What’s the current consensus on the best cement for implant crowns?
This question was submitted by a general dentist: What’s the current consensus on the best cement for implant crowns?
Dr. Joseph Fava and Dr. Suham Alexander prepared this quick initial response.
Today, clinicians can choose between cement or screw-retained implant restorations. Cemented restorations have gained popularity for various reasons (1 – 5):
- More easily achieved passive superstructures.
- Less complex correction of non-passive superstructure.
- Simpler axial loading.
- Possible use of traditional core supported crown and bridge techniques.
- Possible use of traditional prosthetic laboratory techniques.
- Decreased technical complications, such as fracture of veneering porcelain or acrylic.
- Simplified esthetics.
Currently, there are several luting agents in the market which serve different clinical purposes. The choice of cement will be influenced by the fine balance between retention and retrievability requirements of a particular restoration. A host of mechanical factors including: distribution and number of abutments, fit of the superstructure, as well as the resistance/retention form of the implant abutment have an impact on the choice of cement used.
Generally, cements are categorized as permanent or provisional luting agents. Permanent luting agents (zinc phosphate, glass ionomer, and resin-based cements) have excellent strength and are recommended for use with single units. Provisional cements, on the other hand, may be better suited for multiple-unit implant-supported restorations or those that may require retrieval. Temporary cements are also known to have weaker retentive strengths. (2)
Although zinc phosphate is a popular cement choice, it makes retrievability very difficult and clinically, the maintenance of a dry field during placement is essential given its solubility in the oral environment. Conversely, resin cements have low water solubility but cleaning excess cement from the restoration(s) is more laborious.
The most practical answer to this question is that there is no clear consensus in the literature as to which cement should be used. When cementing a prosthesis, it may be best to use temporary cement to aid with retrievability. If the implant prosthesis loosens within 1 year, you should then consider recementing it with a permanent cement. Retraction cord should be inserted prior to cementation and removed when the cement reaches the gel phase to facilitate removal of excess cement. This will also help minimize any potential biological complications to the implant.
References
- Gultekin, P, Gultekin, BA, Aydin, M, Yalcin, S. Cement Selection for Implant-Supported Crowns Fabricated with Different Luting Space Settings. Journal of Prosthodontics. 2013. 23:112-119.
- Kheur, MG, Parulekar, N., Jambhekar, S. Clinical Considerations for Cementation of Implant Retained Crowns. IJDA 2(2), April-June 2010.
- Misch, CE. Dental Implant Prosthetics. 2005. Elsevier-Mosby. St. Louis, Missouri.
- Pan,Y-H, Lin, C-K. The Effect of Luting Agents on the Retention of Dental Implant-Supported Crowns. Chang Gung Med J. 2005. 28(6):403-410.
- Fava, J. Comparing Screw Retention and Cement Retention in Implant Prosthodontics. Spectrum Implants Vol 5 No.2 2014
Dr. Joseph Fava completed his undergraduate dental degree, his masters degree and prosthodontic specialty program at the University of Toronto. The main focus of his masters program was related to the topic of dental implants in the aesthetic zone. Dr. Fava instructs in the Implant Prosthodontic Unit at the University of Toronto and is actively involved in clinical research. His scope of practice includes cosmetic dentistry, surgical and prosthetic components of dental implants as well as advanced restorative and reconstructive full mouth therapies. He is a distinguished Kois Mentor and Co-director of the University of Toronto’s Implant Residency Program. Currently, Dr. Fava maintains a private prosthodontic specialty practice in the Yorkville area of Toronto with emphasis and focus on aesthetic and implant dentistry.
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Could you please post some information regarding what is the best cement material for full porcelain crowns in different teeth: vital, non vital/with enamel in margins and no enamel?
Thank you for your inquiry Dr. Saeidi. I will seek and answer and get back to you as soon as I can.
JCDA Oasis Team
I tend to agree that if there is a question of retievability, a temporary cement may be considered…but how often would this be the case?
When placing crowns on implants, I would like this to be a “permanent” step. In my early days of placing implant crowns, I was following the recommended use of temporary cements as the permanent cement (Nobel), but soon abandoned their use when the crowns would work their way loose.
Also,especially for posterior crowns, I find screw-retained ones to be more reliable, and in the case of retievability, MUCH easier to accomplish. Albeit a few more steps and a bit of a compromised occlusal Re:esthetics (composite rest in access hole vs porcelain of the crown), I feel the crown is more secure and less likely to loosen with time.
I would like to know how much time it takes to cement crown on implant? When is it possible?