The Team approach To managing implanT complicaTions

Dental implants are considered to be highly sophisticated medical devices that provide real value for patients and potential improved quality of life.1 With the introduction of the cemented restoration came the ability to restore implants in a manner similar to the way the natural dentition is treated— namely, crown and bridge prosthetics.2 However, in recent years there appears to have been an increase in the incidence of periimplant disease, which may be associated in one form or another with this type of restoration.3-6 A recent report by the American Academy of Periodontology includes residual cement as a risk factor for peri-implant disease (perimucositis and peri-implantitis).7 It appears that all implants are susceptible to peri-implant disease.8,9 The purpose of this article is to explore why such a relationship between cements, implants, and disease may exist and to offer guidance related to prevention of the problem. Contributing Factors A common misconception is that it is only the type of luting cement used that leads to an implant disease process. However, any cement can lead to destruction around an implant, and even though some cements may present more issues than others, the disease process—as is the case with most diseases—is multifactorial. In order to prevent peri-implant diseases, it is important to understand factors that contribute to implants being vulnerable to the cement-induced disease process, including biology, depth, environment, implant materials, cement properties, cement application, abutment design, and maintenance. While it is not feasible to discuss all of these issues in one article, several of these topics will be covered. Clinicians are familiar with dealing with the natural dentition and have, therefore, taken many of the concepts and techniques used when restoring a tooth with a cemented restoration and transferred them to the cemented implant restoration. This must be considered an error, because teeth and implants have very different requirements from each other, as discussed in the following sections.