Purpose: To assess excess cement removal after cementation of implant-supported cement-retained restorations with different cements. Material and Methods: A dental model with imitation soft tissue, 20 individual zirconium oxide abutments, and 20 zirconium oxide crowns were fabricated. Half of the restorations were cemented using resin cement (RX) and the other half with resin-modified glass-ionomer cement (GC). After cement cleaning, each abutment-crown unit was removed from the model, photographed, and analyzed on four surfaces, resulting in a final sample size of 80 measurements. Radiographic examination and the computerized planimetric method in Adobe Photoshop were used to determine the amount of cement left and evaluate the ratio between the area of cement residue and all abutment-crown surfaces. Significance was set to .05. Results: GC resulted in 7.4% more cement residue on all surfaces (P < .05) than RX. The P value on three surfaces (all except the mesial) was < .05, indicating that the data were statistically significantly different between groups and surfaces. Complete removal of the cement was impossible in all cases (100%), but in 95% of cases, cement remnants could not be detected radiographically. Conclusions: More undetected cement remains when using GC. It was impossible to remove excess of both types of cement completely. Most of the cement remnants were located on the distal surface. Radiographic examination could not be considered as a reliable method to identify excess cement.
Background: Dentists have become more aware of cementation on implants as there is quite a lot evidence in the literature that undetected cement might cause many clinical problems. It has been agreed that safe cementation margin fulfilling aesthetic demands and ensuring removal is up to 1 mm subgingivally. Unfortunately, there is a lack of information what type of cement should be selected in case of cementation, knowing that cements can differ in removal possibilities and even radiographic contrast. Aim/Hypothesis: The aim of the study is to assess cement excess removal possibilities after cementation of implant-supported cementretained restorations in in vitro study while using different cements and to determine radiographic examination reliability while trying to detect residual cement. Materials and Methods: 1 model with interchangeable gum imitation, 20 individual zirconium dioxide abutments, 20 zirconium dioxide crowns, 2 different cements: RX-resin cement (3M ™ RelyX ™ U200 Self-adhesive Universal Resin Cement, 3M ESPE) and GC-resin modified glass ionomer cement (Ketac ™ Cem Plus Luting Cement, 3M ESPE). Ten crowns were cemented using cement RX, another ten using cement GC, afterwards removal of the cement was performed by the same researcher. Following this procedure, the implant model was examined radiographically. After verifying that no residual cement is noticeable, each crown-abutment unit was detached from the implant analog, was photographed and analyzed in 4 surfaces: labial, mesial, palatal and distal, resulting in a final sample size of 80. Computerized planimetric method in "Adobe Photoshop CS6" were used to detect and evaluate ratio between cement residue and entire crown-abutment unit surface. RStudio IDE and IBM SPSS Statistics v. 23 were used for statistical analysis. Results: Cement GC resulted in 7.4% more cement residue on all surfaces (as evidenced by the extremely low P value, P < 0.05) than cement RX. The p value on L, P, D surfaces was <0.05, meaning that data are significantly different between groups and surfaces, variables are related. When measuring each cement separately, the ratio of residues on the surface D was the highest, M-1.1% lower than D, L-2.3% lower than D and P-the lowest (2.7% lower than D). Twenty x-ray images were made after cementation. Cement residuals were found only once on the mesial surface. This was followed by a re-cleaning and a radiographic re-examination. Planimetric examination showed that residual cement was present on all surfaces of the crowns and implant abutments 100% of cases. Conclusions and Clinical Implications: •Impossible to remove both of the cements excess completely. •More undetected cement remains if using glass ionomer resin modified cement. •Most of the cement (regardless of its type) remains on the distal (D) surface, the least-on the palatal (P) surface. •Radiological examination is not an effective method for detecting residual cement.
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