Chandur Wadhwani: The impact of cement, its techniques and protocols for long term outcomes

Residual cement is considered a main causal risk factor for peri-implant disease. Cement remnants causing microbial activity, immune reaction, allergic response, activation of titanium surface may be the route by which bone is lost around implants. Dr Wadhwani discusses the possible etiology of restorative driven peri-implant disease and the little knowledge that exists in the dental industry about the technical and physical background of cementation techniques and protocols, e.g. how cement flows and how the hydraulic forces developing during cementation procedures can lead to tissue destruction around the implant. By using sophisticated computational fluid dynamics the attempt is to increase the knowledge and give important insights, identifying the ideal cement application location within the crown lumen, use of adequate amount of cement, influence of speed of crown seating, and explaining how to minimize residual excess cement and the the related problems. Cement brands are reviewed and ranked as of their suitability for use with implant based restorations. A screw-retained design is the easiest alternative - and the screw retained angulated screw (ASC) abutment increases considerably the options to use screw-retained design in the esthetic zone.