Restorative Options That Eliminate or Reduce the Potential for Cement-Induced Peri-implant Disease

Abstract

With the knowledge that cement-retained restorative options for treating implant sites may increase the risk for disease, screw-retained solutions are being considered. Dealing with the screw access channel esthetics and ability to control occlusal force has been considered the primary motivation for the use of cement-retained implant restorations. The implant crown with an esthetic plug was published to offer a solution to this problem. Using currently available materials, any dental laboratory capable of pressing ceramic porcelains can use this design and improve both the esthetics and occlusal contacting site. The cement-screw restoration is described as another alternative. This takes advantage of extraoral cementation of the restoration onto the abutment, which negates the problem of pushing cement down into the vulnerable soft tissues, and then using the screw(s) to lock the crown or bridge to the implant body.

Where esthetic demands are high and the screw channel angulation an issue, using supragingival margins that allow for ceramic to ceramic bonding is described in the implant crown with an esthetic adhesive margin section. This design uses porcelains that are bonded and matched producing a highly effective result.

Implant companies are also developing new abutment designs to further promote the use of screw-retained restorations. Using novel screwdrivers and funneling the screw around angle changes appear to be a promising solution for the future.