SMART 1 Implants: Retention Methods

mm Written by Andrew Sedler

Patients' lives can be dramatically improved through the use of dental implants. In most instances, dental implants offer a superior treatment option over other possible options, such as a fixed bridge. These restorations help maintain the surrounding oral environment by mimicking natural dentition.

They help to stimulate the jaw, which helps to prevent bone loss, and they help to reduce the occurrence of gum disease.

Their biggest advantage is that they return the mouth to a more normal state that helps with proper mastication and overall improved esthetics.

Implant Retention Methods

Once a patient has opted to be treated with an implant restoration, many considerations must be made in following through with the treatment. One of the key considerations after surgery, however, is how the implant will be restored. More specifically, the decision as to whether the restorations will be screw-retained or cement-retained must be determined.

Cement-Retained Implants

Cement-retained Implants are a widely used option in the treatment of single-unit and multi-unit tooth loss. These restorations have no screw access hole and are considered a more esthetic option.

Also, because there is no access hole, these restorations provide a more ideal occlusal anatomy and load.

SMART 1 Implants: Cement-Retained Implant Success

SMART 1 Implant Abutments

Burbank Dental Labs’ SMART 1 cement-retained custom abutments are designed with an ideal preparation design.

SMART 1 Implants: Cement-Retained Implant Success

This allows for the final restoration to have a passive seat, better retention, and a more natural emergence profile.

Cement-retained restorations, when cemented over a SMART 1 custom abutment, offer an excellent solution when there is an issue with the implant's angulation.

In addition, cement-retained restorations have the following benefits:

  • There is no screw access hole.
  • They offer a more aesthetic outcome.
  • Failure of the porcelain fracturing is reportedly less common.
  • Restorations are less likely to come off or be lost as there are no issues with screws loosening.
  • If the implant was not placed in an ideal situation and the access hole is exiting through the buccal, a cement-retained restoration is highly desirable.
  • A passive fit is easier to achieve.
  • A solid occlusal table provides for better occlusion.

When doing a cement-retained abutment, these can either be fabricated in titanium or zirconia with a ti base. They are indicated for either single or multi-unit cases.

When seating these cases, the following is recommended:

  • Tighten the abutment to the implant manufacturer's specifications.
  • Use a cement that is specifically designed for cementing to the implant abutments. This will help with retrievability.

Cementation and Cement-retained Restorations

When implants are mal-aligned, a cement-retained restoration is usually recommended. However, one of the biggest drawbacks of this type of restoration is the highly sensitive nature of proper cementation.

In addition, dental cement has been linked with peri-implant disease.

SMART 1 Implants: Cement-Retained Implant Success

This disease can lead to implant failure as a result of bone loss. It is estimated that it can take several months to several years before a dentist will discover that a patient is suffering from a peri-implant disease.

It is crucial that proper cementation techniques are followed to ensure these restorations last and that the patient does not create further damage.

The first step in creating the ideal situation is to ensure the implant is placed in the best possible position as determined by the treatment plan. The abutment margin's placement is important and should be placed either slightly below or just at the tissue level. This will make the clean-up of residual cement easier.

When cementing, the appropriate cement must be used as well as the appropriate cementation technique. Because it is weak, soft tissue adhesion between the soft tissue and implant, any excess cement can cause issues.

The clean-up of excess cement is crucial to the case's success since it is the excess cement that has been shown to cause peri-implant disease. Removing this excess cement can be difficult.

In addition to leaving residual cement at the implant site and possibly causing peri-implantitis, cement-retained restorations are more challenging to retrieve.

Because the data shows the connection between cement-retained restorations and peri-implantitis, the use of cement-retained restorations in the rehabilitation of implant cases is recommended in the following situations:

  • In cases where the access hole is undesirable, such as the facial of the restoration or if the occlusal of the crown is too narrow.
  • When margins are placed either just at or above the tissue

Screw-Retained Option

SMART 1 Implants: Cement-Retained Implant Success

In contrast, screw-retained restorations should be used when retrievability is desired. These restorations require only a minimal amount of occlusal space. Because you can retrieve them very easily, they are more indicated for hygiene maintenance or repairs. In addition, screw-retained restorations have the following indications:

  • When inter-arch space is limited
  • In cases with long-span fixed restorations
  • When the ability to retrieve the restoration is necessary
  • When used for temporization to help with soft tissue healing
  • In cases with a cantilever

In most cases, when presented with the option, it is recommended to prescribe a screw-retained restoration. Retrievability is one of the key advantages of the screw-retained option.

Cement-retained implants are a great option for cases where the implants are mal-aligned and the margins are at or above the tissue. However, proper cementation procedures are a must to avoid complications.

Contact a Burbank Dental Lab implant team member to discuss your next implant case.

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