How Abutment Margin Design Influences Cement Flow: Abutment Selection and Cement Margin Site
With residual excess cement now considered a high-risk factor associated with peri-implant disease, the cement margin site needs to be scrutinized. Clinical guidance on the appropriate margin depth is always a consideration with subgingival cement margin
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How Abutment Margin Design Influences Cement Flow: Abutment Selection and Cement Margin Site Tomas Linkevičius
Abstract
With residual excess cement now considered a high-risk factor associated with peri-implant disease, the cement margin site needs to be scrutinized. Clinical guidance on the appropriate margin depth is always a consideration with subgingival cement margin sites, which have distinct benefits from an esthetic prospective but are higher risk for residual excess cement. In vitro as well as in vivo studies have demonstrated that this risk is reduced when equigingival and supragingival cement margins are employed. The difficulty in detecting cement clinically and with radiographs is discussed. A second in vivo study evaluates the impact of implant diameter, undercut, and implant site, evaluating the amount of cement remaining as it relates to undercut or horizontal distance between the most marginal implant neck point and the gingival margin of the restoration emergence profile. These novel, clinical-based studies help explain the complexities of implant restoration as compared with the natural toothcemented restoration.
Introduction Cement-retained implant-supported restorations are a very popular way to restore dental implants. Besides many well-known advantages, this approach has drawbacks, especially the ability to
T. Linkevičius, DDS, Dip Pros, PhD Department of Prosthetic Dentistry, Institute of Odontology, Vilnius University, Zalgiris str. 115/117, Vilnius LT 08217, Lithuania e-mail: [email protected]
adequately remove all residual excess cement (REC). Clinical research has shown that deeper subgingival cementation margins are problematic for REC despite painstaking cleaning by the clinician. Other factors, like undercut, cement properties, and location, were shown to form additional liabilities for cement removal. With the knowledge that REC is a risk factor in peri-implant disease development, abutments with cementation margins equal to or, where possible, above the free gingival margin level following the contour of conditioned peri-implant mucosa should be employed.
C.P.K. Wadhwani (ed.), Cementation in Dental Implantology: An Evidence-Based Guide, DOI 10.1007/978-3-642-55163-5_6, © Springer-Verlag Berlin Heidelberg 2015
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Cement-Retained Restorations and Residual Excess Cement Historically, cement-retained restorations were introduced as an esthetic solution for improperly inclined implants to avoid screw access holes, which were mandatory features of screw-retained restorations. Simple fabrication, lower costs, and similarity to tooth-borne prostheses have made this form of implant restoration the method of choice for many clinicians. Other advantages included improved passivity compared to casted screw-retained restorations, and better esthetic occlusal appearance and function, due to the absence of emergent screw access holes. However, despite many advantages, cemented restorations have a number of shortcomings, such as predictable removal, if necessary, and inadequate rete
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