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Crestal Bone Loss and the Consequences of Retained Excess Cement Around Dental Implants

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01/06/2012 at 5:10 pm #15559
DrAnilDrAnil
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Figure 1  Radiograph demonstrating retained excess cement on abutment (see arrow).

Figure 1

Figure 2  Clinical photograph of an implant restoration replacing the congenitally missing maxillary left lateral incisor. Note the cyanotic color changes, due to inflammation and cement, of the marginal gingiva in a 31-year-old female patient with thin biotype.

Figure 2

Figure 3  Clinical photograph of maxillary left lateral incisor implant restoration in a 60-year-old man. Implant had been restored 5 years earlier. The thick gingival tissue demonstrated redness and cyanotic color changes, swollen marginal contour, and loss of fibrous tone; bleeding and suppuration was noted on probing.

Figure 3

Figure 4  Radiograph of the implant restoration in the maxillary left lateral incisor shown in Figure 3.

Figure 4

Figure 5  Excess cement noted below the crown margin resulting in peri-implant inflammation as shown in Figure 3. After facial and palatal flap elevation for direct visualization, excess cement was removed with curettes. Care was taken to avoid scratching the abutment surface. The site was irrigated with a 0.12% chlorhexadine-based oral rinse; flaps were replaced and closed with resorbable gut suture.

Figure 5

Figure 6  Marginal inflammation noted in the sulcus of an implant provisional crown in place for 6 weeks.

Figure 6

Figure 7  Provisional restoration with excess cement noted below the margin resulting in crevicular inflammation.

Figure 7

Figure 8  Clinical photograph of gingival recession resulting from excess cement around an implant crown in the maxillary right lateral incisor in a 24-year-old woman.

Figure 8

Figure 9  Clinical photograph of retained cement on abutment margin.

Figure 9

Figure 10  Radiograph demonstrating localized bone loss associated with retained cement on the mesial aspect of implant abutment. Bone loss was only noted on mesial where cement was found; no bone loss was noted on distal where cement was absent. (Actual bone loss was more evident clinically than radiographically.)

Figure 10

Figure 11  Radiograph demonstrating a quantity of excess cement on the mesial aspect of an implant crown and abutment.

Figure 11

Figure 12  Radiograph demonstrating crestal bone loss around an implant collar in a 48-year-old man returning to the surgical office for a yearly examination.

Figure 12

Figure 13  Clinical photograph demonstrating excess cement below the crown margin with resulting circumferential bone loss.

Figure 13

Figure 14  Cementation technique of creating a duplicate abutment using dense bite registration paste within the implant crown.

Figure 14

Figure 15  Duplicate abutment created.

Figure 15

Figure 16  Cementation technique of creating a duplicate abutment using dense bite registration paste within the implant crown. Cement applied to the inner aspect of the crown.

Figure 16