In the last couple of years there has been a lot of chatter concerning the effect of residual cement on implant cases: bacteria build-up, peri-implantitis, bone loss, etc. Although there are many methods of managing cement, we would like to offer three.
The number one method of eradicating these issues is, of course, to eliminate cement altogether, and choose screw-retention. We have witnessed a surge in one-piece, screw-retained crowns and bridges. Our most popular is a zirconia/titanium hybrid (TLZ-SR) that is very durable and esthetic and only costs $299.
Another method is to request a two-piece restoration, which includes a custom abutment and a crown designed with a hole in the occlusal or lingual surface. This allows simple clean-up through the following method: seat the abutment using a thumb driver; place a cotton pellet in the access hole of the abutment; insert the crown to check margins, contacts and occlusion; cement the crown in place; remove the cotton pellet before the cement hardens; unscrew the abutment through the hole; remove the crown and abutment together; clean the excess cement; torque down the cleaned restoration, and fill the screw hole with composite. Be sure to have an abutment removal tool, or a driver that can be reversed, when using a friction-fit system, i.e. Zimmer Dental.
A third method is to order a duplicate resin die. This die can be used for “cement pumping”. Here are the steps: torque in the abutment; check margins, contacts and occlusion; place cement in the crown; seat the crown on the duplicate die; clean the excess cement expressed at the margin, and transfer the crown from the die to the mouth.