I am glad I waited! Today one of the biggest causes of
implant failure is due to cement induced peri-implantitis.
There are many reasons why cements are now one of the
biggest reasons for implant failure.
From a biological perspective, the tooth socket no longer
has a periodontal ligament, a natural barrier that reduces excess cement
accumulation.
From a placement perspective implants may not initially be
as stable as a natural tooth with potential greater mobility and compression
during crown seating, again allowing for excess cement to be extruded into the “sulcus”.
Cement visualization may also be complicated by pink colored cements, making
excess cement removal difficult.
From a practice perspective, reluctance exists by some to
select a permanent cement, and choose to use a temporary cement while keeping
the option open to remove the crown, if needed. Temporary cements by design are
weak and often crumbly, making again excess cement removal more difficult in
having to remove all of these little bits and pieces.
Finally, nearly ALL implant cements are NOT radio-opaque,
making their diagnostic observation impossible. I know that some readers may
believe their cement is radio-opaque because it says so on the package, I also did
at one time. For this proof, I cite
“Radiographic Appearance of Commonly Used Cements in Implant Dentistry”,
Pette, G.A., Ganeles, J., and Norkin, F.J., Intl J Periodontics Restorative
Dentistry, 2013, Jan-Feb 33(1):61-8., a publication which evaluates this claim.
The authors concluded that these cements “are not radiographically detectable
at an appropriate sample thickness”.
How would you know if your cement is radio-opaque if you
can’t see it? After observing tissue inflammation is not the time to learn that
your cement is not radio-opaque. This paper and the development of a new
generation of implant cements are based on a 350% level of radio-opacity, not
at the < 100% aluminum equivalent that are cited in this paper.
And if this is not enough, in a healing and already
compromised environment, almost all implant cements are not anti-bacterial,
allowing weak, crumbly, porous excess cement to be a site for bacterial growth.
All of these
conditions can lead to inflammation, tissue breakdown, and cement induced
peri-implantitis.
So, in 10 years, we have learned a lot as to what an implant
cement should provide.
Still wondering about the importance of cement induced
peri-implantitis, just look at the websites of some of the leading implant
companies to see their cases of peri-implantitis, a problem which I can assure
you they want to go away. This is a topic of another blog, someday.
To solve these problems, a current generation of true
implant cements has emerged. These products are long-term cements, not weak,
soluble, crumbly temporary cements; they are strong, but retrievable; they are
enamel or dentin colored; they should be at least 350% aluminum equivalent
radio-opaque; and they are anti-bacterial.
I encourage both new practitioners and experienced implantologists
to learn more about these cements and avoid the all too common problem of
trying to retrieve excess cement that they can not see, until its too late.
______________________________________
One such product
that solves this problem is Harmony
Implant Cement.
To learn
about its qualities and benefits, please visit www.DenaliCorporation.com.
