The dental implant treatment is a revolutionary way to replace missing teeth, which is usually not accompanied by significant complications; But failure to detect residual cement in this process will cause biological side effects. Remaining cement causes several important complications; including the development of peri-implantitis disease. The worst problem with this, is that removing the excess cement is a difficult process and in practice, it is sometimes impossible to remove it from the subgingival margins completely.
One of the research projects that have been done in this field describes a case of cement residue in its report; This event caused the patient not only to develop peri-implantitis, but also involve draining the sinus tract, tenderness on chewing, and tissue contact above the implant-supported restoration. Meanwhile, the important point is that the implant was restored about three years ago and the patient had been suffering from these diseases and problems after this period.
Today, experts consider excess cement as one of the possible risks for peri-implant diseases. Results from 26 publications referring to 21 study groups were published between 1999 and 2016 and comprised 945 subjects with 1010 cemented implant restorations in 10 prospective and eight retrospective studies and eight case reports/series with pronounced heterogeneity of the study designs, show that peri-implant diseases due to excess cement is a common disease among patients who have had dental implants.
Peri-implantitis disease is one of the side effects of remaining excess cement. Peri-implantitis is a destructive inflammatory process that affects the soft and hard tissues around the implant. The soft tissue is inflamed and the hard tissue is destroyed over time. Peri-implant does not occur in all patients and occurs in very rare cases. To prevent this disease, patients are advised to regularly attend dental appointments and ask for recommendations from their dentist if they are concerned about their oral health. On the other hand, the place around the implant is suitable for the accumulation of bacteria, which over time causes inflammation and in acute cases causes gum infection.
Experts also recommend some measures be taken during the treatment process, such as ensuring sufficient access to a crown margin at the level of the mucosal margin to reduce the risk of peri-implant disease associated with excess cement. It also should be ensured that the soft tissue will become mature after a specified period.
Routinely, the edges of the crowns go below the gingiva, making it a challenge to remove excess cement during crown bonding. The reason for this issue is the adhesion and very close contact of the implant tissues with the newly placed coating. Another reason for this problem is also the mismatch between the dimensions and angles of the healing abutment with the final abutment.
One of the ways to reduce this problem is to use a temporary cover for a while and then use an abutment and the final cemented crown. Wherever possible, the implant cover should not be placed deeper than 2 to 3 mm under the gingiva, because otherwise, it will be almost impossible to completely remove the excess cement. The quality and precision of 2 to 3 cm of the depth of the crown entering the gingiva is considered one of the most sensitive tasks of implant specialists and laboratory, which should be done in the best way.
Another important issue is that it should not use too much cement during the process; When a tooth is covered, the issue of additional cement is not very important, but the gingiva structure around the implant is very different from the tooth. It is important to notice that there are ways to remove excess cement including the use of dental floss, periodontal probe, and scaling, and it is better to do these processes before the cement hardens.
The Process of removing excess cement should be done under complete anesthesia of the area and by a probe. The important point is that in the condition of remaining cement for some time, the gingiva becomes inflamed and soft, and edematous, and removing the excess cement possibility results in damaging the tissue. Therefore, the implant specialist must make slow and careful movements to remove the excess cement so they can create the best result without damaging the tissue.
The more important issue is that if the patient has thin gums, it can easily cause gingivitis in aesthetic areas. In these cases, it is recommended that to use plastic probes instead of metal ones because metal devices can cause scratches and dents on the abutment surface, which leads to the accumulation of mass and plaque in the long term.
Since the implant is placed under the gingiva, especially in the anterior areas, it is usually impossible to check the complete and correct seating of the crown with the eye.
Incomplete seating of the crown on the implant abutment creates a step or gap under the gingiva, which is very susceptible to plaque, and ultimately causes chronic inflammation in the tissues around the implant, in cases where the gum is thin, incomplete seating of the crown causes a fistula in the gingiva.
Failure to place the crown correctly on the implant abutment has various reasons, including strong contact with the adjacent tooth, use of a larger size crown, and failure to properly place the abutment on the implant.To avoid these problems, the seating of the crown should be checked by eye wherever possible, and otherwise, a radiograph must be prepared before the further process. If the tissues around the blanch, it can be the reason for the crown not sitting properly.
In cases where there are excess tissues, the laser diode can be used to reduce the internal volume of the gum to provide enough space for the correct placement; But it is better not to use electrocautery in these cases. Considering these cases, it is recommended that after the delivery of the prosthesis, the patient should be visited once in the next 3 months to make sure that the crown and abutment are properly seated and radiographed.