Residual Excess Cement Detection
Residual excess cement detection is mandatory if the material is to be entirely removed. Luting cement formulations do not always account for this need, with some cements colored pink so camouflaging in with the soft tissue surroundings. Detection of exce
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Residual Excess Cement Detection Chandur P.K. Wadhwani and Thomas D. Faber
Abstract
Residual excess cement detection is mandatory if the material is to be entirely removed. Luting cement formulations do not always account for this need, with some cements colored pink so camouflaging in with the soft tissue surroundings. Detection of excess cement with radiography is also limited with many of the cements currently available. The peripheral eggshell effect is a characteristic frequently encountered when the cement is visible on a radiograph. How patterns develop and how they relate on a radiograph to the radiodensity of the cement used will assist the clinician in cement selection as well as detection. The lack of ability to find excess cement is not limited to dentistry; orthopedic medicine has also failed to understand cement flow and detection that has also resulted in failures.
Introduction Survey data from clinicians has indicated that most dentists apply far in excess of the amount of cement required. When the restoration is fully seated, this excess must be extruded out of the abutment/crown system. Where this occurs at subgingival sites, it must be detected and adequately removed so as not to cause issues. C.P.K. Wadhwani, BDS, MSD (*) Department of Restorative Dentistry, University of Washington School of Dentistry, Seattle, WA, USA Private Practice Limited to Prosthodontics, 1200, 116th Ave NE #A, Bellevue, WA 98004, USA e-mail: [email protected] T.D. Faber, DDS, MSD Department of Periodontics, University of Washington School of Dentistry, Seattle, WA, USA
The cement type plays a vital role in the ability to allow for both detection and removal. This is not as straightforward as it appears. Some cements have been manufactured to represent gingival shading for natural esthetics—in essence they are made “pink.” This increases the likelihood that they will NOT be detected visually and has presented some great issues with peri-implant disease (Figs. 5.1 and 5.2a, b). Cement removal may also be compounded by some cement formulations being adhesive to titanium. In 1997, Agar reported on the inability to completely remove some resin cements from implant surfaces that were machined smooth. The newer resin-based cements produced today that are intended for universal use are extremely adhesive, making removal even more problematic. Coupled with the new implant surfaces that are
C.P.K. Wadhwani (ed.), Cementation in Dental Implantology: An Evidence-Based Guide, DOI 10.1007/978-3-642-55163-5_5, © Springer-Verlag Berlin Heidelberg 2015
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predominantly rough, a greater tendency will exist for cement to remain (Fig. 5.3).
tions. Recommendations have been made with respect to radiodensity levels of dental materials used to restore or cement restorations on teeth.
Radio-Opacity of Cements Comparing Implant-Specific Cements As previously mentioned, residual excess cement can be the initiating factor for peri-implant disease. Being able to detect it and remove it are imperative for
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