Crown Cementation as a Risk Factor of Peri-implantitis: A Systematic Review

Abstract

Introduction: Cemented crowns are usually used on implant abutments instead of screw-retained crowns. The amount of cement excess that is left in the peri-implant tissues depended on the depth of the crown margins. The remnants of cement in peri-implant tissues can trigger an inflammatory response because it is considered a foreign body.
Methods: Electronic databases were searched including MEDLINE and EMBASE using the PubMed search engine. Furthermore, the search will be conducted in databases and repositories of grey literature such as Open Grey and OAIster. The databases of a systematic review and clinical trials such as Cochrane libraries and the Center for Reviews and dissemination were screened for eligible primary studies. Based on the primary screening results the irrelevant studies, duplicates and reviews were excluded. We used checklists containing items used to judge the quality of sampling, data collection, and statistical analysis, in addition to the risk of bias within included studies.
Results: Five of included studies evaluated only implants supported by single crowns and five studies assessed different types of implants supported by single crowns or FPDs. Only one study, a randomized clinical trial, focused on implants supported FPDs using split mouth design. The sites of implant placement were different, however commonly anterior teeth, bicuspid teeth, and first molars. Concerning the type of cementation, zinc oxide cement was reported in some studies, other studies used glass ionomer cement, resin cement, zinc phosphate cement, and temporary cement. Only two studies reported the detection of cement remnants, while other studies reported the use of procedures to reduce or remove excess cement.
Conclusions: Peri-implant disease has been shown to be associated with residual cement in particular in patients with predisposing periodontal disease. Cement remnants in patients without a history of periodontitis may cause less severe peri-implant disease or may not predispose to infection at all. Screw-retained implant restorations might be considered in periodontally susceptible patients.