Removal Of Cement Research Articles

Cement leakage following percutaneous kyphoplasty in a patient after a posterior lumbar fusion: a case report

BackgroundPercutaneous kyphoplasty (PKP) has become an important minimally invasive surgical technique for fracture stabilization and pain relief in patients with vertebral compression fractures. However, intraspinal cement leakage following PKP is a serious postoperative complication that can lead to morbidity and mortality.Case presentationWe describe an uncommon case of epidural leakage of bone cement in an 81-year-old woman who underwent posterior lumbar decompression and fusion from L3–5 4 years prior and had an unremarkable postoperative course. The patient was admitted to Peking Union Medical College Hospital with complaints of muscle weakness and severe low back pain radiating to the left thigh 1 week after PKP of L5 due to an acute osteoporotic compression fracture. Computed tomographic imaging revealed massive leakage of cement into the spinal canal at L5-S1, and therefore, surgical decompression and removal of epidural cement were performed carefully without causing a dural tear. She improved remarkably and no neurologic deterioration was observed in the postoperative period during the one-year follow-up.ConclusionsWe present the rare reported case, to our knowledge, of epidural cement leakage after PKP at the segment of internal fixation and discuss the most likely etiologies and preventive measures for this condition.

Advanced therapeutics for peri-implant problems

When bone loss is present around a dental implant, advanced diagnosis and treatment are necessary. Excess cement is a known cause of peri-implant disease and should be ruled out as a first step. If cement is present, it should be removed with a curette, not an ultrasonic scaler. The dental endoscope can aid the clinician with cement removal using a non-surgical approach. Occasionally, surgical access with a videoscope is necessary for cement removal and/or treatment of the implant surface. Surgical treatment that is not aimed at regeneration is similar to osseous surgery around natural teeth. This is a predicable approach but yields unaesthetic results. Regeneration of bone and re-osseointegration of the implant is unpredictable and the surgical methods used are controversial.

Novel Digital Technique to Quantify the Area and Volume of Cement Remaining and Enamel Removed after Fixed Multibracket Appliance Therapy Debonding: An In Vitro Study.

The aim of this study was to construct a novel, repeatable, reproducible, and accurate measurement protocol for the area and volume of the remaining cement after removal of fixed multibracket appliances, the area and volume of remaining cement after cement removal, the area and volume of enamel removed after cement removal, and the volume of cement used to adhere fixed multibracket appliances. A total of 30 brackets were cemented and removed with over 30 extracted teeth embedded into three experimental models of epoxy resin. The models were scanned before and after bracket placement, bracket debonding, and polishing the remaining cement. The brackets were submitted to micro-computed tomography. The standard tessellation language digital files were aligned, segmented, and re-aligned using geomorphometric software. The digital measurement technique accuracy, repeatability, and reproducibility were analyzed using Gage R&R statistical analysis. The variability attributable to the area and volume measurement techniques of the total variability of the samples was 0.70% and 0.11% for repeatability, respectively, and 0.79% and 0.01% for reproducibility, respectively. The re-alignment procedure is a repeatable, reproducible, and accurate technique that can be used to measure the area and volume of the remaining cement after removal of fixed multibracket appliances, the area and volume of remaining cement after cement removal, the area and volume of enamel removed after cement removal, and the volume of cement used to adhere the fixed multibracket appliance.

Staged Revision of Infected-hip Arthroplasty Using an Antibiotics-loaded Intra-articular Cement Spacer: Impact on Cemented and Cementless Stem Retention.

PurposeCurrently, standard management of a peri-prosthetic infection is a two-stage revision precedure. However, removal of well-fixed cement is technically demanding and associated with numerous potential complications. For theses reasons, two-stage revision with preservation of the original femoral stem can be considered and several previous studies have achieved successful results. While most prior studies used cemented stems, the use of cementless stems during arthroplasty has been gradually increasing; this study aims to assess the comparative effectiveness of a two-stage revision of infected hip arthroplasties at preserving cemented and cementless stems.Materials and MethodsBetween December 2001 and February 2017, Inje University Sanggye Paik Hospital treated 45 cases of deep infections following hip arthroplasty with a two stage revisional arthroplasty using antibiotics-loaded cement spacers. This approach was applied in an effort to preserve the previously implanted femoral stem. Of these 45 cases, 20 were followed-up for at least two years and included in this analysis. Perioperative clinical symptoms, radiological findings, function and complications during insertion of an antibiotics-loaded cement spacer were analyzed in this study.ResultsPeri-prothetic infections were controlled in 19 of the 20 included cases. Clinical outcomes, as assessed using the Harris hip score, Western Ontario and McMaster University score, also improved. Importantly, similarly improved outcomes were achieved for both cemented and cementless femoral stems.ConclusionIn cases of deep infection following hip arthroplasty, two-stage revision arthroplasty to preserve the previously implanted femoral stem (cemented or cementless) effectively controls infections and preserves joint function.

Repair of lateral calcaneal wound with the lateral supramalleolar flap pedicled with the end perforator of peroneal artery

Objective To explore the method and effect of repairing the soft tissue defect of the lateral heel with the retrograde lateral supramalleolar flap pedicled with the end perforator of peroneal artery. Methods From May, 2015 to February, 2018, 16 cases of lateral calcaneal soft tissue defect were repaired with the retrograde lateral supramalleolar flap pedicled with the end perforator of peroneal artery. All wounds were treated with one-stage dilatation and VSD to control infection. In cases of chronic calcaneal bone infection, the bone defect formed after extensive resection of infected bone was temporarily filled with antibiotic bone cement. The area of soft tissue defect on the lateral heel was 3.0 cm×2.0 cm-8.0 cm×5.0 cm, and the area of flaps was 3.5 cm×2.5 cm-8.5 cm×5.5 cm. The small donor area of the flap was sutured directly, and the larger area was repaired by skin grafting. Patients with chronic calcaneal bone infection underwent bone cement removal and autogenous bone transplantation after inducing membrane formation 6 to 8 weeks after flap transplantation. All cases were followed-up, including 7 cases outpatient follow-up and 9 telephone follow-up. Results All the 16 flaps survived smoothly. The donor and recipient areas of the flaps healed primarily. All cases were followed-up for 3 to 13 months. The flaps had good shape, no swelling, similar color to heel skin and no pigmentation. Ankle flexion and extension were not restricted. Four cases with chronic osteomyelitis of calcaneus healed well after second-stage bone grafting, with an average healing time of 8.5 months. Conclusion The retrograde lateral supramalleolar flap with the end perforator of peroneal artery is an ideal method for repairing the soft tissue defect on the lateral heel with simple operation and reliable blood supply. Key words: Lateral supramalleolar flap; Perforator of peroneal artery; Repair; Heel wound; Microsurgical technique

Application of Poly-γ-Glutamic Acid Flocculant to Flocculation–Sedimentation Treatment of Ultrafine Cement Suspension

We examined the effect of poly-γ-glutamic acid flocculant (PGAF) on the removal of ultrafine cement (UFC) particles stabilized by a poly-carboxylate co-polymer, which is a superplasticizer (SP). The flocculation–sedimentation treatment with PGAF successfully removed the SP-stabilized cement particles through the gravitational settling of the formed flocs. The removal efficiency reduced with the increase in the ionic strength, probably because of the shrunk form of poly-γ-glutamic acid (γ-PGA) at high ionic strengths. Increasing the mixing intensity during rapid mixing improved the removal efficiency. A series of flocculation–sedimentation experiments provided a diagram showing the relationship between ionic strengths and the addition amount of PGAF. Our results suggest that PGAF is a good candidate for the purification of cement suspension by flocculation–sedimentation, and a better removal performance can be obtained at lower ionic strengths with intense rapid mixing. From the diagram of the control charts presented in this study, we can determine the optimal addition amount of PGAF for achieving the target removal rate for cement suspension under any ionic strength.

On-line measurement and monitoring of pulsating saline and water jet disintegration of bone cement with frequency 20 kHz

This paper deals with performance analysis of disintegration of polymethylmethacrylate using pulsating liquids jet with different density with frequency 20 kHz using condition monitoring. The influence of the liquid on the cutting depth was studied by using contactless measurement device MicroProf, FRT. The cutting depths were compared to studies that used a continuous water jet to assess the volume flow reduction. On-line condition measurement was used for controlling the disintegration process without compromising the structural integrity of neighbouring materials. With a flow rate of 0.54 l/min, a maximum disintegration depth of 1.3 mm and material removal of 0.4 mm3 was obtained using physiological saline and 1.1 mm and 0.2 mm3 for water. Continuous jets required approximately 1.0 l/min to reach similar cutting depths. Hence, a pulsating liquid jet enhances the cutting capacity with reduced flow rate. Signal strength for individual pressures 7–10 MPa is not significant, but signal increases during significant bone cement removal. The results open new avenues for research a minimally invasive and non-thermal technique for on-line controlled processes for medical purposes.

Effect of temporary cement removal methods from human dentin on zirconia-dentin adhesion

This study evaluated the effect of temporary cement residue removal methods from human coronary dentin on the bond strength of adhesively-luted zirconia on dentin. Forty non-carious human molars were embedded in acrylic resin and the dentin surfaces were exposed. Temporary acrylic crowns were provisionally cemented with zinc oxide cement without eugenol and stored in distilled water (37 °C/15 days). After crown removal, the excess temporary cement was removed from dentin according to one of the following cleaning methods: (n = 8 per group): (a) air-water rinse (AW), (b) pumice paste (PP), (c) air-abrasion with aluminum oxide particles (Al2O3) (AA), (d) sodium bicarbonate spray (SB) or (e) glycine powder (CP). Forty zirconia cylinders were made and each cylinder was adhesively luted onto each tooth after adhesive resin (Scotch Bond Universal, 3 M ESPE-SBU) application using resin cement (RelyX Ultimate, 3 M ESPE) and photo-polymerized from each surface for 20 s. The bonded specimens were stored in distilled water (37 °C) for 90 days. The bonded interface was loaded under shear (1 mm/min). Data (MPa) were analyzed using 1-way ANOVA and Tukey's test (α = 0.05). Mean bond strength was significantly affected by the cleaning method (p = 0.0289). Cleaning with AA method resulted in significantly higher bond strength than with SB (p < 0.05) but similar to CP, PP and AW (p > 0.05). All cleaning methods were effective in removing temporary resin cement from dentin surfaces. Air-abrasion with aluminum oxide particles was more effective than with sodium bicarbonate spray promoting adhesion between zirconia and dentin.

Ultrasonic cement removal in cement-in-cement revision total hip arthroplasty: What is the effect on the final cement-in-cement bond?

ObjectivesPrevious studies have evidenced cement-in-cement techniques as reliable in revision arthroplasty. Commonly, the original cement mantle is reshaped, aiding accurate placement of the new stem. Ultrasonic devices selectively remove cement, preserve host bone, and have lower cortical perforation rates than other techniques. As far as the authors are aware, the impact of ultrasonic devices on final cement-in-cement bonds has not been investigated. This study assessed the impact of cement removal using the Orthosonics System for Cemented Arthroplasty Revision (OSCAR; Orthosonics) on final cement-in-cement bonds.MethodsA total of 24 specimens were manufactured by pouring cement (Simplex P Bone Cement; Stryker) into stainless steel moulds, with a central rod polished to Stryker Exeter V40 specifications. After cement curing, the rods were removed and eight specimens were allocated to each of three internal surface preparation groups: 1) burr; 2) OSCAR; and 3) no treatment. Internal holes were recemented, and each specimen was cut into 5 mm discs. Shear testing of discs was completed by a technician blinded to the original grouping, recording ultimate shear strengths. Scanning electron microscopy (SEM) was completed, inspecting surfaces of shear-tested specimens.ResultsThe mean shear strength for OSCAR-prepared specimens (33.6 MPa) was significantly lower than for the control (46.3 MPa) and burr (45.8 MPa) groups (p < 0.001; one-way analysis of variance (ANOVA) with Tukey’s post hoc analysis). There was no significant difference in shear strengths between control and burr groups (p = 0.57). Scanning electron microscopy of OSCAR specimens revealed evidence of porosity undiscovered in previous studies.ConclusionResults show that the cement removal technique impacts on final cement-in-cement bonds. This in vitro study demonstrates significantly weaker bonds when using OSCAR prior to recementation into an old cement mantle compared with cement prepared with a burr or no treatment. This infers that care must be taken in surgical decision-making regarding cement removal techniques used during cement-in-cement revision arthroplasty, suggesting that the risks and benefits of ultrasonic cement removal need consideration.Cite this article: A. Liddle, M. Webb, N. Clement, S. Green, J. Liddle, M. German, J. Holland. Ultrasonic cement removal in cement-in-cement revision total hip arthroplasty: What is the effect on the final cement-in-cement bond? Bone Joint Res 2019;8:246–252. DOI: 10.1302/2046-3758.86.BJR-2018-0313.R1.

Commentary on: Ultrasonic cement removal in cement-in-cement revision total hip arthroplasty: What is the effect on the final cement-in-cement bond?

Commentary on: Ultrasonic cement removal in cement-in-cement revision total hip arthroplasty: What is the effect on the final cement-in-cement bond?

Cannulated System for Sequential Intramedullary Cement Extraction From Humerus During Revision Shoulder Arthroplasty

Removal of the cement mantle during revision shoulder arthroplasty is often challenging. Previous techniques utilizing a humeral window or split osteotomy have been described. These techniques can be technically challenging, put the patient at risk for nonunion or fracture, and require implants or sutures for fixation. Intramedullary techniques have been described including the use of specialized osteotomes or cement splitters as well as the use of ultrasonic cement extraction devices. However, concerns related to fracture and thermal damage to neurovascular structures remain a concern. Here we describe an intramedullary technique for cement removal utilizing a cannulated system for sequential removal of the cement mantle and cement plug from within the humeral canal after the cemented implant has been removed. This technique allows for a mechanical method of efficient cement extraction that utilizes common instruments and does not require an osteotomy or window, and has a limited risk of fracture and neurovascular damage.

A New Cement Removal Method for Cemented Type Implant Superstructures and Its Evaluation Using Various Types of Temporary Cement

A New Cement Removal Method for Cemented Type Implant Superstructures and Its Evaluation Using Various Types of Temporary Cement

Comparison of the effects of cement removal from zirconia and titanium abutments: An in vitro study

Statement of problemExcess cement around dental implants is a significant cause of peri-implant inflammation. Research has focused on approaches to cement removal, the type of cement used, and the different instruments used for cement removal with titanium abutments. However, data comparing zirconia with titanium abutments are lacking. PurposeThe purpose of this in vitro study was to compare the effectiveness of excess cement removal from zirconia and titanium custom abutments using an explorer and to compare the effects of cement removal on the abutment surfaces. Material and methodsImplant analogs were placed in a cast in the position of the 2 maxillary central incisors. After creating similar emergence profiles for both the implant abutments, 18 zirconia and titanium custom abutments were fabricated with 1-mm subgingival finish lines on the facial and interproximal areas and an equigingival finish line on the palatal side. The crowns were cemented with zinc oxide-eugenol cement, and a steel explorer was used to remove the excess cement. All abutments were analyzed under a scanning electron microscope for cement remnants and scratches. ResultsThe mean surface area of cement remnants on the zirconia abutments was 778 ±113 μm2, and for titanium abutments, it was 1123 ±252 μm2, which in terms of the mean percentage area was 3.27% of the total surface area of zirconia and 4.71% of titanium abutments. Only a few abutments from each group showed scratches, and no deep scratches or gouges were observed. ConclusionsZirconia and titanium abutments had statistically similar cement remnants. Scratches were observed on only a few specimens.

Fourteen-year experience with short cemented stems in total hip replacement.

The age of the population requiring total hip replacement (THR) is increasing and this may lead to a return of cemented stems. Advantages of a short cemented femoral device include preservation of metaphyseal bone, easier insertion, and easier cement removal in case of revision. The purpose of this study is to describe the rationale and assess midterm results of unique innovative short cemented double-tapered polished stem applied with contemporary cementing techniques. Our experience with this short cemented stem includes two different groups of elderly patients. Group 1 (prototype version of the short stem) from January 2005 to January 2008 counts 43 THR. Group 2 (final commercial version of the short stem) from January 2013 to January 2015 counts 54 THR. The average age in groups 1 and 2 was 79 and 75 respectively. Patients underwent clinical follow-up with the Harris Hip Score (HHS) and completed radiographic evaluation. Thirty-one patients of group 1 had died for reasons unrelated to their THR. The surviving 9 hips have a follow-up of 11.2years. In group 2, eight patients died for reasons unrelated to their THR. Follow-up for the surviving 40 patients is 4.6years. HHS improved in both groups. In 34/43 hips of group 1 and in 41/54 of group 2 we observed a Barrack grade A cement mantle. Survival with revision of the stem for aseptic loosening as the endpoint was 100%. This study confirms the effectiveness of a short, polished, collarless, tapered cemented stem implanted with contemporary cementing techniques which appears as successful as the standard sized components.

Antibacterial Effect of a Temporary Cement-Dissolving Liquid.

Methods for removing temporary cement with an antibacterial effect might improve prosthetic treatment prognosis. Three removal methods were assessed: (1) immersion of an acrylic provisional restoration in a temporary cement dissolver (Temp-off); (2) mechanical removal with a dental explorer; and (3) sandblasting. Two temporary cements, one with eugenol (Temp-Bond) and one without eugenol (Temp-Bond NE) and of two thicknesses (100 μm and 250 μm), were examined. Immersion in Temp-off produced the most effective bacterial count decrease compared to the other methods (P < .05). No significant difference was found between the two cement types, although the decrease in count was more evident in the thicker (250 μm) cement layer. Temp-off dissolving liquid used for removal of temporary cement exhibited an antibacterial effect and nonmechanical cleaning ability.

Friday, September 28, 2018 4:05 PM–5:05 PM abstracts: tumor and deformity: 250. Safety and efficacy of fenestrated pedicle screws with cement augmentation for spinal metastases: early experience with 292 screws

BACKGROUND CONTEXT Pedicle screw fixation can be a major challenge in patients with spinal metastases. The osteopenic nature of the vertebrae along with factors like previous radiation, immunosuppression, and marrow replacement by cancer affect the bone quality for fixation. Complications related to cement augmentation are known. We share our initial experience with the fenestrated screws. PURPOSE To demonstrate the efficacy and safety of this new screw technology in challenged fixation environements, specifically vertebral column metastases. STUDY DESIGN/SETTING Retropsective analysis from a prospective spine oncology database at a major cancer center. PATIENT SAMPLE We identified 38 consecutive patients who underwent posterior thoracic, lumbar, or sacral decompression and stabilization for pathologic fracture or cord compression (T1-sacrum) related to metastatic cancer over a 1 year period. OUTCOME MEASURES Preoperative SINS (spine instability neoplastic score), ASIA grade, cancer histology, radiation history, ECOG, and patient demographics were recorded and analyzed in a multivariable regression analysis. Postoperative CT was performed in all cases. CT was reviewed and cement extravasation was recorded at each level of pedicle screw placement in (1) the epidural space, (2) neural foramen, (3) paravertebral space, (4) lung, and (5) nearby vasculature including the segmental vessels and aorta. Complications and instrumentation or implant failure were recorded. Patient reported outcomes measures were recorded prospectively including EQ-5D, PROMIS-pain, PROMIS-disability, PROMIS-depression, Spine Oncology Study Group Questionnaire. METHODS IRB approval was obtained and a retrospective analysis was performed on a prospective spine oncology outcomes database. Fenestrated screws became available at our institution in November 2016. We identified 38 consecutive patients who underwent posterior thoracic, lumbar, or sacral decompression and stabilization for pathologic fracture or cord compression (T1-sacrum). In each case, postoperative CT imaging was performed within 24 hours of surgery. The investigators independently reviewed the studies evaluating for the extent of cement fill and extravasation. Chart review was performed for analysis of implant or construct failure and complications. RESULTS Thirty eight patients were identified and a total of 292 fenestrated screws were placed with an mean 7.21 screws implanted percase. The most common construct was two levels above and two levels below the site of worst vertebral fracture or cord compression. Cement extravasated into the (1) epidural space at six levels (2.97%), (2) neural foramen at three levels (1.49%), (3) paravertebral space at 37 levels (18.3%), (4) lung – 0, (5) nearby vasculature at 15 levels (7.42%). There was no cement spread to the aorta or vena cava. No patients developed a symptomatic radiculopathy from foraminal extent. No patient required reexploration, cement removal, or hardware revision. Follow-up ranged from 1 month to 15 months with no significant change invertebral body height at the instrumented levels by CT and x-ray. CONCLUSIONS Fenestrated screws with cement provide a safe and effective method for stabilization in the cancer patient.

Two stage revision arthroplasty for infected THA with handmade antibiotic impregnated cement hip spacer: A prospective cohort study

Introduction: Periprosthetic joint infection is a serious problem and requires great effort and cost for its treatment. The issues related to this situation are duration of antibiotic, stages of surgery and time of reimplantation of prosthesis. The surgical solution may vary from Antibiotic suppression, Irrigation and Debridement, Head and Liner exchange, One stage exchange, two stage exchange and Resection Arthroplasty. Two stage revision remains the gold standard for the treatment of periprosthetic joint infection after THA. It has seen infection free survival rates of 80-100%. We aim to find the efficacy and cost effectiveness of handmade antibiotic impregnated articulating cement spacer over commercially available prefabricated hip spacer for the treatment of deep periprosthetic joint infection. Material and methods: A total of 23 patients were enrolled in this prospective cohort study. In the two stages of revision, the first stage surgery comprised of removal of infected prosthesis and bone cement, thorough debridement of all infected and necrotic tissue and implantation of handmade articulating antibiotic impregnated cement hip spacer. Antibiotics were given for 6 weeks after first stage surgery based on culture sensitivity. Antibiotics were stopped two weeks prior to second stage to foresee the patient’s response. Routine aspiration of the involved joint was done prior to 2nd stage. The decision to proceed with prosthesis implantation was determined by clinical evaluation, resolution of blood markers (ESR and CRP) and a negative hip joint aspirate. The second stage surgery consisted of removal of cement spacer and implantation of new prosthesis. Patients were evaluated for rate of infection control and hip joint function.Results: The two stage revision total hip arthroplasty with handmade articulating antibiotic impregnated cement spacer was done in 23 patients. The mean age of the patients was 57+_7 years, with 15 male and 8 females. All patients had deep chronic periprosthetic joint infection with increased ESR and CRP level. Coagulase negative staphylococci were the most common pathogen followed by Staphylococcus aureus. The mean time between the two stages is 16-20weeks.All hip cultures were found to be negative before second stage. Three patients had persistent joint infection following the first stage of surgery. In one patient the infection was cured by additional debridement and repeated first stage surgery. In two patents, infection was not cured, Resection Arthroplasty was done. 19 patients were free of infection at an average follow up of 24months. Infection free survival was 82.60% at the end of 2 years. HHS was 82 (Range) at 2 years follow up. Conclusion: After evaluation of our 23 patients we conclude that two stage revision by hand made cement spacer for treatment of infected arthroplasty is an effective means of treating infected THR. Our handmade antibiotic impregnated cement spacer is safe and cost effective and provides effective local antibiotic delivery.

Short Humeral Stems in Shoulder Arthroplasty.

Since the introduction of shoulder arthroplasty by Neer in 1974, the design of not only the glenoid component but also the humeral component used in shoulder arthroplasty has continually evolved. Changes to the design of the humeral component include a gradually disappearing proximal fin; diversified surface finishes (such as smooth, grit-blasted, and porous coating); a more contoured stem from the originally straight and cylindrical shape; and the use of press-fit uncemented fixation as opposed to cemented fixation. Despite the evolution of the humeral component for shoulder arthroplasty, however, stem-related complications are not uncommon. Examples of stem-related complications include intraoperative humeral fractures, stem loosening, periprosthetic fractures, and stress shielding. These become much more common in revision arthroplasty, where patients are associated with further complications such as surgical difficulty in extracting the humeral component, proximal metaphyseal bone loss due to stress shielding, intraoperative humeral shaft fractures, and incomplete cement removal. Physicians have made many attempts to reduce these complications by shortening the stem of the humeral component. In this review, we will discuss some of the limitations of long-stem humeral components, the feasibility of replacing them with short-stem humeral components, and the clinical outcomes associated with short-stemmed humeral components in shoulder arthroplasty.

Evaluation of Effectiveness of Cement Removal From Implant-Retained Crowns Using a Proposed "Circular Crisscross" Flossing Technique.

Extruded cement during dental implant crown cementation may cause peri-implant diseases if not removed adequately. The purpose of this study was to evaluate the efficiency of removal of cement after cementation of implant crowns using an experimental circular crisscross flossing technique (CCFT) flossing technique, compared to the conventional "C"-shape flossing technique (CSFT). Twenty-four patients rendered 29 experimental and 29 control crowns. Prefabricated abutments were secured to the implant such that the margins were at least 1 mm subgingivally. The abutments were scanned using computer-aided design/computer-aided manufacturing technology and Emax crowns were fabricated in duplicates. Each crown was cemented individually and excess cement was removed using the CSFT and the CCFT techniques. After completion of cementation was completed, the screw access holes were accessed and the crown was unscrewed along with the abutment. The samples were disinfected using 70% ethanol for 10 minutes. Crowns were divided into 4 parts using a marker to facilitate measurement data collection. Vertical and horizontal measurements were made for extruded cement for each control and experimental groups by means of a digital microscope. One-hundred and seventeen measurements were made for each group. Mann-Whitney test was applied to verify statistical significance between the groups. The CCFT showed a highly statistically significant result (104.8 ± 13.66, P < .0001) for cement removal compared with the CSFT (291.8 ± 21.96, P < .0001). The vertical measurements of the extruded cement showed a median of 231.1 μm (IQR = 112.79-398.39) and 43.62 μm (IQR = 0-180.21) for the control and the experimental flossing techniques, respectively. The horizontal measurements of the extruded cement showed a median of 987.1 μm (IQR = 476.7-1,933.58) and 139.2 μm (IQR = 0-858.28) for the control and the experimental flossing techniques, respectively. The CCFT showed highly statistically significant less cement after implant crowns cementation when compared with the CSFT.

Effect of removal of temporary cement on zirconia-dentin bond strength

Effect of removal of temporary cement on zirconia-dentin bond strength