12 Implant Cement Best Practices

The following tips were compiled from lessons learned during the annual American Academy of Periodontology meeting and after reading recent articles by Chandur Wadhwani, DDS and Alfonso Pineyro, DDS, both prosthodontists from University of Washington.

1. Use radiopaque Temp-bond, Temp-bond NE, or zinc phosphate cement (Zn inhibits bacterial growth).
   
2. Use a custom abutment and not a stock abutment (this brings the cement line closer to the margin).
   
3. Use less cement. 
   
4. Place a vent hole in the abutment (or instruct your lab do this).
   
5. Place gutta percha, cotton, or teflon tape in occlusal access opening (but leave space for excess cement).
   
6. Seat crown on an abutment replica to remove excess cement prior to inserting in the mouth.
   
7. Do not use Resin modified glass ionomer cement (it is the most commonly used final cement, but it is radiolucent and difficult to remove in a deep sulcus).
   
8. Do not use Durelon (it will corrode titanium).
   
9. Do not use tissue colored cements.
   
10. Understand that most cements were tested to inhibit caries forming bacteria (not periodontal pathogens which are commonly found associated with implant failures and excess cement).
    
11. Understand the different biology of attachment of gingival tissues to a tooth versus an implant (there is not a strong intact compartment of tissue fibers to stop peri-implant disease penetration once it starts).
    
12. Recommend having your hygienists pay close attention to the gingiva around implant restorations.
    

Feedback?  Questions?  Please feel free to post a comment below. 

Best Regards,
Joseph Pechter, DMD, Peridontist and Dental Implant Surgeon

References:
Implant Cementation - Clinical Problems and Solutions

The Role of Dental Cements on Implant Success - Part 1

The Role of Dental Cements on Implant Success - Part 2 

Technique for Controlling the Cement for an Implant Crown

Techniques to Control or Avoid Cement around Implant-Retained Restorations