Advertisement
Journal of Prosthetic Dentistry

Evaluation of the amount of excess cement around the margins of cement-retained dental implant restorations: The effect of the cement application method

      Statement of problem

      Complete removal of excess cement from subgingival margins after cementation of implant-supported restorations has been shown to be unpredictable. Remaining cement has been shown to be associated with periimplant inflammation and bleeding.

      Purpose

      The purpose of this study was to investigate and compare the amount of excess cement after cementation with 4 different methods of cement application for cement-retained implant-supported restorations.

      Material and methods

      Ten implant replicas/abutments (3i) were embedded in acrylic resin blocks. Forty complete veneer crowns (CVCs) were fabricated by waxing onto the corresponding plastic waxing sleeves. The wax patterns were cast and the crowns were cemented to the implant replicas with either an interim (Temp Bond) or a definitive luting agent (FujiCEM). Four methods of cement application were used for cementation: Group IM-Cement applied on the internal marginal area of the crown only; Group AH-Cement applied on the apical half of the axial walls of the crown; Group AA-Cement applied to all axial walls of the interior surface of the crown, excluding the occlusal surface; and Group PI-Crown filled with cement then seated on a putty index formed to the internal configuration of the restoration (cementation device) (n=10). Cement on the external surfaces was removed before seating the restoration. Cement layers were applied on each crown, after which the crown was seated under constant load (80 N) for 10 minutes. The excess cement from each specimen was collected and measured. One operator performed all the procedures. Results for the groups were compared, with 1 and 2-way ANOVA and the Tukey multiple range test (α=.05).

      Results

      No significant difference in the amount of excess/used cement was observed between the 2 different types of cements (P=.1). Group PI showed the least amount of excess cement in comparison to other test groups (P=.031). No significant difference was found in the amount of excess cement among groups MI, AH, and AA. Group AA showed the highest amount of excess cement. The volume of cement used for group PI specimens was significantly higher than for those in the other groups (P=.001). With respect to the volume of cement loaded into the test crowns no statistically significant difference was observed among other test groups (groups IM, AH, and AA). Group MI used the least amount of cement, followed by group AH and AA. No correlation between the amount of used cement and the amount of excess cement was found in any of the tested groups.

      Conclusions

      Within the limitations of this in vitro study, the least amount of excess cement was present when a cementation device was used to displace the excess cement before seating the crown on the abutment (Group PI). With this technique a uniform layer of the luting agent is distributed over the internal surface of the crown leaving minimal excess cement when the restoration is seated.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Prosthetic Dentistry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Chee WW
        • Torbati A
        • Albouy JP
        Retrievable cemented implant restorations.
        J Prosthodont. 1998; 7: 120-125
        • Chee WW
        • Jivraj S
        Screw versus cemented implant supported restorations.
        Br Dent J. 2006; 21 (501-7.): 201
        • Chee W
        • Felton DA
        • Johnson PF
        • Sullivan DY
        Cemented versus screw-retained implant prostheses: which is better?.
        Int J Oral Maxillofac Implants. 1999; 14: 137-141
        • Hebel KS
        • Gajjar R
        Cement-retained versus screw-retained implant restorations: achieving optimal occlusion and esthetics in implant dentistry.
        J Prosthet Dent. 1997; 77: 28-35
        • Weber HP
        • Kim DM
        • Ng MW
        • Hwang JW
        • Fiorellini JP
        Peri-implant soft-tissue health surrounding cement- and screw-retained implant restorations: a multi-center, 3-year prospective study.
        Clin Oral Implants Res. 2006; 17: 375-379
        • Thomas GW
        The positive relationship between excess cement and peri-implant disease: a prospective clinical endoscopic study.
        J Periodontol. 2009; 80: 1388-1392
        • Dumbrigue HB
        • Abanomi AA
        • Cheng LL
        Techniques to minimize excess luting agent in cement-retained implant restorations.
        J Prosthet Dent. 2002; 87: 112-114
        • Wadhwani C
        • Hess T
        • Faber T
        • Piñeyro A
        • Chen CSK
        A descriptive study of the radiographic density of implant restorative cements.
        J Prosthet Dent. 2010; 103: 295-302
        • Wadhwani C
        • Rapoport D
        • La Rosa S
        • Hess T
        • Kretschmar S
        Radiographic detection and characteristic patterns of residual excess cement associated with cement-retained implant restorations: a clinical report.
        J Prosthet Dent. 2012; 107: 151-157
        • Wadhwani CP
        • Piñeyro A
        Technique for controlling the cement for an implant crown.
        J Prosthet Dent. 2009; 102: 57-58
        • Wilson TG
        The positive relationship between excess cement and peri-implant disease: a prospective clinical endoscopic study.
        J Periodontol. 2009; 80: 1388-1392
        • Pauletto N
        • Lahiffe BJ
        • Walton JN
        Complications associated with excess cement around crowns on osseointegrated implants: A clinical report.
        Int J Oral Maxillofac Implants. 1999; 14: 865-888
        • Gapski R
        • Neugeboren N
        • Pomeranz AZ
        • Reissner MW
        Endosseous implant failure influenced by crown cementation: a clinical case report.
        Int J Oral Maxillofac Implants. 2008; 23: 943-946
        • 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.
        Clinical Oral Implant Research. 2011; 22: 1379-1384
        • Agar JR
        • Cameron SM
        • Hughbanks JC
        • Parker MH
        Cement removal from restorations luted to titanium abutments with simulated subgingival margins.
        J Prosthet Dent. 1997; 78: 43-47
        • Breeding LC
        • Dixon DL
        • Bogacki MT
        • Tietge JD
        Use of luting agents with an implant system: Part I.
        J Prosthet Dent. 1992; 5: 737-741
        • Assif D
        • Azoulay SH
        • Gorfil C
        The degree of zinc phosphate cement coverage of complete crown preparations and its effect on crown retention. J.
        Prosthet Dent. 1992; 68: 275-278
        • Wong RH
        • Wilson PR
        The effect of seating force and die spacing on pulpward cementation pressure transmission: a laboratory study.
        Int Dent J. 1997; 47: 45-52
        • Jivraj S
        • Reshad M
        • Chee WW
        Critical appraisal. Immediate loading of implants in the esthetic zone.
        J Esthet Restor Dent. 2005; 17: 320-325
        • Lepe X
        • Bales DJ
        • Johnson GH
        Retention of provisional crowns fabricated from two materials with the use of four temporary cements.
        J Prosthet Dent. 1999; 81: 469-475