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Int Poster J Dent Oral Med 14 (2012), No. 1     15. Mar. 2012

Int Poster J Dent Oral Med 2012, Vol 14 No 1, Poster 573

Cemented and screwed implant restorations

Language: English
 

Authors:
Assistant Lect. Dr. Ana Petre, Assistant Prof. Dr. Vlad Naicu, Assistant Prof. Dr. Ruxandra Sfeatcu,
University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania

Date/Event/Venue:
November 11-13, 2010
2nd Future Trend in Implantology International Dental Conference FTI
Florence (Italy)
 

Introduction

The most common complication of a cemented implant restoration is loosening of the abutment screw. The retrieval of the crown for accessing the screw is almost impossible without destroying the crown1.
The problems that may occur in case of screw retained prosthesis are mainly determined by the limited possibilities to cast a high quality implant abutment in dental laboratories.
We present a method to design the implant supported restorations, in order to benefit of the advantages of both retaining methods and minimize their disadvantages.

Fig. 1a+b: Advantages and disadvantages
 
Fig. 1c: Advantages and disadvantages
 
 

Material and Methods

A 28-year-old female patient attending in the clinic for the rehabilitation of the fourth quadrant. One implant has been inserted corresponding to the mandibular right second premolar (3.75 X 11,5 mm). Six months later it has been loaded with a metalo-ceramic crown.
One straight titanium abutment was used to support the metalo-ceramic restorations. The crown has been designed with a tunnel for the access to the abutment screw. After the cementation with a definitive glass ionomer cement the access hole has been closed with a "ceramic repair" composite with an opaque base2.
 

Discussions

In cases of screwed restoration the settling effect and the "microgap" are greater than in the cemented ones, due to the roughness of casted surfaces, both of them possible failure causes. Plastic abutments with titanium hex have a deficitary bonding between titanium and castable alloy.
For cemented restorations, the definitive cement can seal, completely and for long term, the voids between crown and abutment and the passive fit is more easily achieved. Unfortunately, we need to retrieve the restoration in case of screw fracture or loosening. Therefore, with a very small modification of a conventional implant supported metalo-ceramic prosthetic structure we can achieve many advantages for a long-term restoration. It works like a cemented restoration and, in the same time, we benefit of an "emergency solution".
The sealing of the screw access hole could be a problem, but the new bonding technology and 6 months recall can solve that.

Fig. 2: Initial clinical situation Fig. 3: Six (6) months later
Fig. 4: Metalo-ceramic crown and titanium abutment Fig. 5: The screw access is closed with Teflon ribbon
Fig. 6: Excess of glass ionomer cement Fig. 7: Etching and silanization
Fig. 8: Opaque base of ceramic repair system Fig. 9: Occlusion checking
Fig. 10: Final - Lateral view
 
Fig. 11: Final - Occlusal view

Conclusions

Due to the advantages driven by the definitive cementation and the possibility to retighten the screw without removing the prosthetic piece, this method can be utilized in following situations:
• Solitaire implant restorations
• Long implant supported bridges
• Mixed bridges (natural & implant abutments)
 

Literature

  1. Bartolomeo Assenza, Antonio Scarano, Giulio Leghissa, Giorgio Carusi, Ulf Thams, Fidel San Roman, and Adriano Piattelli Screw- vs Cement-implant-retained Restorations: An Experimental Study in the Beagle. Part 1. Screw and Abutment Loosening [Journal] // Journal of Oral Implantology. - October 2005. - pp. Volume 31, Issue 5, pp. 242-246.
  2. Ryan C. Taylor Ashraf S. Ghoneim, and Edwin A. McGlumphy An Esthetic Technique to Fill Screw-Retained Fixed Prostheses [Journal] // Journal of Oral Implantology. - December 2004. - pp. Volume 30, Issue 6, pp. 384-385. (Kano SC)
  3. Chee W Jivraj S. Screw versus cemented implant supported restorations. [Journal] // Br Dent J. 2006 Oct 21. -pp.501-7.
  4. Scarano A Assenza B, Piattelli M, Iezzi G, Leghissa GC, Quaranta A, Tortora P, A 16-year study of the microgap between 272 human titanium implants and their abutments [Journal]. - J Oral Implantol. 2005. - pp.269-75.
  5. Kano SC Binon PP, Bonfante G, Curtis DA. The effect of casting procedures on rotational misfit in castable abutments. [Journal] // nt J Oral Maxillofac Implants. 2007 Jul-Aug;22(4). pp.575-9.
     

This Poster was submitted by Assist. Lect. Dr. Ana Petre.
 

Correspondence address:
Dr. Ana Petre
Dental Studio 31
Anton Pann str., Sector 3
030795, Bucharest
Romania