Retention and leakage of implant-supported restorations luted with provisional cement: a pilot study

Retention of different temporary cements tested on zirconia crowns and titanium abutments in vitro

Purpose

The aim of the present study was to examine the retention force of monolithic zirconia copings cemented with various temporary cements on implant abutments in vitro.

Methods

Sixty exercise implants with pre-screwed implant abutments were embedded in resin. Subsequently, 60 CAD/CAM manufactured zirconia copings were divided into three main groups [Harvard Implant Semi-permanent (HAV), implantlink semi Forte (IMP), Temp Bond NE (TBNE)]. The zirconia copings were cemented on the implant abutments and loaded with 35 N. Specimens were stored in distilled water (37 °C) for 24 h. Half of the test specimens of each group were subjected to a thermocycling (TC) process. Retention force was measured in a universal testing machine. Using magnifying glasses, the fracture mode was determined. Statistical analysis was performed applying the Kruskal-Wallis test, the post hoc test according to Dunn-Bonferroni and a chi-square test of independence.

Results

Without TC, IMP showed the highest retention of the three temporary luting agents (100.5 ± 39.14 N). The measured retention forces of IMP were higher than those of HAV (45.78 ± 15.66 N) and TBNE (61.16 ± 20.19 N). After TC, retention was reduced. IMP showed the greatest retentive strength (21.69 ± 13.61 N, three fail outs). HAV and TBNE showed pull-off forces of similar magnitude (17.38 ± 12.77 N and 16.97 ± 12.36 N, two fail outs). The fracture mode analysis showed different results regarding the tested cements before and after TC (facture type before/after TC): IMP (III+II/III), HAV (I/II) and TBNE (III/III). There were clear differences of the fracture modes regarding the examination before and after TC.

Conclusions

Within the limits of this study, IMP showed the highest pull-off forces under the chosen test conditions. All three temporary luting agents showed lower retention forces after TC. Retention values in the individual cement classes were very heterogeneous. Easy cement removal in the crown lumen favours the dominance of adhesive cement fractures on the abutment and adhesive/cohesive cement fractures on the abutment with HAV appears advantageous in case of recementation of the superstructure.

Comparative evaluation of microleakage of metallic copings luted with three different commercially available luting cements: An in vitro study

Aim

To evaluate the microleakage of metallic copings luted with three different commercially available luting cements.

Setting and Design

Comparative evaluation in vitro study.

Materials and Methods

Thirty replicas of abutment analog were milled and divided into 3 groups. Nickel chromium copings were fabricated; marginal gap was evaluated with optical microscope and luted with Zinc Oxide Non Eugenol cement, Zinc Polycarboxylate cement and Zinc Phosphate cement. After Thermocycling, cemented specimens were placed into 0.5% aqueous solution of basic fuchsin solution for 24 hours for dye penetration. Copings were longitudinally sectioned and microleakage scores were evaluated.

Statistical Analysis Used

Kruskal-Wallis analysis of variance (ANOVA) followed by Chi-Square test. Pairwise comparison of groups with Mann Whitney U test.

Result

Mean microleakage score was least for Zinc Phosphate cement (1.075 ± 0.85) followed by Zinc Polycarboxylate cement (1.80± 0.23) and most for Zinc Oxide Non Eugenol (2.1± 0.37). The results of the study were statistically significant, P < 0.05.

Conclusions

Within the limitations of the study, it was found that all cements exhibited certain amount of microleakage. Zinc Phosphate cement exhibited a mean microleakage score that was significantly lower than Zinc Oxide Non Eugenol cement and Zinc Polycarboxylate cement. When microleakage scores of Zinc Oxide Non Eugenol cement and Zinc Polycarboxylate cement were compared, the difference was found to be insignificant indicating that microleakage in these cements is similar.

Retention Strength after Compressive Cyclic Loading of Five Luting Agents Used in Implant-Supported Prostheses

The purpose of this study was to evaluate and compare the retention strength of five cement types commonly used in implant-retained fixed partial dentures, before and after compressive cyclic loading. In five solid abutments screwed to 5 implant analogs, 50 metal Cr-Ni alloy copings were cemented with five luting agents: resin-modified glass ionomer (RmGI), resin composite (RC), glass ionomer (GI), resin urethane-based (RUB), and compomer cement (CC). Two tensile tests were conducted with a universal testing machine, one after the first luting of the copings and the other after 100,000 cycles of 100 N loading at 0.72 Hz. The one way ANOVA test was applied for the statistical analysis using the post hoc Tukey test when required. Before and after applying the compressive load, RmGI and RC cement types showed the greatest retention strength. After compressive loading, RUB cement showed the highest percentage loss of retention (64.45%). GI cement recorded the lowest retention strength (50.35 N) and the resin composite cement recorded the highest (352.02 N). The type of cement influences the retention loss. The clinician should give preference to lower retention strength cement (RUB, CC, and GI) if he envisages any complications and a high retention strength one (RmGI, RC) for a specific clinical situation.

Retention of Implant Supported Metal Crowns Cemented with Different Luting Agents: A Comparative Invitro Study

INTRODUCTION

To overcome limitations of screw-retained prostheses, cement-retained prostheses have become the restoration of choice now a days. Selection of the cement hence becomes very critical to maintain retrievability of the prostheses.

AIM

The purpose of this study was to assess and compare the retention of base metal crowns cemented to implant abutments with five different luting cements.

MATERIALS AND METHODS

Ten implant analogs were secured in five epoxy resin casts perpendicular to the plane of cast in right first molar and left first molar region and implant abutments were screwed. Total of 100 metal copings were fabricated and cemented. The cements used were zinc phosphate, resin modified glass ionomer cement, resin cement, non-eugenol acrylic based temporary implant cement & non-eugenol temporary resin cement implant cement. Samples were subjected to a pull-out test using an Instron universal testing machine at a crosshead speed of 0.5mm/min. The load required to de-cement each coping was recorded and mean values for each group calculated and put to statistical analysis.

RESULTS

The results showed that resin cement has the highest retention value 581.075N followed by zinc phosphate luting cement 529.48N, resin modified glass ionomer cement 338.095 N, non-eugenol acrylic based temporary implant cement 249.045 N and non-eugenol temporary resin implant cement 140.49N.

CONCLUSION

Within the limitations of study, it was concluded that non-eugenol acrylic based temporary implant cement and non-eugenol temporary resin implant cement allow for easy retrievability of the prosthesis in case of any failure in future. These are suitable for cement retained implant restorations. The results provide a possible preliminary ranking of luting agents based on their ability to retain an implant-supported prosthesis and facilitate easy retrieval.

The selection criteria of temporary or permanent luting agents in implant-supported prostheses: in vitro study

PURPOSE

The use of temporary or permanent cements in fixed implant-supported prostheses is under discussion. The objective was to compare the retentiveness of one temporary and two permanent cements after cyclic compressive loading.

MATERIALS AND METHODS

The working model was five solid abutments screwed to five implant analogs. Thirty Cr-Ni alloy copings were randomized and cemented to the abutments with one temporary (resin urethane-based) or two permanent (resin-modified glass ionomer, resin-composite) cements. The retention strength was measured twice: once after the copings were cemented and again after a compressive cyclic loading of 100 N at 0.72 Hz (100,000 cycles).

RESULTS

Before loading, the retention strength of resin composite was 75% higher than the resin-modified glass ionomer and 2.5 times higher than resin urethanebased cement. After loading, the retentiveness of the three cements decreased in a non-uniform manner. The greatest percentage of retention loss was shown by the temporary cement and the lowest by the permanent resin composite. However, the two permanent cements consistently show high retention values.

CONCLUSION

The higher the initial retention of each cement, the lower the percentage of retention loss after compressive cyclic loading. After loading, the resin urethane-based cement was the most favourable cement for retrieving the crowns and resin composite was the most favourable cement to keep them in place.

Cement selection for implant-supported crowns fabricated with different luting space settings

PURPOSE

To measure and compare the retentive strength of cements specifically formulated for luting restorations onto implant abutments and to investigate the effect of varying cement gap on retention strength of implant-supported crowns.

MATERIALS AND METHODS

Standard titanium abutments were scanned by means of a 3D digital laser scanner. One hundred and sixty standard metal copings were designed by a Computer Aided Design/Computer Aided Manufacturing (CAD/CAM) system with two cement gap values (20 and 40 μm). The copings were cemented to the abutments using the following eight cements with one being the control, zinc oxide temporary cement, while the other seven were specifically formulated implant cements (n = 10): Premier Implant Cement, ImProv, Multilink Implant, EsTemp Implant, Cem-Implant, ImplaTemp, MIS Crown Set, and TempBond NE. The specimens were placed in 100% humidity for 24 hours, and subjected to a pull-out test using a universal testing machine at a 0.5 mm/min crosshead speed. The test results were analyzed with two-way ANOVA, one-way ANOVA, post hoc Tamhane' s T2, and student's t-tests at a significance level of 0.05.

RESULTS

Statistical analysis revealed significant differences in retention strength across the cement groups (p < 0.01). Resin-based cements showed significantly higher decementation loads than a noneugenol zinc oxide provisional cement (TempBond NE) (p < 0.01), with the highest tensile resistance seen with Multilink Implant, followed by Cem-Implant, MIS Crown Set, ImProv, Premier Implant Cement, EsTemp Implant, and ImplaTemp. Increasing the cement gap from 20 to 40 μm improved retention significantly for the higher strength cements: Multilink Implant, Premier Implant Cement, ImProv, Cem-Implant, and MIS Crown Set (p < 0.01), while it had no significant effect on retention for the lower strength cements: EsTemp Implant, ImplaTemp, and TempBond NE (p > 0.05).

CONCLUSIONS

Resin cements specifically formulated for implant-supported restorations demonstrated significant differences in retention strength. The ranking of cements presented in the study is meant to be an arbitrary guide for the clinician in deciding the appropriate cement selection for CAD/CAM-fabricated metal copings onto implant abutments with different luting space settings.

Vertical misfit of laser-sintered and vacuum-cast implant-supported crown copings luted with definitive and temporary luting agents

OBJECTIVES

This study aimed to evaluate the vertical discrepancy of implant-supported crown structures constructed with vacuum-casting and Direct Metal Laser Sintering (DMLS) technologies, and luted with different cement types.

STUDY DESIGN

Crown copings were fabricated using: (1) direct metal laser sintered Co-Cr (LS); (2) vacuum-cast Co-Cr (CC); and (3) vacuum-cast Ti (CT). Frameworks were luted onto machined implant abutments under constant seating pressure. Each alloy group was randomly divided into 5 subgroups (n = 10 each) according to the cement system utilized: Subgroup 1 (KC) used resin-modified glass-ionomer Ketac Cem Plus; Subgroup 2 (PF) used Panavia F 2.0 dual-cure resin cement; Subgroup 3 (RXU) used RelyX Unicem 2 Automix self-adhesive dual-cure resin cement; Subgroup 4 (PIC) used acrylic/urethane-based temporary Premier Implant Cement; and Subgroup 5 (DT) used acrylic/urethane-based temporary DentoTemp cement. Vertical misfit was measured by scanning electron microscopy (SEM). Two-way ANOVA and Student-Newman-Keuls tests were run to investigate the effect of alloy/fabrication technique, and cement type on vertical misfit. The statistical significance was set at α = 0.05.

RESULTS

The alloy/manufacturing technique and the luting cement affected the vertical discrepancy (p < 0.001). For each cement type, LS samples exhibited the best fit (p < 0.01) whereas CC and CT frames were statistically similar. Within each alloy group, PF and RXU provided comparably greater discrepancies than KC, PIC, and DT, which showed no differences.

CONCLUSIONS

Laser sintering may be an alternative to vacuum-casting of base metals to obtain passive-fitting implant-supported crown copings. The best marginal adaptation corresponded to laser sintered structures luted with glass-ionomer KC, or temporary PIC or DT cements. The highest discrepancies were recorded for Co-Cr and Ti cast frameworks bonded with PF or RXU resinous agents. All groups were within the clinically acceptable misfit range.

Prosthetic outcome of cement-retained implant-supported fixed dental restorations: a systematic review

The aim of the article is to assess the current literature in terms of the prosthetic outcome of cement-retained implant-supported fixed restorations, as well as to determine the type of cement that can be recommended for clinical application. A review of the literature published up to May 2010 was conducted to identify clinical studies about cement-retained implant-supported fixed restorations. The search strategy applied was a combination of MeSH terms and free text words, including the following keywords: implants, implant-supported fixed dental prostheses (FDPs), bridges, implant-supported single crowns (SCs), cement-retained, cement fixation, cement, cementation, cement failure, retention, and loss of retention, technical complications, mechanical complications, prosthetic complication, retrievability and maintenance. Thirty-two studies met the inclusion criteria. The studies were divided into two categories: 15 short-term clinical studies with an observation period of less than 5 years, and 17 long-term clinical studies with an observation period of 5 years and more. The most common technical complications of cement-retained implant-supported fixed restorations were loss of retention, chipping and abutment screw loosening. The results of the current review revealed no guidelines about cement or cementation procedures. It may be stated that despite the questionable retrievability of cement-retained implant-supported fixed restorations, this treatment modality is a reliable and effective option, especially for implant-supported SCs and short-span FDPs. The literature does not provide accurate information about the clinical outcome of cement-retained implant-supported fixed restorations nor about the ideal type of cement that facilitates stability and maintains retrievability. Standardised randomised clinical trials will provide valuable information to this issue.

A descriptive study of the radiographic density of implant restorative cements

STATEMENT OF PROBLEM

Cementation of implant prostheses is a common practice. Excess cement in the gingival sulcus may harm the periodontal tissues. Identification of the excess cement may be possible with the use of radiographs if the cement has sufficient radiopacity.

PURPOSE

The purpose of this study was to compare the radiographic density of different cements used for implant prostheses.

MATERIAL AND METHODS

Eight different cements were compared: TempBond Original (TBO), TempBond NE (TBN), Fleck's (FL), Dycal (DY), RelyX Unicem (RXU), RelyX Luting (RXL), Improv (IM), and Premier Implant Cement (PIC). Specimen disks, 2 mm in thickness, were radiographed. Images were made using photostimulable phosphor (PSP) plates with standardized exposure values. The average grey level of the central area of each specimen disk was selected and measured in pixels using a software analysis program, ImageTool, providing an average grey level value representative of radiodensity for each of the 8 cements. The radiodensity was determined using the grey level values of the test materials, which were recorded and compared to a standard aluminum step wedge. An equivalent thickness of aluminum in millimeters was calculated using best straight line fit estimates. To assess contrast effects by varying the exposure settings, a second experiment using 1-mm-thick cement specimens radiographed at both 60 kVp and 70 kVp was conducted. The PSP plates with specimens were measured for a grey level value comparison to the standard aluminum step wedge, using the same software program.

RESULTS

The highest grey level values were recorded for the zinc cements (TBO, TBN, and FL), with the 1-mm specimen detectable at both 60- and 70-kVp settings. A lower grey level was recorded for DY, indicative of a lower radiodensity compared to the zinc cements, but higher than RXL and RXU. The implant-specific cements had the lowest grey level values. IM could only be detected in 2-mm-thick sections with a lower aluminum equivalence value than the previously mentioned cements. PIC could not be detected radiographically for either the 1-mm or 2-mm thicknesses at either of the kVp settings.

CONCLUSIONS

Some types of cement commonly used for the cementation of implant-supported prostheses have poor radiodensity and may not be detectable following radiographic examination.

Retention of zirconia copings on zirconia implant abutments cemented with provisional luting agents

The purpose of this study is to measure and compare the retentive force of zirconia-based all-ceramic crowns cemented on zirconia abutments using five provisional luting agents. In addition, the effect of sandblasting and thermocycling on the retentive force was evaluated. Two hundred zirconia abutments and copings were fabricated (Procera system; Nobel Biocare) and divided into five groups. Hy bond temporary cement hard (Hard), Hy bond temporary cement soft (Soft), experimental temporary cement (New), Tempbond NE (Temp) and Freegenool temporary pack (Pack) were used according to the manufacturers' instructions. Each group was divided into two groups, one with and one without sandblasting. Furthermore, thermocycling up to 2000 cycles was conducted on half of each group. After 24 h and thermocycling, the retentive force was measured using a universal testing machine. The data were subjected to analysis of variance, and comparisons of the means were performed with a Games-Howell test at a level of 95%. As a result, Hard showed the highest retentive force, sandblasting was effective for improving the durability, and no effect of sandblasting was detected in the others. New showed stability of the retentive force even after thermocycling. The retentive force of Temp and Pack decreased significantly after thermocycling even with sandblasting. The retentive forces were different from the provisional cement and sandblasting, and Temp and Pack may not be appropriate for the retention of single-tooth zirconia abutments and coping restorations.

Retention of cast crown copings cemented to implant abutments

BACKGROUND

The cementation of crowns to dental implant abutments is an accepted form of crown retention that requires consideration of the properties of available cements within the applied clinical context. Dental luting agents are exposed to a number of stressors that may reduce crown retention in vivo, not the least of which is occlusal loading. This study investigated the influence of compressive cyclic loading on the physical retention of cast crown copings cemented to implant abutments.

METHODS

Cast crown copings were cemented to Straumann synOcta titanium implant abutments with three different readily used and available cements. Specimens were placed in a humidifier, thermocycled and subjected to one of four quantities of compressive cyclic loading. The uniaxial tensile force required to remove the cast crown copings was then recorded.

RESULTS

The mean retention values for crown copings cemented with Panavia-F cement were statistically significantly greater than both KetacCem and TempBond non-eugenol cements at each compressive cyclic loading quantity. KetacCem and TempBond non-eugenol cements produced relatively low mean retention values that were not statistically significantly different at each quantity of compressive cyclic loading. Compressive cyclic loading had a statistically significant effect on Panavia-F specimens alone, but increased loading quantities produced no further statistically significant difference in mean retention.

CONCLUSIONS

Within the limitations of the current in vitro conditions employed in this study, the retention of cast crown copings cemented to Straumann synOcta implant abutments with a resin, glass ionomer and temporary cement was significantly affected by cement type but not compressive cyclic loading. Resin cement is the cement of choice for the definitive non-retrievable cementation of cast crown copings to Straumann synOcta implant abutments out of the three cements tested.