Cement implant crown
- Get a custom abutment (or stock for the rare case that the margins are above the tissue) and have the lab leave all margins but the esthetically critical areas ABOVE the gum line. In esthetic areas have them place the margin just barley below the gum line. Most people bury the lingual and IP margins. WHY???
- To aid in seating your abutment you can use a seating jig.
- Pack your plumbers tape in the hole but leave room for excess cement to flow into access hole. The tape is only there to protect the screw head from damage. There is no need to fill the whole implant chamber with anything! That leaves nowhere for excess cement to go but down the side of the abutment.
- Use the right cement (radio-opaque preferred). Most “implant cements” sold today are radio-lucent resin. Probably the worst choice you could pick. I personally use Relyx luting.
- Use a small amount of cement. Most techniques involve placing one layer of plumbers tape inside the crown and seating it on the abutment, then making a mold of the interior of the crown with acrylic or impression material. The next step you remove the tape, place cement, and seat the crown on your duplicate mold to remove excess cement before seating on the torqued abutment.
- Pack a small cord around the abutment and remove after cementing OR if tissue very tight can try floss like this
Cement implant crown without cement sepsis
One of the biggest problems we see emerging with dental implants is cement sepsis. I feel the primary causes are
- Lack of use of a custom abutment causing the margin to be sub-gingival (Usually done so the doc can save the cost of having a custom abutment with proper dimensions made)
- Implant companies selling resin cement as “implant cement”. Of all the cements available to a dentist, I think resin is the worst choice for implants. Not sure why the industry went down this path. Resin cement is radio-lucent so can’t see excess on xray AND it sticks to Ti extremely well so hard to remove excess AND it flows too well (low viscosity). Bone is porous and the resin will literally flow right down the side of an implant.
- Inexperience of the dentist placing the crown. (I think the vast majority of cases of implant sepsis are caused by young and/or inexperienced implant dentists or careless dentists that haven’t been paying attention to the dental industry research or lecturers)
So let’s fix this problem!
Here are my favorite three solutions to cement implant crown in no particular order