Incidence of peri-implant disease associated with cement- and screw-retained implant-supported prostheses: A systematic review and meta-analysis

A 7.5-year randomized controlled clinical study comparing cemented and screw-retained one-piece zirconia-based implant-supported single crowns

OBJECTIVES

To compare marginal bone levels, biological, and technical outcomes of screw-retained versus cemented all-ceramic implant-supported zirconia-based single crowns after an observation period of 7.5 years.

METHODS

Forty-four single implants in the esthetic zone in 44 patients (22 females, 22 males) were randomly assigned to two types of restorations: SR (screw-retained); veneered one-piece zirconia abutment and CR (cement-retained); veneered lithium disilicate crown intraorally cemented on a one-piece zirconia abutment. Patients were recalled annually up to 7.5 years and survival rates, biological, and technical parameters assessed.

RESULTS

A total of 31 patients attended the 7.5-year follow-up visit (17 SR group, 14 CR group). The survival rate on the restorative level was 77.5% (74.0% CR, 81.0% SR, p = .6399). Median marginal bone loss (MBL) values yielded -0.073 mm (-0.305; 0.238) in the CR and -0.215 mm (-0.500; 0.555) in the SR group (intergroup p = .6194). Mean bleeding on probing (BoP) values were significantly in favor of group SR with 20 ± 17% compared to 40 ± 22% in group CR (p = .011). The overall biological complication rate amounted to 27.5% (42.1% CR, 14.3% SR, p = .0775), whereas the technical complication rate was 32.5% (42.1% CR, 23.8% SR, p = .314). In total, CR restorations showed significantly more complications (84.2% for CR, 38.1% for SR, p = .0041).

CONCLUSION

One-piece zirconia-based single crowns on two-piece dental implants exhibited a high rate of technical and biological complications at 7.5 years of follow-up. Cemented restorations revealed significant higher rates of bleeding on probing and total complications compared to screw-retained restorations.

Digital workflow for prosthetic management of malpositioned implant in an adolescent patient: A 20-year follow-up

OBJECTIVE

Dental implants placed in adolescent patients pose a challenge to restore and maintain an esthetic outcome over longer period of follow-up. Maxillomandibular changes throughout adulthood may lead to complications such as implant infraocclusion and interproximal contact loss. This case report describes an alternate prosthetic treatment strategy for maxillary single implant placed in an adolescent patient in the esthetic zone with inappropriate implant axis and screw hole placement.

CLINICAL CONSIDERATIONS

With temporary restorations, the gingiva and soft tissues were shaped to imitate the emerging profile of the contralateral side. A zirconia screw-retained abutment was customized as a copy-mirror from the contralateral prepared tooth to mimic the exact shape and to avoid labiolingual over contour by computer-aided design/computer-assisted manufacture (CAD/CAM). The porcelain laminate veneer was bonded to the zirconia abutment. Porcelain adhesive approach was used instead of traditional principles of retention and resistance form of the abutment.

CONCLUSIONS

A functional and esthetic outcome was achieved and maintained, while a minimally invasive procedure was implemented to use the malplaced implant instead of explanting it.

CLINICAL SIGNIFICANCE

The present report illustrates the prosthetic management of a malpositioned dental implant placed 20 years ago, utilizing a minimally invasive digital protocol.

Subperiosteal implants constructed with digital technology: A systematic review

STATEMENT OF PROBLEM

Atrophied jaw is a condition where there is insufficient bone quantity and quality. Several treatment plans are available for treating atrophied jaws, including subperiosteal implants.

PURPOSE

To evaluate the spectrum of subperiosteal implants for severely atrophied jaws using digital technology.

MATERIALS AND METHODS

An electronic and manual search was conducted in the PubMed, Scopus, and Google Scholar databases. Publications of cohort studies, case series, and case reports written in English without data restrictions that reported on subperiosteal implant management of patients with severely atrophied jaws in a completely and partially edentulous population.

RESULTS

A total of 26 articles, comprising 302 cases, were analyzed. In patients with severely atrophied jaws. The success rate was 87.7%, the surviving rate was 95.3%. The most common complications were biological, such as dehiscence and framework exposure. The rates of biologic complications were 11.5%, and the rates of prosthetic problems were 5.9%.

CONCLUSIONS

Subperiosteal implants designed and constructed using digital technology are a promising treatment in the short term. Attention should be directed to decrease the biological complication. Correct designing, implanting, fixing, and patient selection and maintenance are critical for the success of the treatment. Longer prospective studies with larger population are needed to view the effect on hard and soft tissue.

Single Dental Implant Restoration: Cemented or Screw-Retained? A Systematic Review of Multi-Factor Randomized Clinical Trials

Background: Dental implant rehabilitation has significantly advanced prosthodontics by providing a reliable, long-lasting solution for missing teeth. This systematic review compares the clinical, technical, and biological outcomes of cemented versus screw-retained single dental implant restorations based on randomized clinical trials (RCTs). Materials and Methods: This review included recent human and in vitro studies focusing on the keywords “cemented vs. screw-retained” and “dental implant”. Eight studies met the inclusion criteria, which investigated parameters, including implant survival rate, bleeding on probing (BOP), probing depth, plaque index, marginal bone loss (MBL), cytokine concentrations, mechanical complications, esthetic outcomes, patient satisfaction, treatment time, and technical failures. Results: The primary outcomes, BOP and MBL, did not statistically differ between cemented and screw-retained implants (p-values for MBL and BOP are 0.5813 and 0.8093, respectively). The reviewed studies, including RCTs, split-mouth studies, and clinical evaluations, demonstrated comparable clinical, technical, and biological outcomes between the two restoration methods. Conclusions: Screw-retained and cemented dental implant restorations exhibit similar clinical, technical, and biological outcomes. Screw-retained restorations offer advantages such as retrievability, ease of repair, and predictable passive fit, while cemented restorations provide superior esthetics. The risk of peri-implant complications due to residual cement in cemented restorations must be considered. Future research should explore long-term stability and the impact of different prosthetic protocols on peri-implant health.

CEMENTED AND SCREW-RETAINED IMPLANT-SUPPORTED RESTORATIONS MAY HAVE A COMPARABLE RISK FOR PERI-IMPLANT MUCOSITIS AND PERI-IMPLANTITIS

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Reis INRD, Fukuoka GL, Nagay BE, Pannuti CM, Spin-Neto R, Silva EVFD. Incidence of peri-implant disease associated with cement- and screw-retained implant-supported prostheses: A systematic review and meta-analysis. J Prosthet Dent. 2023 Oct 2:S0022-3913(23)00563-2. doi:10.1016/j.prosdent.2023.08.030. Epub ahead of print. PMID: 37793953.

SOURCE OF FUNDING

None declared.

TYPE OF STUDY/DESIGN

Systematic review and meta-analysis.

N-acetylcysteine as a novel methacrylate-based resin cement component: effect on cell apoptosis and genotoxicity in human gingival fibroblasts

BACKGROUND

N-acetylcysteine (NAC) reduces the cytotoxicity and genotoxicity induced by monomers leached from dental composite resins. Herein, we investigated the effects of methacrylate-based resin cement used in dental implant restoration on apoptosis and genotoxicity, as well as the antiapoptotic and antigenotoxic capabilities of its component, NAC.

METHODS

The antioxidant NAC (0.1 or 1 wt.%) was experimentally incorporated into the methacrylate-based dental resin cement Premier®. The Premier® + NAC (0.1 or 1 wt.%) mixture was subsequently immersed into Dulbecco's modified Eagle's medium for 72 h, and used to treat human gingival fibroblasts (HGFs). The viability of HGFs was determined using the XTT assay. The formation of deoxyribonucleic acid (DNA) double-strand breaks (DNA-DSBs) was determined using a γ-H2AX assay. Reactive oxygen species (ROS), apoptosis, necrosis, and cell cycles were detected and analyzed using flow cytometry.

RESULTS

The eluate of Premier® significantly inhibited HGF proliferation in vitro by promoting a G1-phase cell cycle arrest, resulting in cell apoptosis. Significant ROS production and DNA-DSB induction were also found in HGFs exposed to the eluate. Incorporating NAC (1 wt.%) into Premier® was found to reduce cell cytotoxicity, the percentage of G1-phase cells, cell apoptosis, ROS production, and DNA-DSB induction.

CONCLUSION

Incorporating NAC (1 wt.%) into methacrylate-based resin cement Premier® decreases the cell cytotoxicity, ROS production, and DNA-DSBs associated with resin use, and further offers protective effects against the early stages of cell apoptosis and G1-phase cell cycle arrest in HGFs. Overall, our in vitro results indicate that the addition of NAC into methacrylate-based resin cements may have clinically beneficial effects on the cytotoxicity and genotoxicity of these materials.