Cement-retained Implant-supported Prostheses Research Articles

A novel technique for retrieval of cement-retained crown from an implant abutment and converting it into a combination prostheses

Dental implant restoration is known to be a widely accepted treatment modality for the replacement of missing teeth and the restoration of masticatory function. Abutment screw loosening is one of the most common causes of failure in single implant-supported restorations, next to loss of osseointegration. Moreover, cement-retained implant-supported prostheses are infamous for their lack of predictable retrievability compared to screw-retained implant-supported prostheses. Management and retrieval of loosening screws are challenging, and this clinical report discusses the procedure for retrieving prosthesis from the abutment of the mandibular molar tooth with minimal damage to the existing restoration, making it possible to be reused.

Comparative analysis of intaglio surface trueness of cement-retained implant-supported prostheses generated by a cast-free digital workflow and a three-dimensionally printed cast workflow

Statement of problemComparative analysis of the accuracy of the prostheses produced by a cast-free digital workflow and 3-dimensional (3D) printing cast workflow is lacking. PurposeThe purpose of the present investigation was to compare the intaglio surface trueness of implant-supported prostheses fabricated by using 3 different digital workflows: cast-free computer-aided design (CAD), 3D printed cast CAD (direct insert), and 3D printed cast CAD (indirect insert). Material and methodsThe laboratory data of 11 partially edentulous arches for prosthetic implant treatment were obtained. Three different workflows were tested to produce the cement-retained prostheses: cast-free CAD (Group CF), 3D printed cast CAD with direct insert (Group PD), and 3D printed cast CAD with indirect insert (Group PI). The intaglio surfaces of the prosthesis CAD data from Groups CF, PD, and PI were superimposed with 3D printed prosthesis scan data from Group CF to measure 3D surface deviation. Using the prosthesis CAD data from Group CF as a reference, those from Groups PD and PI were compared by superimposition analysis. The root mean square (RMS) estimates, positive average deviations, and negative average deviations were measured. The Kruskal-Wallis test and Dunn test with Bonferroni correction, and the Wilcoxon rank sum test were used for statistical analyses (α=.05). ResultsSignificant differences were found among the 3 groups when the 3D printed prosthesis scan data were referenced (P<.05). Group CF showed the lowest RMS, positive average deviation, and negative deviation values, while Group PI showed the highest values. Significant differences in the RMS, positive average deviation, and negative average deviation values were found between Groups PD and PI when the prosthesis CAD data (Group CF) were referenced (P<.05). ConclusionsAmong the 3 different workflows tested, the prostheses generated from the cast-free CAD flow showed significantly lower intaglio surface deviation than those generated from the 3D printed cast CAD flows, regardless of the insertion method of the implant replicas.

The effect of different cleansing methods for removing temporary cement on the tensile bond force of permanently cemented implant-supported metal copings: An in vitro study.

ObjectivesComplete cleaning of temporary cement before permanent cementation of cement‐retained implant‐supported prosthesis (CISP) when recementing the crown is critical. This study evaluated the effect of different cleaning methods for removing traces of temporary cement on the final tensile bond force (TBF) of CISP recemented with resin cement.Materials and MethodsSeventy computer‐aided design/computer‐aided manufacturing metal implant‐supported copings were prepared and distributed into seven groups (N = 10). Copings of six groups (60 samples) were cemented with temporary cement with eugenol and subjected to 5000 thermocycling. After debonding by a universal testing machine, the internal surfaces of the copings were cleaned using one of the six following methods: 1‐an ultrasonic water bath (UW), 2‐sandblasting, then washing with water (SW), 3‐sandblasting and an ultrasonic water bath (SUW), 4‐an ultrasonic isopropyl alcohol bath (UA), 5‐sandblasting, then washing with isopropyl alcohol (SA) or 6‐sandblasting and an ultrasonic isopropyl alcohol bath (SUA). Then the subjects were subsequently cemented by dual‐cure self‐adhesive resin cement. In the seventh group (control, N = 10), the copings were cemented by dual‐cure self‐adhesive resin cement without the temporization phase. The TBF was tested using a universal testing machine with a cross‐head speed of 1 mm/min. Two‐way analysis of variance (ANOVA) and post‐hoc Tamhane tests were used for statistical analysis at a significance level of α = .05.ResultsThe maximum mean of TBF value was observed in SUA group (845 ± 203 N), and the minimum was observed in the temporary cement group (49 ± 20 N). All groups which were cleaned with isopropyl alcohol showed significantly higher TBF values compared with those cleaned with water.ConclusionsCleaning of the inner surface of metal copings after debonding with sandblasting and isopropyl alcohol results in the highest value of TBF by eliminating the effect of remaining eugenol and removing traces of temporary cements.

A novel method of 3D printing locating guide for abutment screw removal in cement-retained implant-supported prostheses

Background/purposeCement-retained restorations have the advantages of passive fit, less complexity of clinical and laboratory methods, cost, esthetics, and dimensional stability over screw-retained restorations, especially in multiple abutment implant-supported prostheses. A common and difficult technical problem with cement-retained implant prostheses is abutment screw loosening. Three-dimensional (3D) printing is a technology that has been rapidly developed and has become widely accepted in dentistry. The aim of this study was to establish a novel method of using 3D implant planning guide to locate the abutment screw in cement-retained implant prosthesis. Materials and methodsSix standard gypsum complete denture models were used to locate the abutment screw. An implant analog (4.5 mm in diameter and 12 mm in length) was placed in the drilling hole (5 mm in diameter and 14 mm in depth). After scanning with a 3D scanner, the 3D printing software was used to design the abutment screw location guide, which was printed by a resin-based 3D printer. ResultsA total of 30 abutment screws were located and removed using the guide. The locating guide's actual diameter was 2.4 mm. The drilling point was accurate and precise, and no excessive loss of the abutment was noticed. ConclusionThe guide would help the dentist in locating the abutment screw access channel, resulting in a more precise and accurate drilling point. The guide for locating the abutment screw enhances the accuracy of screw channel access and reduces damage to the crown and abutment.

Effect of materials on axial displacement and internal discrepancy of cement-retained implant-supported prostheses

Statement of problemHow axial displacement may be affected by the mechanical properties and internal discrepancy of a cement-retained implant-supported prosthesis is unclear. PurposeThe purpose of this in vitro study was to assess the difference in internal discrepancy and axial displacement according to the prosthesis material in cement-retained prostheses splinting nonparallel implants. Material and methodsComputer-aided design and computer-aided manufacture (CAD-CAM) titanium abutments were fabricated for a vertically placed implant and a 15-degree tilted implant. Three types of prostheses, in zirconia, cobalt-chromium (Co-Cr) alloy, and polymethylmethacrylate resin (PMMA), were fabricated (n=10). The internal discrepancy between the CAD-CAM titanium abutment and the prosthesis was measured by using the replica technique. After luting with an interim cement, they were mounted in Type IV gypsum. The specimens were cyclic loaded, and axial displacement of the prosthesis was measured after 3, 10, 100, and 106 cycles. The internal discrepancy and cumulative axial displacement were assessed by using a 3-way analysis of variance and repeated measures analysis of variance (α=.05). ResultsThe internal discrepancy of the prosthesis did not differ based on the prosthesis material (P=.869); however, it was significantly different based on the measurement location, with the occlusal discrepancy (224 ±29 μm) being greater than the axial discrepancy (21 ±10 μm) (P<.05). Implants with an angled placement exhibited less axial displacement than implants with vertical placement (P<.05). The PMMA prosthesis demonstrated significantly greater axial displacement than the zirconia or Co-Cr prostheses (P<.05), which were similar (P=.623). ConclusionsProstheses made with high-elastic moduli materials exhibited less axial displacement than PMMA prostheses, even though the internal discrepancy was not different. Moreover, vertically placed implants presented a greater axial displacement of the prosthesis than implants with angled placement.

A method for determining the position of the abutment screw of any cement-retained implant-supported prosthesis

Removing cement-retained implant-supported prostheses may be challenging for clinicians. A method combining a cone beam computed tomography (CBCT) and a digital scan with a virtual surgical planning software program is described to identify the perforation site of a cement-retained implant-supported prosthesis to locate the abutment screw.

An in vitro investigation comparing methods of minimizing excess luting agent for cement-retained implant-supported fixed partial dentures

Statement of problemThe use of cement-retained implant-supported prostheses is a well-established treatment option. Techniques have been proposed to reduce the amount of residual excess cement (REC) around cement-retained single-implant restorations. However, studies evaluating the effectiveness of such techniques related to cement-retained implant-supported fixed partial dentures (CRISFPDs) are lacking. PurposeThe purpose of this in vitro study was to evaluate the effectiveness of various cement application techniques for CRISFPDs. Material and methodsTwo implant analogs were placed in the lateral incisor sites in a maxillary, 3D printed cast with 4 missing incisors. Twenty standardized, removable, printed soft-tissue replicas, 40 milled titanium custom abutments, and 20 milled zirconia CRISFPDs were fabricated. Two cement application techniques, the brush on technique (BOT), and the polyvinyl siloxane index (PI) technique were compared. Two cementation techniques, without bib (control) (n=10) and with a polytetrafluoroethylene (PTFE) bib (test) (n=10), were used. A premeasured amount of interim cement was used to cement the CRISFPDs. The CRISFPDs were retrieved after cementation, and standardized photographs of 4 quadrants of each abutment-CRISFPD assembly were made by using a software program that is used to calculate the ratio between the area covered with REC and the total specimen area. The extension of the REC on both the abutment and soft-tissue replica was measured at sites before and after cleaning the REC. A generalized linear mixed-model procedure was used for statistical analysis (α=.05). ResultsFor cement application, the polyvinyl siloxane (PVS) index technique had significantly less REC than the brush on technique (P<.05). The use of a PTFE bib led to significantly less REC than when no bib was used (P<.05). ConclusionsThe use of the PVS index technique along with a PTFE bib was effective in reducing REC for CRISFPDs.

Influence of Ceramic Materials on Biomechanical Behavior of Implant Supported Fixed Prosthesis with Hybrid Abutment.

This study evaluated the stress distribution in different cement-retained implant-supported prostheses with a hybrid abutment. Two factors were evaluated: restorative material for the crown and hybrid abutment - zirconia, lithium disilicate and hybrid ceramic, yielding 9 combinations. For finite element analysis, a monolithic crown cemented on a hybrid abutment was modeled and cemented on a titanium base (Ti base). An oblique load (45°, 300 N) was applied to the fossa bottom and system fixation occurred on the bone's base. Each structure was evaluated separately to find the possible weaknesses in geometry and failure criteria. In this context, results demonstrated a significant decrease of maximum principal and von-Mises stresses concentration when crowns with high elastic modulus are cemented onto a hybrid abutment with lower elastic modulus. Considering this theoretical study for a Morse taper implant, the association of a rigid crown with a more resilient hybrid abutment reduces the tensile stress concentration in the restoration cervical region.

An in vitro study to compare the influence of newer luting cements on retention of cement-retained implant-supported prosthesis.

Purpose:The study was conducted to evaluate the retentiveness of specifically formulated implant cements and compare its retentiveness with a commonly used noneugenol zinc oxide luting cement and also to assess the influence of abutment height on the retentiveness of these cements.Materials and Methods:A master stainless steel mold was used to mount snappy abutment-implant analog complex in acrylic resin. A total of six snappy abutments (Nobel Biocare®) of 4 mm and 5.5 mm height with their analogs were used. A total of 66 ceramill® Sintron metal copings fabricated using computer-aided design/computer-aided manufacturing system and divided into six groups (n = 11) according to the height (three 4 mm abutment and three 5.5 mm abutment). The cements that were compared were a Noneugenol zinc oxide provisional cement (Temp-Bond™ NE), a Noneugenol temporary resin cement (Premier® Implant Cement) and a resin based acrylic urethane cement (Implalute® Implant Cement). After cementation samples were immersed in artificial saliva for 7 days and subjected to a pull-out test using a universal testing machine at a crosshead speed of 1 mm/min. The load required to de-cement each coping was recorded and analyzed using one-way ANOVA, post hoc multiple comparison, and independent t-test.Results:Noneugenol temporary resin cement had the highest tensile strength followed by noneugenol zinc oxide cement and the least retentive strength was observed in resin-based acrylic urethane cement.Conclusion:The results suggest that noneugenol temporary resin cement may be considered as a better choice for cementation of implant prosthesis, as it has shown to have better mechanical properties.

Evaluation of the success rate of cone beam computed tomography in determining the location and direction of screw access holes in cement-retained implant-supported prostheses: An in vitro study

Statement of problemCement-retained implant-supported restorations have advantages over screw-retained restorations but are difficult to retrieve. Identifying the approximate location of the screw access hole (SAH) may reduce damage to the prosthesis. PurposeThe purpose of this in vitro study was to evaluate the ability of cone beam computed tomography (CBCT) imaging to determine the location and direction of SAHs in cement-retained implant prostheses. Material and methodsFive clear acrylic resin casts were made based on a mandibular model. Several implant osteotomies (n=30) were created on the models with surgical burs, and crowns were made using the standard laboratory method with a transfer coping and the closed tray impression technique. CBCT images from the acrylic resin casts were evaluated by a maxillofacial radiologist who was blind to the locations and angles of the osteotomies. The locations of the access holes were determined on multiplanar reconstruction images and transferred to the clinical crown surface as defined points. Based on cross-sectional images, the predicted angle of the access hole was provided to a prosthodontist who was requested to pierce the crown at the proposed location in the specified direction. If the location and/or direction of the access hole were found, the process was considered successful, as the crown could then be removed from the implant abutment through the SAH. The success rate in the detection of the location and direction of the SAH was calculated, and chi-square and Fisher exact tests were applied for data analysis (α=.05). ResultsAccording to the results of this study, the success rate of CBCT to define the location of SAHs was 83.3% and 80% to determine the direction. No significant differences were found among the different dental groups in determination of the location (P=.79) or the direction (P=.53) of the SAHs. Most of the failures in determining the location and direction of the access hole in the buccolingual and mesiodistal directions were in the buccal and mesial locations of the SAH. The success rate of using CBCT to determine the location of SAHs in straight abutments was 100%. A significant difference was found between angled and straight abutments (P=.042). ConclusionsUsing CBCT could help determine the direction and location of SAHs in clinical situations.

A method of locating the abutment screw access channel with cone-beam computed tomography and a 3D-printed drilling guide

In managing loose abutment screws, locating precisely the position of the screw access channel is difficult. This technique describes the use of cone-beam computed tomography (CBCT) and surgical guide planning software to locate the screw access channel with the intention of retrieving a loosened cement-retained implant-supported prosthesis. The method minimizes damage to the abutment crown assembly.

Sealing the Screw Access Channel with Polytetrafluoroethylene Tape: Advantages of the Technique.

The aim of this article is to describe the procedure for sealing the screw access channel using plastic tape, polytetrafluoroethylene, in screw- or cement-retained implant-supported prostheses. This technique is viable and easily performed, and the functional and esthetic results are satisfactory.

Screw- vs. Cement-retained Implant-supported Prosthesis in Partially Edentulous Patients: An Oral Health Technology Assessment Report.

Understanding the morbidity events, incidence, and cost associated with each type of retention system used for implant supported prosthesis will help the clinician in better decision making. This study assessed the clinical and cost-effectiveness of the screw- and cement-retained implant-supported single crown and fixed partial denture for the replacement of teeth in partially edentulous jaws, from a health services perspective. A systematic literature search conducted in 10 databases, complemented by 4 journal databases and International Association for Dental Research abstracts, identified 92 studies on the single crown and 40 studies on the fixed partial denture. Minor and major technical complication events, as well as failure events, were extracted from strong- and medium-quality studies. Studies based on similar designs were pooled with a random-effects Poisson regression model. A decision tree was developed to estimate the cost-effectiveness over a 15-y period posttreatment. The initial and maintenance costs to treat technical complication events were based on an American Dental Association survey of 2011 to 2012. Probabilistic sensitivity analysis was used to examine the uncertainty in the data input parameters. Clinical evidence generated from the meta-analysis suggested no statistical difference between the 2 retention systems. The cost-effectiveness is presented as an incremental cost-effectiveness ratio. The evidence from this report suggests that cement retention is the more cost-effective strategy as compared with screw retention prosthesis. Knowledge Transfer Statement: Evidence generated by this study will help clinicians make an appropriate cost-effective treatment decision in choosing the retention system for partially edentulous patients.

Management of a Fractured Multiunit Maxillary Implant-Supported Fixed Prosthesis with Stripped Abutment Screws Using a Hybrid Cement-Retained and Screw-Retained Design: A 5-Year Follow-Up Clinical Report.

Fracture and loosening of implant-supported prostheses (ISPs) are complications encountered in routine dental practice. In the present report, management of a fractured maxillary full-arch cement-retained (CR) fixed dental prosthesis supported by six implants is presented. Due to stripped screws, complications were encountered that prevented the retrieval of two of the six abutment screws, which was managed by using a hybrid retention approach, whereby a single full-arch CR and screw-retained (SR) ISP was used. The techniques used to successfully retrieve four of the abutment screws are described. The final retention design involved a combination of three CR and three SR restorations, which offers the advantages of both retention designs.

Cement Selection for Cement-Retained Implant-Supported Prostheses: A Literature Review.

Cement-retained implant-supported prostheses are widely used for restoring missing teeth; however, they show some complications in comparison to screw-retained restorations, such as difficulty in retrieving the restoration and biocompatibility of cement. Therefore, the practitioner should consider several important aspects when using this type of restoration. In this regard, one major concern is appropriate cement selection, with considerations including cement biologic compatibility, methods for limiting the excess cement, ease of removing the excess cement, radiographic view of the cement, and also the possibility of future retrieval of the prosthesis. The aim of this review article was to address most aspects related to this type of prosthesis in terms of cementation.

Effects of Screw- and Cement-Retained Implant-Supported Prostheses on Bone: A Nonlinear 3-D Finite Element Analysis.

To compare the stresses and displacements on perimplant bone generated by screw- and cement-retained prostheses using the finite element method. Two models were constructed: partial fixed implant-supported prostheses with three elements retained by screws (SFP) or cement (CFP). Vertical and oblique loads of 100 N were applied on the models. Bone was analyzed by the principal stresses σ1 and σ3. The displacement between the implant and the bone was identified by the penetration and gap. Results showed a similar pattern in the distribution of the principal stresses between both prostheses. Under the σ1 stresses, the SFP showed similar values in the bone compared with the CFP. The analysis of the σ3 showed stress peaks 28% higher in the SFP, considering vertical and oblique loads. Displacement analysis showed a similar pattern and similar values between the prostheses for penetration and gap under both loads. There were no important differences in the σ1 analysis and the displacement between the SFP and CFP. The differences in marginal bone level reported between SFP and CFP in some clinical studies may not be related to a mechanical factor.

Compressive resistance of abutments with different diameters and transmucosal heights in Morse-taper implants.

The aim of this study was to evaluate the compressive resistance under oblique loads of abutments with two different diameters and transmucosal heights used for cement-retained implant-supported prostheses in Morse-taper implants. Forty Morse-taper implants were divided into four groups with different abutment sizes for cement-retained prostheses in order to perform the compressive test. The groups were divided by abutment diameter and transmucosal height as follows: Group 1: 4.5 x 2.5 mm; Group 2: 4.5 x 3.5 mm; Group 3: 3.3 x 2.5 mm; and Group 4: 3.3 x 3.5 mm. An oblique compressive loading test was performed on each sample located in a platform at 30° using a universal testing machine with a load cell of 1,000 kgf and 0.5 mm/min speed until achieving the deformation of abutment's neck. The compressive resistance and its mechanical behavior were recorded for each group and the data were analyzed using ANOVA, the Shapiro-Wilk and Scheffé tests. In addition, the detailed damage of all samples was recorded with a conventional camera linked to the endoscopic equipment. Significant differences were observed among the groups, except between Groups 2 and 3 (p>0.005). All the abutments showed permanent deformations in the upper region and at the transmucosal portion, but the threads of the screws were intact. Fractures were only identified in Groups 3 and 4. Stronger mechanical behavior and compressive resistance was observed in the abutments with 4.5 mm diameter and 2.5 mm transmucosal height.

Biomechanical evaluation of screw- and cement-retained implant-supported prostheses: A nonlinear finite element analysis

The mechanical stability of the prosthetic components in the implant-prosthesis complex is essential to the long-term success of the restorations. However, little is known about the differences in the biomechanical behavior of screw- and cement-retained prostheses. The purpose of this study was to compare the preload maintenance, stresses, and displacements of prosthetic components of screw- and cement-retained implant-supported prostheses by using the finite element method in a nonlinear analysis. Two 3-dimensional models were constructed: implant-supported fixed partial prostheses with 3 elements retained either by screws (SFP) or cement (CFP). After the simulation of screw tightening, the preload was calculated for both prostheses. Then vertical and oblique loads (100 N) were applied on the models. The preload was identified, the maximum von Mises equivalent stresses (SEQV) were obtained on the screws, and the displacement among the abutment, the implant, and screw was identified by observing the penetration and gap in the contact interfaces. Under vertical load, there was a higher decrease in the preload and in the SEQV on the screw in the SFP. Under oblique load, the SEQV was 24% higher on the screw of the SFP. In the displacement analysis under vertical load, penetration was concentrated in the threads of the screw in the SFP and between the abutment and implant in the CFP. The gap was 118% greater for the SFP and was concentrated on the abutment extension. Under oblique load, the displacement pattern was similar for both prostheses, but with values 66% higher for penetration and 96% higher for gap for the SFP. The SFP showed a higher biomechanical risk of failure than the CFP.

A technique for retrieval of cement-retained implant-supported prostheses

Predictable retrievability of cement-retained prostheses has been a clinical concern. This article presents a technique that describes an implant restoration design which will allow predictable removal of cement-retained implant-supported prostheses.

Cementable Implant-Supported Prosthesis, Serial Extraction, and Serial Implant Installation: Case Report

Cement-retained implant-supported prostheses are particularly indicated where access for screw placement is limited or impossible like in posterior locations or where there is limited jaw opening. The patient in this case report suffered from limited jaw opening as a result of a long history of temporomandibular joint ankylosis related to hemophilia. Cement-retained implant-supported prostheses coupled with serial extraction, serial implant installations, and chairside provisional restorations made uneventful treatment possible.