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Dr. George Priest is a prosthodontist in South Carolina, who recently published a literature review that he compiled over the years on the topic of screw-retained single implants. It was a pleasure for me to get to know him and to host him on CDA Oasis. Dr. Priest promised to come back again to present other relevant clinical topics. In the meantime, I hope you enjoy my interview with him! Chiraz Guessaier, CDA Oasis Manager |
Highlights
- There is a trend toward increased use of screw-retained single-implant restorations. A comprehensive literature review was undertaken to examine the data related to screw- and cement-retention and to objectively evaluate the innovations in implant dentistry that have led to this resurgence.
- When comparing the two options, survival and complication rates are similar, bone and soft-tissue levels are comparable, and zirconia offers esthetic advantages for both selections.
- Zirconia abutments with bonded titanium inserts provide esthetic alternatives to titanium abutments for both choices. Bone- and soft-tissue responses are similar, but residual cement of cement-retained restorations is associated with significant soft- and hard-tissue complications.
- The potential weakness of ceramic discontinuity of screw-access openings can be lessened by the incorporation of stronger ceramic materials, such as zirconia and lithium disilicate. The overriding remaining indication for cement-retained restorations is to compensate for angled implants.
Findings
Screw-retained single-implant crowns should be reconsidered for many clinical situations for the following reasons:
- Predictable retention and retrievability
- No potential for the biologic consequences associated with residual cement
- As with cement-retained restorations, the choice between metal ceramics or all ceramics
- Only one margin, at the implant/abutment interface
- A single abutment/crown ceramic margin that can extend gingivally to the implant interface
- Nearly imperceptible blend of a composite resin in ceramic abutment access openings
- One component instead of two, which may simplify the restorative process
Full Interview (8″)
From the presentation, there appears to be nothing new to report, and I guess we should continue to accept the current published complication rates for screwed-in prosthetics. Large reviews – 45%, J Derks et al 2016 – 65% of implants. Can we do better? Refinement of both the screw-in and the cement-in installation techniques could reduce complication rates by 60%, extrapolated from the 2009 TG Wilson’s study. I invite Dr Priest to consider some new information about safer installation procedures at www. ReversMargin.com.. I would be interested in his comments.