A few months ago I received a referral for “Bone loss around implant”. Typically if I am going to treat an ailing fixture I will remove the crown to allow for easier primary closure over the treatment site. Clearly this was a cement retained crown… In this case the patient was treated years ago when cement retained restorations were more common yet folks were terrified to place an instrument anywhere near an implant surface. Aside from the fact that many have completely abandoned cement retained crowns in favor of screw retained or screwmented I am wondering if this fear of touching an implant surface still exists within the profession. I have always subscribed to the theory that they should be treated just like crowns on teeth as we are pretty good at removing the residual cement from these but the dissimilar metal/galvanic reaction fear has always prevailed within the profession. Given that implant fixtures are titanium and the restorative components that they attach to are made of a variety of alloys is it reasonable to assume that using our tools to adequately remove cement is actually not a sin. For the record I prefer screw retained restorations when possible but I sure do like the simplicity of cement retained crowns on a tissue level fixture with the margin properly placed.
If it’s a PFM based crown, Zinc phosphate cement can be used. Radiographically visible, zinc inhibits bacterial growth in case of excess cement left behind or undetected. If i remember correctly Zinc phosphate was introduced in 1879.
Just food for thought.
But how would someone who subscribes to the theory of not touching an implant surface with a metal instrument clean the excess zinc phosphate? I agree with you but a lot of the docs that refer to me are still terrified to use an explorer anywhere near an implant fixture…
I guess continuing education could help.
there’s even clinicians afraid of treating pregnant patients. Some clinicians, there isn’t enough CE to help them correct erroneous information taught by faculties in dental school. And some clinicians are so afraid of being liable for something they didn’t do that they just don’t even want to touch it. but cement in implant crown is difficult to clean. bc it can sink deep into the sulcus to bone level and pt usually not numbed. that looks like a trilobe platform and from your driver in the access hole, the implant is placed pretty straight. should have been easily a screw retained crown. well. i guess you converted to a screw retained crown. how did the PA and bone loss look?
It is not my intent to criticize the decision of the provider who cemented this crown as it was done at a time when cement retained restorations were favored. 20 years ago when I first started placing implants cement retained restoration were the norm and we despised the thought of screw retained because it took forever to deliver one. While I was not involved in either the placement or the restoration of this case I can certainly relate to, and sympathize with, the decision to cement the restoration as I know the atmosphere and time period in which it was completed. Times have changed but I am curious if the mentality about touching an implant with an instrument has changed as well.