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Dr.Manoj Rajan.,MDS.,DNB,(Phd)
Professor, Dept of Prosthodontics
Ragas Dental College & Hospital
 Cement retained implant
prosthesis
• Implant prosthesis is cemented over
abutments
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Cemented prosthesis

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Screw retained implant prosthesis
• Implant prosthesis is screwed over abutments

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Screw retained prosthesis

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 Abutments for cemented
prosthesis
• One piece abutment
• Indications Next

- Multiple splinted implants

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• Two-piece abutment(Straight and angled)
• Indication
Single and multiple implant prosthesis
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• Castable Abutments
• Indications
Fabricating custom abutments

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• Custom abutments

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Computer generated abutments

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 Abutments for screw retained
prosthesis
• Screw receiving abutments
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• UCLA abutments
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 Restorative applications
• Cemented crown and bridge

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• Screw retained crown and bridge

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• Screw retained denture

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• Ball bar overdenture
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 Which is better
• To screw
• To cement Next

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Retrieval of prosthesis

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• Possible with both screw retained and
cemented prosthesis
Chee et al .Cemented versus screw retained prosthesis.Which
is better?Int J Oral Maxillofac implants 1999;14:137-141
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• Use of definitive cements is
recommended
• Cements include resin cement,zinc
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phosphate and resin modified glass
ionomer. Back

HebelKS, Gajjar RC.Cement versus screw retained

implant restorations:achieving optimum occlusion and
esthetics in implant dentistry
• Resin composite demonstrated the highest mean retentive
strength. Zinc phosphate and resin-reinforced glass-
ionomer cements were the next most retentive, while glass
ionomer and zinc oxide-non-eugenol cements
demonstrated minimal retention. Next

Squier RS et al . Retentiveness of dental cements used with Back

metallic implant components. Int J Oral Maxillofac implants 2001
Nov-Dec;16(6):793-8.
Temporary cements tend to get dissolved by
oral fluids over time
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Chee et al .Cemented versus screw retained prosthesis.Which

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is better?Int J Oral Maxillofac implants 1999;14:137-141
Implant temporary cement

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 Improv cement
• 90 Seconds Working Time

• Final Set in 3.5 Minutes

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• Compressive Strength: 8200 psi

• Film Thickness: < 20 Microns Back

• Water Sorption: 1.314mg/cm2

• Shelf-Life: 1.5 Years

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• Cements do not tend to adhere strongly to
titanium as to teeth
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Chee et al .Cemented versus screw retained prosthesis.Which
is better?Int J Oral Maxillofac implants 1999;14:137-141
• Abutment Preparations with 20 degrees of TOC and 8
mm of occlusocervical dimension had significantly
higher mean retentive values for all of the cements
tested. Significant differences in mean tensile strength
were observed, with the highest tensile resistance seen Next
with IMProv and the lowest tensile resistance seen with
Temp-Bond plus Vaseline.
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Bernal G et al. The effects of abutment taper, length

and cement type on resistance to dislodgement of
cement-retained, implant-supported restorations.
J Prosthodont. 2003 Jun;12(2):111-5.
Removal of cemented prosthesis
• Using a crown and bridge remover gently
• Making a slot in the lingual or palatal part Next
of the prosthesis where the crown remover
can engage. Back
• Accessing the abutment screw in a two
piece abutment through the crown.

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• Fabricating a cemented prosthesis with a
patent access hole.(Rajan et al. Fabrication
of a cement and screw retained implant
prosthesis.J Prosthet Dent 2004;92:578-80)
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 Passive Casting
• Metal to metal system with zero tolerance
for error in screw-retained prosthesis.
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Microstrain in bone
• Truly passive Screw retained restorations Back

impossible to fabricate(Carrab,Stewart-JPD
1993)
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• Passive castings possible in cemented
prosthesis
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• 40 micron die spacer compensates for some
dimensional variation Back
• Milling titanium prosthesis produces reliable frameworks
with accurate fit.
Hedkvist L, Mattsson T, Hellden LB.
Clinical performance of a method for the fabrication of implant-supported
precisely fitting titanium frameworks: a retrospective 5- to 8-year clinical
follow-up study. Clin Implant Dent Relat Res. 2004;6(3):174-80.

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Axial loading

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 Esthetics
• Difficult in anterior screw retained
prosthesis due to facial overlap

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• Unesthetic occlusal screw holes in screw
retained posterior prosthesis.

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 Occlusal material fracture

• Screw hole may act as stress

concentration leading to fracture of
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unsupported porcelain/acrylic.(most
studies) Back
• Screw-retained implant-supported metal-ceramic crowns
demonstrated a significantly lower porcelain fracture
resistance than cement-retained crowns. Placing the screw
access opening 1 mm offset from the center of the occlusal
surface did not result in lower fracture resistance. Next
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• Torrado E, A comparison of the porcelain fracture

resistance of screw-retained and cement-retained implant-
supported metal-ceramic crowns.
J Prosthet Dent. 2004 Jun;91(6):532-7.
 Access
• Difficult in posterior regions to access small
screws
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 Fatigue
• Screw fracture and screw loosening due to
screw fatigue
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• Abutment vibrations, tipping and
microrotation during function are leading Back

causes of fixation screw loosening.Common

in external hex implants
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• Reduced due to improved screw designs
and materials
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• Abutment screw loosening of cemented
prosthesis reduced due to new screw Back

designs
• Torque on screws reduces screw loosening

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 Abutment crown microgap
• Screw retained prosthesis does not seal the
microgap encouraging bacterial
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proliferation
• Cemented crown seals the crown abutment Back

interface with cement

 Cost and time
• Significant cost and time required for screw
retained prosthesis
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Advantages of screw retained
prosthesis

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• If less interarch space exists screw retained
prosthesis is indicated.Cemented prosthesis
require at least 5mm of abutment height for
adequate retention and resistance
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 – No risk of cement in sulcus
• Peri-implant inflammation associated with swelling,
soreness, deeper probing depth, bleeding and/or exudation
on probing, and radiographic evidence of peri-implant
bone-loss. Flap exposure revealed, foe all cases, an excess Next
of cement at the abutment crown interface.Cements used
were zinc phosphate and glass ionomer
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Pauletto N etalComplications Associated with Excess

Cement Around Crowns on Osseointegrated Implants: A
Clinical Report
Int J Oral Maxillofac Implants 1999; 14: 865-868
 Conclusion
Cement retained implant prosthesis has the
following advantages
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• Passive casting
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• Axial load transfer
• Esthetics and hygiene
• Abutment microgap sealed
• Cost and time component reduced
 Advantages of screw retained
prosthesis
• Low profile retention
• Limited interarch space Next

• No cement in sulcus
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 Clinical applications
• Cemented prosthesis
-All fixed prosthetic situations
• Screw retained prosthesis
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-reduced interarch space
-deep implant placement making cement removal Back
difficult
-Full arch round hybrid prosthesis with metal and
acrylic resin
-immediate temporary provisional
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Thank you Back