Cement sepsis – What is it?
Cement sepsis is an infection and inflammation resulting from dental cement being around the crown abutment margin. The body doesn’t like the rough surface as it harbors bacteria. Since the body can not expel it, bone resorbs as an attempt to get away. If we do not treat cement sepsis it is very possible that the dental implant will fail. Cement sepsis is fairly common. Many dentists have figured out ways to completely avoid this complication and probably never cause this, others well not so much. Dentists are going to see a lot of it if they use stock abutments and poor techniques to cement their dental crowns. If a dentist is going to cement a crown (they can be screw retained), then the steps found on the cement dental crown post should be followed.
How does cement sepsis feel and present for a patient?
Cement sepsis typically will present as a painful gum infection. The tissue will be red and will bleed easily. Often there is some pus in the area around the cement. This can be seen in the photo below.
Treatment of cement sepsis
Treatment involves removing the dental cement somehow. One might be able to remove the cement in a similar manner as we clean teeth, but that is unlikely. Usually the cement is deep under the gums and we do not have adequate access to remove the cement. When this is the case, we must do a more invasive procedure. The two basic techniques involve making an incision in the gums to gain access or removing the crown to gain access. In my experience we can usually save the crown! If you wold like to know more about the methods to remove cement from around a dental implant click on dental code cement sepsis.
What is initial cause for cement sepsis?
This is always the dentists fault. I mean, it happens and is a known risk but ultimately it is our fault when it occurs. Like many things in life, experience and knowledge decrease the risk of occurrence significantly. However, if providing lower cost care and using things like stock abutments the risk of this occurring skyrockets. Typically the main causes are stock abutments, too much cement, and, for lack of a better term, bad dental skills in general.
The case below is a stock abutment but it’s also just bad dentistry. The crown was never fully on the abutment and that is just bad work. The clear ring is the band of resin cement.
Case example of cement sepsis removal
I feel removing the crown and abutment is more consistent and less invasive, so that’s what I usually do. The following case is an example of such. A new patient came to our office with some bone loss and pus around their front dental implant, so an x-ray was taken. The x-ray revealed not just bone loss but cement around the edge of where the crown ended. Unfortunately, this is a clear case of cement sepsis.
There are several issues with trying to identify cement sepsis with x-rays. First off the cement is often radiolucent to the point of being invisible on an x-ray. The second issue is that you can not see the direct front of back at all, due to the metal.
Treatment of cement sepsis case
As I mentioned there are several ways we can address cement sepsis. I have found that if the cement is only on the crown and we remove the the offending material, the body settles down and bone loss is halted. In the posterior more aggressive surgery can be done to help regain bone. In the anterior where the gum levels are esthetcially critical, I try not to cut any gum tissue. The trauma from the surgery alone may have undesirable effects. In this case, although there was bone loss, the tissue levels were good. In order to avoid losing this tissue, I decided to just attempt removal and watch healing.
My main concern with removal was that the access to the screw would be out the front of the crown, necessitating removal of the crown. I could have taken a CBCT and known for sure what the angle was, but my treatment would not have changed. Had the angle been bad we would have to remove the crown, if not we access the screw just like we do a root canal. We remove, clean and replace. I started by drilling into the back side of the crown and fortunately I had straight line access to the screw from this hole.
One can design a surgical guide to give you direct access but after just viewing the CBCT you should be able to free hand easily. If you can’t get this right just from viewing the CBCT then you probably shouldn’t be doing this, but that doesn’t get you an article in JPD.
Photos of a crown causing cement sepsis.
The above two photos show the cement on the abutment that was causing the cement sepsis. It also shows my access on the lingual to the dental implant. This patient has a chip in the porcelain with a previous repair. With the crown removed a much better repair was possible.
This photo shows how the cement is going past where the crown is. Later, we clean off the cement and replace the crown.
Want to see more cement sepsis?
In conclusion, if you wish to check our more cement sepsis cases and related posts click here.