 8.
Linkevicius T, Puisys A, Vindasiute E, Linkeviciene L, Apse P. Does residual cement around implant-supported restorations cause peri-implant disease? A retrospective case analysis. Clin Oral Implants Res. 2013 Nov;24(11):1179–84. doi: 10.1111/j.1600-0501.2012.02570.x. Epub 2012 Aug 8.
Papavasileiou D, Behr M, Gosau M, Gerlach T, Buergers R. Peri-implant Biofilm Formation on Luting Agents Used for Cementing Implant-Supported Fixed Restorations: A Preliminary In Vivo Study. Int J Prosthodont. 2015 Jul–Aug;28(4):371–3. doi: 10.11607/ijp.4100.
Schiessl C, Schaefer L, Winter C, Fuerst J, Rosentritt M, Zeman F, Behr M. Factors determining the retentiveness of luting agents used with metal- and ceramic-based implant components. Clin Oral Investig. 2013 May;17(4):1179–90. doi: 10.1007/s00784-012-0798-x. Epub 2012 Jul 31.
Wilson TG Jr. The positive relationship between excess cement and peri-implant disease: a prospective clinical endoscopic study. J Periodontol. 2009 Sep;80(9):1388–92. doi: 10.1902/jop.2009.090115
Wittneben JG, Buser D, Salvi GE, Bürgin W, Hicklin S, Brägger U. Complication and failure rates with implant-supported fixed dental prostheses and single crowns: a 10-year retrospective study. Clin Implant Dent Relat Res. 2014 Jun;16(3):356–64. doi: 10.1111/cid.12066. Epub 2013 Apr 2.
Wittneben JG, Millen C, Brägger U. Clinical performance of screw- versus cement-retained fixed implant-supported reconstructions--a systematic review. Int J Oral Maxillofac Implants. 2014;29 Suppl:84–98. doi: 10.11607/jomi.2014suppl.g2.1.
This summary was prepared by the EAO Congress Scientific Report rapporteurs and approved by the speaker.
View the full publication at: www.eao.org
In this session, four different issues were addressed: immediate implant placement; prosthodontic rehabilitation of edentulous jaws; immediate CAD/CAM restorations; and cemented fixed restorations. These different topics have a common denominator: they are all clinical protocols that have been subject to a change of opinion due to failures.
Cement-retained restorations
Facts that make us think
After a period when the majority of implant restorations were screw-retained, cemented retention on simplified abutments became more popular again. Cementation is widely used by prosthodontists because of its simplicity; capacity for hermetic sealing; passive fit; and favourable aesthetic appearance.
However, cement-retained restorations are often associated with mucositis and peri-implantitis, due to open margins and cement excesses (Figure 1). Cement-retained crowns with a poor marginal fit can cause significantly more crestal bone loss – even in tissue-level implants – than well-fitting crowns after a mean of 3 years (Chen et al. 2013). Increased incidences of inflammation are found in cases where there is an excess of cement around the restoration (Korsch et al. 2015). This is especially the case in aesthetic areas, where the abutment finishing line is generally lower and cement excess may be displaced subgingivally, where it is difficult to remove (Linkevicius et al. 2011; Linkevicius et al. 2013).
Facts associated with intraoral cementation
Fact 1. Various techniques have been developed to avoid the excess of cement, such as dual cord application in the sulcus; venting the crown; or using a practice abutment. These techniques have been demonstrated in vitro (Begum et al. 2014), but currently lack definitive conclusions
Fact 2. A high number of cemented restorations exhibit excess cement in the peri-implant sulcus (Kosrch et al. 2015)
Fact 3. Excess cement has been associated with signs of peri-implant disease 81% of cases (Wilson et al. 2009)
Fact 4. The frequency of undetected excess depends on the type of cement used, and is significantly greater in methacrylate cements than in ZOE cements (Korsch et al. 2014)
Fact 5. Removal of excess cement is difficult. Well-trained clinicians were only successfully able to remove excesses of ZOE cement from models (Behr et al. 2014)
Fact 6. The retentiveness of luting agents varies (Garg et al. 2014)
Fact 7. The retentiveness of provisional luting agents is less predictable (Schiessl et al. 2013)
Fact 8. The interface between abutment, cement and suprastructure in the subgingival region is a critical area, offering ideal conditions for the formation of biofilms near the crestal alveolar bone. Higher levels of bacteria accumulating on cement lines have been demonstrated in vivo than on machined titanium surfaces (Papavasileiou et al. 2015)
To conclude: forget cementation
A comparison of the clinical performance of screw- and cement-retention reveals no significant differences. However, screw-retained reconstructions exhibit fewer technical and biological complications overall than cement-retained ones (Wittneben et al. 2013; Wittneben et al. 2014). Technical complications are partially dependent on the systems used.
Fact 9. Occlusal discontinuity of access holes in screw-retained crowns may affect their resistance
Fact 10. Screw retention has the potential for reintervention (Figure 2)
The speaker recommended that we forget cementation, even though screw-retained reconstructions are more technically complex. For example, a passive fit is crucial for preventing mechanical problems in reconstructions on multiple abutments, and it is advisable to convert conicaconnections to flat non-locking ones in order to facilitate passivity (Figure 3).
References
Begum Z, Sonika R, Pratik C. Effect of different cementation techniques on retained excess cement and uniaxial retention of the implant-supported prosthesis: an in vitro study. Int J Oral Maxillofac Implants. 2014 Nov-Dec;29(6):1333–7. doi: 10.11607/jomi.3724. Epub 2014 Aug 20.
Behr M, Spitzer A, Preis V, Weng D, Gosau M, Rosentritt M. The extent of luting agent remnants on titanium and zirconia abutment analogs after scaling. Int J Oral Maxillofac Implants. 2014 Sep–Oct;29(5):1185–92. doi: 10.11607/jomi.3523.
Chen CJ, Papaspyridakos P, Guze K, Singh M, Weber HP, Gallucci GO. Effect of misfit of cement-retained implant single crowns on crestal bone changes. Int J Prosthodont. 2013 Mar–Apr;26(2):135–7. doi: 10.11607/ijp.3137.
Garg P, Pujari M, Prithviraj DR, Khare S. Retentiveness of various luting agents used with implant-supported prosthesis: an in vitro study. J Oral Implantol. 2014 Dec;40(6):649–54. doi: 10.1563/AAID-JOI-D-12-00008.
Korsch M, Robra BP, Walther W. Cement-associated signs of inflammation: retrospective analysis of the effect of excess cement on peri-implant tissue. Int J Prosthodont. 2015 Jan–Feb;28(1):11–8. doi: 10.11607/ijp.4043.
Korsch M, Walther W. Peri-Implantitis Associated with Type of Cement: A Retrospective Analysis of Different Types of Cement and Their Clinical Correlation to the Peri-Implant Tissue. Clin Implant Dent Relat Res. 2015 Oct;17 Suppl 2:e434–43. doi: 10.1111/cid.12265. Epub 2014 Sep 2.
Linkevicius T, Vindasiute E, Puisys A, Peciuliene V. The influence of margin location on the amount of undetected cement excess after delivery of cement-retained implant restorations. Clin Oral Implants Res. 2011 Dec;22(12):1379–84. doi: 10.1111/j.1600-0501.2010.02119.x. Epub 2011 Mar 8.
Linkevicius T, Puisys A, Vindasiute E, Linkeviciene L, Apse P. Does residual cement around implant-supported restorations cause peri-implant disease? A retrospective case analysis. Clin Oral Implants Res. 2013 Nov;24(11):1179–84. doi: 10.1111/j.1600-0501.2012.02570.x. Epub 2012 Aug 8.
Papavasileiou D, Behr M, Gosau M, Gerlach T, Buergers R. Peri-implant Biofilm Formation on Luting Agents Used for Cementing Implant-Supported Fixed Restorations: A Preliminary In Vivo Study. Int J Prosthodont. 2015 Jul–Aug;28(4):371–3. doi: 10.11607/ijp.4100.
Schiessl C, Schaefer L, Winter C, Fuerst J, Rosentritt M, Zeman F, Behr M. Factors determining the retentiveness of luting agents used with metal- and ceramic-based implant components. Clin Oral Investig. 2013 May;17(4):1179–90. doi: 10.1007/s00784-012-0798-x. Epub 2012 Jul 31.
Wilson TG Jr. The positive relationship between excess cement and peri-implant disease: a prospective clinical endoscopic study. J Periodontol. 2009 Sep;80(9):1388–92. doi: 10.1902/jop.2009.090115
Wittneben JG, Buser D, Salvi GE, Bürgin W, Hicklin S, Brägger U. Complication and failure rates with implant-supported fixed dental prostheses and single crowns: a 10-year retrospective study. Clin Implant Dent Relat Res. 2014 Jun;16(3):356–64. doi: 10.1111/cid.12066. Epub 2013 Apr 2.
Wittneben JG, Millen C, Brägger U. Clinical performance of screw- versus cement-retained fixed implant-supported reconstructions--a systematic review. Int J Oral Maxillofac Implants. 2014;29 Suppl:84–98. doi: 10.11607/jomi.2014suppl.g2.1.
This summary was prepared by the EAO Congress Scientific Report rapporteurs and approved by the speaker.
View the full publication at: www.eao.org
{{ help_message }}
{{filter}}