The success rate and prognosis of implants in our day and age has made implants the gold standard in restoring an edentulous space. Clinicians placing implants have become very proficient, and when proper treatment planning with the end restoration in mind is utilized, patients are satisfied with the result. However, an increasing trend of failures has arose that deals not with the placement and retention of the titanium screw, but of an inflammatory nature that can be completely avoided.
When a restorative dentist cements a crown on an abutment, especially on bone level abutments with limited view, they must be mindful of removing all residual cement. In, 2009 study was published by Dr. J Wilson in the Journal of Periodontology that looks at the positive relationship between excess cement and peri-implant disease. In 81% of the cases of peri-implantitis, residual cement was found to be the etiology of disease. This problem can be avoided by either adopting screw retained restorations which do not require cement, or utilizing a PVS custom abutment to gauge how much cement is needed. This PVS strategy is performed by injecting impression material into the crown to be cemented. After the material has set and the crown is ready to be cemented, the crown can be seated on the custom PVS abutment to extrude excess cement from the crown before permanently seating on the implant abutment. If clinicians want to avoid this lawsuit altogether, screw-retained crowns can be used. However, these crowns have disadvantages such as fracture propagation, decreased esthetics, and increased lab fees.
It is ultimately up to the restorative dentist and the patient to discuss the alternatives and agree on a treatment plan.