Coronas cementadas comparado con coronas atornilladas para pacientes con restauraciones fijas implantosoportadas / Cement-retained versus screw-retained crowns in patients with implant rehabilitation

RESUMEN: Introducción: Los implantes dentales se han transformado en una opción de tratamiento de suma relevancia para pacientes parcial o totalmente desdentados. El éxito del tratamiento puede verse afectado por la elección del tipo de retención de estos (cementada o atornillada). A pesar que ambas presentan ventajas, aún no existe consenso sobre el mejor tipo de retención para restauraciones fijas implantosoportadas. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos 14 revisiones sistemáticas que en conjunto incluyeron 43 estudios primarios, de los cuales cinco corresponden a ensayos aleatorizados. De estos, solamente dos ensayos responden a la pregunta de interés de manera directa. Concluimos que las coronas atornilladas podrían aumentar levemente el riesgo de pérdida de implante a largo plazo, podrían resultar en nula o poca diferencia en el riesgo de pérdida de implante a mediano plazo, reabsorción ósea y periimplantitis, pero la certeza de evidencia ha sido evaluada como baja. Por otro lado, no es posible establecer con claridad si las coronas cementadas disminuyen el riesgo de complicaciones estéticas y protésicas, ya que la certeza de la evidencia existente ha sido evaluada como muy baja.

ABSTRACT: Introduction: Dental implants have become a highly relevant treatment option for partially or totally edentulous patients. Implant retention systems (cemented or screwed) can influence the treatment success. Although both have advantages, there is still no consensus on the best type of retention for implant-supported fixed restorations. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified 14 systematic reviews including 43 primary studies overall, of which five were randomized trials. Of these, only two trials answer the question of interest. We concluded that screw-retained crowns may increase long-term implant loss, may make little or no difference in the risk of medium-term implant loss, bone resorption, and peri-implantitis, but the certainty of the evidence has been assessed as low. On the other hand, it is not possible to clearly establish whether cemented crowns reduce the risk of cosmetic and prosthetic complications, since the certainty of the evidence has been assessed as very low.

Challenges in Managing a Fractured Cement retained Crown Located at the Aesthetic Zone: A Case Report

ABSTRACT@#Implant prosthesis is a popular treatment modality but it is not complication free. This article discussed the management of a cemented, all-ceramic implant crown in the maxillary anterior region that had veneering ceramic fracture after three years in function. A screw-retained prosthesis was prescribed to avoid the show of the screw access channel on the incisal edge of the crown. This was achieved by changing the location of the screw hole using the angle screw channel that overcame the angulation issue.

Clinical application of integrated angulated screw channel abutment crown in implant-supported rehabilitation of aesthetic area / 华西口腔医学杂志

OBJECTIVES@#To evaluate the clinical effect of integrated angulated screw channel (ASC) abutment crown in implant-supported rehabilitation of the aesthetic area.@*METHODS@#Sixteen patients who received single implant-supported rehabilitation using integrated ASC abutment crown in the aesthetic area were included in the study. After one-year follow-up, the cumulative survival rate, aesthetic effectiveness, bone resorption around implants, and patient satisfaction were analyzed through periapical film, clinical examination, and the visual analog scale (VAS).@*RESULTS@#The implant cumulative survival rate of the integrated ASC abutment crown in the implant-supported rehabilitation of the aesthetic area was 100%. The average pink esthetic index scores reached 9.5, and the white esthetic index scores reached 9.4. The mean marginal bone loss of implants was (0.439±0.123) mm at the mesial side and (0.341±0.118) mm at the distal side. The average VAS satisfaction score was 8.9, which showed that all patients were satisfied with the final restorative effect.@*CONCLUSIONS@#Using integrated ASC abutment crown for implant restoration is an ideal implant restoration design in the aesthetic zone and can be applied clinically.

Prótesis sobre implantes: ¿atornillada o cementada? / Implant supported prosthesis: screw retained or bonded?

El objetivo de este artículo es revisar la evidencia científica existente acerca de los tipos de retención protética fija sobre implantes: atornillada, cementada y cemento-atornillada. Fueron evaluadas sus ventajas y desventajas a fin de facilitar al clínico la elección del sistema de retención en el tratamiento rehabilitador con implantes. Si bien la evidencia científica no es concluyente, la prótesis atornillada presentaría más complicaciones técnicas, y las cementadas, más complicaciones biológicas. Por ello, las prótesis cemento-atornilladas podrían ser en la actualidad una opción de elección, por su versatilidad en la rehabilitación implanto-soportada, combinando las ventajas de cada tipo de retención (AU)

The objective of this article is to review the existing scientific evidence about the different types of retention of fixed prosthetic on implants: screwed, cemented and cement-screwed. The advantages and disadvantages of them were evaluated in order to facilitate the clinician's choice of the retention system in the rehabilitation treatment with implants. Although the scientific evidence is inconclusive, the screwed prosthesis would present more technical complications, while the cemented, more biological complications. Therefore, cement-screwed prostheses could be an option of choice, due to their versatility when rehabilitating an implant, combining the advantages of each type of retention (AU)

Application of digital immediate implant restoration and angle screw channel abutment in the aesthetic area:case report and literature review / 口腔疾病防治

Objective @# To investigate the application of digital immediate implant and angle screw channel abutment in the aesthetic area and the related influencing factors by reviewing the data of one case of immediate implant repair of the upper anterior teeth and related literature. @*Methods@#One case of refractory chronic apicitis of the upper anterior teeth involved immediate implantation after extraction. The digital information of the patient was obtained by CBCT and intraoral scanning. According to the information from the patients, a preoperative evaluation was performed; a treatment scheme was formulated; a minimally invasive extraction was performed; implants were placed under a digital guide plate; and temporary restoration was immediately performed. Six months after the operation, the patients underwent individualized mold removal, and angle screw channel fixation was completed. We observed the cosmetic effects and soft and hard tissue and gingival contour maintenance effects after restoration and reexamined the patients 6 months after restoration. In addition, the relevant literature was reviewed. @*Results @#The height of the gingival margin and gingival papilla and gingival contour of this patient were well maintained. The red and white aesthetic effect was good. There was no redness or swelling of the gingiva nor obvious changes in the soft and hard tissues around the implant 6 months after restoration, and the patient was satisfied. The results in the literature review show that a preoperative design based on CBCT and intraoral scanning data combined with digital software and a whole digital guide plate make the procedure more accurate and safer. These factors can not only avoid important anatomical structures and serious surgical complications but can also result in implantation in the best three-dimensional position. In addition, the application of digital impression technology and CAD/CAM increases the efficiency, speed, accuracy, simplicity, and comfort of oral impressions and the construction of temporary and final prostheses more precise and faster, greatly improving clinical efficiency. @*Conclusion@#Digital immediate implant and angle screw channel abutment is a good method to restore the aesthetics and function of missing teeth and to avoid the complications caused by adhesive residue.

Clinical observation of cement-retained and screw-retained implant-supported denture in edentulous patients / 口腔疾病防治

Objective@# To evaluate the clinical effects of full-arch cement-retained implant-supported combined crowns and screw-retained implant-supported bridge dentures in complete or half edentulous patients. @*Methods @#A total of 25 patients with complete or partial edentulous dentures followed up for 1, 3, and 5 years in our hospital from June 2013 to June 2018 and were treated with Straumann bone horizontal implantation, cobalt-chromium stenting and cobalt-chromium porcelain restoration with cement-retained and screw-retained implant-supported fixed dental prostheses to evaluate the accumulative implant survival rate, accumulative prosthesis survival rate, mechanical complications, and biological complications in both groups. @*Results @#There were 25 complete or half edentulous patients who received 165 Straumann implants and 28 implant-supported fixed dental prostheses in this study. There were 11 cases with 69 implants in the cement group and 17 cases with 96 implants in the screw group. The accumulative implant survival rate was 100% in the cement group and 96.9% in the screw group. The accumulative prosthesis survival rate was 100% in both groups. The cumulative peri-implant mucositis rate was 23.2% in the cement group and 29.2% in the screw group, and the peri-implantitis rate was 6.8% in the cement group and 7.3% in the screw group. There was 1 case of porcelain collapse (n=1/11) and no screw of abutment loosening in the cement group and 4 cases of porcelain collapse (n=4/17) and 1 case of screw loosening in the screw group. No fracture of abutment was observed in either group. There was no difference in bone loss between the two groups in the first year (P > 0.05), and a higher rate of bone loss was found in the screw group in the third and fifth years (P < 0.05). There was no difference in the sulcus bleeding index(mSBI) between the two groups in the first year and the third year (P > 0.05) and a higher modified mSBI value in the cement group in the fifth year (P < 0.05).@*Conclusion @#The survival rates of the implant and prosthesis for cement-retained or screw-retained implant-supported fixed dental prostheses were both high, but there were more mechanical and biological complications in the traditional cobalt-chromium alloy screw-retainer group. The removal of residual adhesives must be reasonably considered when choosing the cement retention method.

Rehabilitation of the esthetic zone using multiple adjacent individual implant-supported restorations: Where are the limits? / Rehabilitación de la zona estética mediante múltiples restauraciones individuales adyacentes apoyadas por implantes: ¿cuáles son los límites?

ABSTRACT Rehabilitation of the partially edentulous anterior maxilla is considered one of the most difficult challenges for the restorative dentist due to the esthetic, functional and psychological implications. Implant-supported restorations provide an appealing treatment alternative that responds to today's patient expectations. The gold standard for this scenario has been the use of an implant-supported fixed partial denture with pontics that masks the soft tissue deficiencies, with acceptable esthetic results. However, nowadays patients are looking for individual single crowns since they believe that this type of restorations resemble the natural dentition, are easy to clean and floss. From the dentist perspective, they are easy to maintain and in case of prosthetic complications they can be repaired or changed without compromising the adjacent restorations. Three parameters have been identified that could guide the decision-making process when multiple adjacent implant supported restorations (MAISR) are selected as the treatment of choice: 1) Smile line 2) Inter-implant distance and tooth-implant distance 3) Patient's expectations and ability to clean.

RESUMEN La rehabilitación del maxilar anterior parcialmente edéntulo se considera uno de los retos más difíciles para el dentista restaurador debido a las implicaciones estéticas, funcionales y psicológicas. Las restauraciones apoyadas por implantes proporcionan una alternativa de tratamiento atractiva que responde a las expectativas actuales de los pacientes. El patrón de referencia en este contexto ha sido el uso de una prótesis parcial fija con implantes con pónticos para enmascarar las deficiencias de tejido blando, el cual ha tenido resultados estéticos aceptables. Sin embargo, hoy en día los pacientes están buscando coronas individuales ya que creen que este tipo de restauraciones se asemejan a la dentición natural y son fáciles de limpiar con cepillado e hilo dental. Desde la perspectiva del dentista, son fáciles de mantener y en caso de complicaciones protésicas pueden ser reparadas o cambiadas sin comprometer las restauraciones adyacentes. Se han identificado tres parámetros que podrían guiar el proceso de toma de decisiones cuando se seleccionan varias restauraciones compatibles con implantes adyacentes como el tratamiento de elección: 1) Línea de sonrisa 2) Distancia entre implantes y distancia de implante dental 3) Las expectativas del paciente y la facilidad de limpieza.

Retention System and Splinting on Morse Taper Implants in the Posterior Maxilla by 3D Finite Element Analysis

Abstract The purpose of this study was to evaluate different retention systems (cement- or screw-retained) and crown designs (non-splinted or splinted) of fixed implant-supported restorations, in terms of stress distributions in implants/components and bone tissue, by 3-dimensional (3D) finite element analysis. Four 3D models were simulated with the InVesalius, Rhinoceros 3D, and SolidWorks programs. Models were made of type III bone from the posterior maxillary area. Models included three 4.0-mm-diameter Morse taper (MT) implants with different lengths, which supported metal-ceramic crowns. Models were processed by the Femap and NeiNastran programs, using an axial force of 400 N and oblique force of 200 N. Results were visualized as the von Mises stress and maximum principal stress (σmax). Under axial loading, there was no difference in the distribution of stress in implants/components between retention systems and splinted crowns; however, in oblique loading, cemented prostheses showed better stress distribution than screwed prostheses, whereas splinted crowns tended to reduce stress in the implant of the first molar. In the bone tissue cemented prostheses showed better stress distribution in bone tissue than screwed prostheses under axial and oblique loading. The splinted design only had an effect in the screwed prosthesis, with no influence in the cemented prosthesis. Cemented prostheses on MT implants showed more favorable stress distributions in implants/components and bone tissue. Splinting was favorable for stress distribution only for screwed prostheses under oblique loading.

Resumo O objetivo deste estudo foi avaliar diferentes sistemas de retenção (cimentada x parafusada) e configuração da coroas (unitárias x esplintadas) de próteses fixas implantossuportadas em relação a distribuição de tensões nos implantes/componentes e tecido ósseo pela análise de elementos finitos 3D. Quatro modelos 3D foram simulados com auxílio dos programas Invesalius, e Rhinoceros 3D, e SolidWorks. Os modelos foram confeccionados simulando bloco ósseo de região posterior da maxila (tipo ósseo III), com 3 implantes cone Morse com 4,0 mm de diâmetro e diferentes comprimentos, suportando prótese metalocerâmica de 3 elementos. Os modelos foram processados pelos programas FEMAP e NEiNastran sob força axial de 400 N e oblíqua de 200N. Os resultados foram plotados através de mapas de tensão de von Mises (vM) (implantes e componentes) e tensão máxima principal (TMP) (tecido ósseo). Sobre o carregamento axial, não foi observada diferenças entre os diferentes sistemas de retenção e tipo de prótese na distribuição das tensões nos implantes/componentes, porém, sobre o carregamento oblíquo as próteses cimentadas apresentaram melhor distribuição de tensões em comparação com as próteses parafusadas, enquanto que as próteses esplintadas apresentou uma tendência de redução das tensões no implante do primeiro molar. No tecido ósseo as próteses cimentadas apresentaram melhor distribuição das tensões em comparação com as próteses parafusadas, independente do carregamento. A esplintagem foi favorável somente para as próteses parafusadas, não havendo influência sobre as próteses cimentadas. As próteses cimentadas sobre implantes cone Morse apresentam melhor comportamento biomecânico nos implantes/componentes e tecido ósseo. A esplintagem foi efetiva somente nas próteses parafusadas sob carregamento oblíquo.

A new retaining method of cement-retained restoration with linguo-horizontal insertion of fiber post / 대한치과보철학회지

The retaining methods of implant prosthesis were classified into a screw-retained and a cement-retained type. A screw-retained prosthesis has many advantages, such as retrievability, preventing residual cement, while their disadvantages include the possibility of screw loosening and fracture, on the contrary advantages of cement-retained prosthesis are relatively low cost, but they are difficult to retrieve. To combine the advantages of both type, screw-cement retained prosthesis (SCRP) type have been introduced. But they still require ideal implant placement. So we introduce fiber post retained prosthesis without residual cement for preventing soft tissue trouble due to excessive cement.

Influence of Sealing of the Screw Access Hole on the Fracture Resistance of Implant-Supported Restorations

Abstract The purpose of this study was to assess the influence of sealing of the screw access hole (SAH) on the fracture resistance of metal-ceramic implant-supported restorations. UCLA abutments were used to make 30 implant-retained mandibular molar restorations and divide equally into three groups: Group SRS: screw-retained restorations with SAH sealed; Group SRNS: screw-retained restorations with SAH not sealed; Group CR: cement-retained restorations. The following protocol was adopted to restore the SAH: the ceramic surface of the SAH was air-abraded with aluminum oxide; etched with 10% hydrofluoric acid; a silane coupling agent and a bonding agent were applied; cotton pellets were used as filling material and P-60 resin composite as restoring material. The cement-retained restorations were cemented with Rely-X U100. A metal rod with a spherical tip of 6.0 mm diameter was used to apply a vertical static load, simultaneously on the buccal and lingual incline cusps, at a crosshead speed of 0.5 mm/min until the fracture of the specimens. Data were analyzed using one-way ANOVA and Dunnet test (p<0.05) for multiples comparisons. The mode of failure was evaluated by a scanning electron microscopy (SEM). No significant difference between screw-retained restorations was found. The highest mean fracture resistance values were observed with CR group. Therefore, it was shown that SAH sealing did not influence the fracture resistance of the screw-retained restorations.

Resumo O objetivo deste estudo foi avaliar a influência do selamento do orifício de acesso ao parafuso (OAP) na resistência à fratura de coroas metalocerâmicas implantossuportadas aparafusadas. Pilares UCLA foram utilizados para fazer 30 molares inferiores implantossuportados e divididos igualmente em três grupos: Grupo AS: coroas aparafusadas com o OAP selado; Grupo ANS: coroas aparafusadas com o OAP não selado; Grupo CC: coroas cimentadas. O seguinte protocolo foi utilizado para selar o OAP: a superfície de cerâmica do OAP foi jateada com óxido de alumínio; condicionada com ácido fluorídrico a 10%; um agente silano e um adesivo dentinário foram aplicados; bolinhas de algodão foram utilizadas como material de preenchimento e a resina composta P-60 como material de restauração. As coroas cimentadas foram cimentadas com Rely-X U100. Uma haste de metal com uma ponta esférica de 6.0 mm de diâmetro foi usada para aplicar uma carga estática vertical, simultaneamente nas vertentes triturantes das cúspides linguais e vestibulares, com 0,5 mm/min velocidade do atuador até a fratura das coroas. Os dados foram analisados através de ANOVA um fator e teste de Dunnett (p<0,05) para as comparações múltiplas. O modo de falha foi avaliado por um microscópio eletrônico de varredura (MEV). Não houve diferença significativa entre restaurações aparafusadas. Os maiores valores médios de resistência à fratura foram observados com o Grupo CC. Portanto, observou-se que o selamento do OAP não influenciou a resistência à fratura das coroas aparafusadas.

Restaurações cimentadas versus parafusadas: parâmetros para seleção em prótese sobre implante / Cement-retained versus screw-retained restorations: selection parameters in implant-supported prosthesis

Com a previsibilidade e longevidade relacionadas à osseointegração, o tratamento com implantes dentários tornou-se uma realidade na clínica odontológica, proporcionando uma significativa melhora no restabelecimento da saúde bucal, da função e da estética nos tratamentos odontológicos. A fim de alcançar um sucesso mais duradouro da restauração protética, é de fundamental importância a seleção adequada do sistema de retenção da prótese sobre implante. Dessa forma, é imprescindível o conhecimento de fatores como a passividade na adaptação da restauração protética, aspectos oclusais, espaço interoclusal, requisitos estéticos, saúde dos tecidos moles peri-implantares, necessidade de manutenção, reversibilidade da restauração e fator financeiro, a fim de fornecer um embasamento científico suficiente aos cirurgiões dentistas para a escolha mais adequada do tipo de sistema de retenção nas mais variadas situações clínicas. Dessa forma, o objetivo do presente estudo foi discorrer, baseado na literatura, as vantagens, desvantagens, indicações, contra-indicações e dificuldades técnicas relacionadas a cada modalidade restauradora sobre implante (parafusada e cimentada).

With the previsibility and longevity related to the osseointegration, the treatment with dental implants became a reality in the dental clinic, providing a significant improvement in the restoration of the buccal health, of the function and of the aesthetics in the dental treatments. In order to reach a prosthetic restoration more successfull, it is very important the appropriate selection of the retention system of the implant-supported prosthesis. By this way, it is indispensable the knowledge of factors as the passivity in the prosthetic restoration adaptation, occlusal aspects, interocclusal space, aesthetic requirements, peri-implant soft tissue health, maintenance necessity, reversibility and financial factor, in order to provide a satisfactory scientific support to the dentists in the most appropriate retention system choice during the several clinical situations. In that way, the aim of the current study was to discourse, based on the literature, the advantages, disadvantages, indications, contraindications and technical difficulties related to each restoring modality implant-supported screwed and cemented.

Relaltionship Between The Depth Access Hole And Prosthetic Components In Screw Retained Implants / 대한치과보철학회지

A total of 605 implant fixture prosthesis delivered by 3 clinics and 2 laboratories were examined in this study. The object of this study was to determine the proper length of screw head. The depth of access hole were measured and compared to the type of fixture, abutment, gold screw and prosthesis. The results were as follows: 1. The average number of fixtures per patient were 2.97. 2. The number of fixture installed in the lower posterior area are 327(55.56 %), the upper posterior area 171(28.25%). 3. The depth of access hole is 4.23 mm in shallow area, and 5.46 mm in deep area and the differences were 1.23 mm. 4. The average depth of the aceess hole of the UCLA abutment were 5.02 mm. 5. The number of 4-5 mm access hole depth were 60(22.39%)in abutment screw level and the number of 4-5 mm depth in fixture level were 101(29.19%). 6. In the shape of screw head, hexed type were 576(95.21%), slotted type were 29(4.79%).