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Screw vs. Cement Retained Implant Restorations - How to Choose?

3/30/2015

Recent studies have shown that screw-retained implant restorations are more biocompatible than cement-retained restorations. It is therefore recommended that cement-retained restorations be limited to the following situations:

1) When a screw access hole would result in unsupported material (greater resistance to porcelain fracture).
2) When resistance to offset loading is desired (allows forces to be better distributed along the axial inclination of the implant).
3) When a screw access hole would be visible (enhance esthetics).
4) When an intact occlusal surface is desired (occlusal table can be adjusted).
5) To correct implant malposition or angulation.
6) To reduce treatment costs.
7) To simplify the fabrication procedure.
8) When a passive fit is desired (40µm of cement space can compensate for laboratory distortions).
9) When a patient has limited opening.

Choosing Between Screw-Retained and Cement-Retained Implant Crowns
Cemented and Screw-Retained Implant Reconstructions: A Systematic Review of the Survival and Complication Rates
Clinical Performance of Screw-Versus Cement-Retained Fixed Implant-Supported Reconstructions- A Systematic Review
Long-Term Outcome of Cemented Versus Screw Retained Implant-Supported Partial Restorations
Principles of Screw-Retained and Cement-Retained Fixed Implant Prosthesis- A Critical Review

Thanks for reading, and I welcome your feedback.

Best,
Dr. Pechter

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12 Implant Cement Best Practices

3/10/2015

4 Comments

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.

Use radiopaque Temp-bond, Temp-bond NE, or zinc phosphate cement (Zn inhibits bacterial growth).
Use a custom abutment and not a stock abutment (this brings the cement line closer to the margin).
Use less cement.
Place a vent hole in the abutment (or instruct your lab do this).
Place gutta percha, cotton, or teflon tape in occlusal access opening (but leave space for excess cement).
Seat crown on an abutment replica to remove excess cement prior to inserting in the mouth.
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).
Do not use Durelon (it will corrode titanium).
Do not use tissue colored cements.
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).
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).
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

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Screw vs. Cement Retained Implant Restorations - How to Choose?

12 Implant Cement Best Practices

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