A technique for minimizing subgingival residual cement by using rubber dam for cement-retained implant crowns

Abstract

Excellent esthetics and a passive fit are facilitated by using cement-retained prostheses. However, eliminating residual cement is difficult in the subgingival area. Residual cement may cause periimplantitis, gingival swelling, pain, bleeding on probing, and other complications.1Pauletto N. Lahiffe B.J. Walton J.N. Complications associated with excess cement around crowns on osseointegrated implants: a clinical report.Int J Oral Maxillofac Implants. 1999; 14: 865-868PubMed Google Scholar Generally, the margin of an anterior implant crown is placed in the subgingival area for esthetic reasons. Because removing residual cement in subgingival areas is difficult, techniques using abutment replicas or Teflon tape have been introduced to minimize the problem.2Galván G. Kois J.C. Chaiyabutr Y. Kois D. Cemented implant restoration: a technique for minimizing adverse biologic consequences.J Prosthet Dent. 2015; 114: 482-485Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar, 3Wadhwani C. Piñeyro A. Technique for controlling the cement for an implant crown.J Prosthet Dent. 2009; 102: 57-58Abstract Full Text Full Text PDF PubMed Scopus (82) Google Scholar, 4Hess T.A. A technique to eliminate subgingival cement adhesion to implant abutments by using polytetrafluoroethylene tape.J Prosthet Dent. 2014; 112: 365-368Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar The presented technique uses rubber dam to allow only the minimal amount of residual cement to flow into the subgingival area when cement-retained prostheses with subgingival margins are delivered. The procedure does not require any additional laboratory steps. Moreover, it enables the isolation of a prosthesis before the cementation procedure. Since the cement does not flow into the subgingival area, less bleeding may occur when the residual cement is removed, thus causing less discomfort. Furthermore, rubber dam protects the gingiva from direct contact with the cement, thus decreasing chemical irritation. 1.Cut a sheet of rubber dam (Blossom; Mexpo Intl Inc) into a size approximating the mesiodistal width of the edentulous area and make a hole in the center with a dental explorer (EXDTU17/236; Hu-Friedy Mfg Co).2.Push the implant abutment (Myplant; RaphaBio Co) through the hole of the rubber dam and place it below the margin of the abutment (Fig. 1A ).3.Connect the customized abutment with rubber dam to the implant fixture and tighten to 30 Ncm. Adjust the occlusal contact of the restoration. After 10 minutes, retighten and seal the hole.5Siamos G. Winkler S. Boberick K.G. Relationship between implant preload and screw loosening on implant-supported prostheses.J Oral Implantol. 2002; 28: 67-73Crossref PubMed Scopus (169) Google Scholar Make sure not to cover the proximal contacts with the rubber dam (Fig. 1B).4.Apply a small amount of cement (RelyX Unicem; 3M ESPE) along the margin of the crown6Wadhwani C. Goodwin S. Cementing an implant crown: a novel measurement system using computational fluid dynamics approach.Clin Implant Dent Relat Res. 2014; 18: 97-106Crossref PubMed Scopus (13) Google Scholar and place the crown over the abutment. Light polymerize for an initial 1 or 2 seconds according to the manufacturer’s instructions (Fig. 2A ).Figure 2A, Place crown over abutment and light polymerize for 1 to 2 seconds. B, Remove residual cement.View Large Image Figure ViewerDownload Hi-res image Download (PPT)5.Remove the initially polymerized cement and carefully cut the rubber dam with scissors and remove it (Fig. 2B). After complete polymerization, ensure no cement remains.