Incidence of Peri-Implant Disease Associated With Cement- and Screw-Retained Implant-Supported Prostheses
TAKE-HOME MESSAGE
- In recent years, screw-retained implant-supported prostheses have been advocated as a modality to prevent peri-implantitis caused by excess luting cement remaining after the cementation of cement-retained prostheses. This systematic review and meta-analysis investigated whether the incidence of peri-implant diseases is higher among cement-retained implant-supported prostheses than among screw-retained prostheses. Based on the six randomized controlled trials included, the meta-analysis found no significant difference between the two methods of prosthesis retention in terms of the risk of peri-implant mucositis or peri-implantitis. However, a limited number of studies were available to be included in the analysis.
- Although screw-retained restorations do not appear to prevent peri-implantitis, clinicians should consider other factors, such as the ease of retrievability, esthetics, and patient-specific factors, when choosing the method of prosthesis retention.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersSTATEMENT OF PROBLEM
Implant-supported fixed dental prostheses can be cement- or screw-retained on the implant or abutment, with advantages and disadvantages for each method. Cemented prostheses have been associated with peri-implant disease because cement remnants act as a reservoir for bacteria and hinder biofilm control. However, contrasting evidence has been presented regarding this association based on studies with varying designs, and a systematic review and meta-analysis is required.
PURPOSE
The purpose of this systematic review and meta-analysis was to answer the focused question: In patients who received implant-supported prostheses, is the incidence of peri-implant diseases higher in cemented implant-supported prostheses than in screw-retained ones?
MATERIAL AND METHODS
The search was conducted using the National Library of Medicine (MEDLINE-PubMed), SCOPUS, EMBASE, and ISI Web of Science databases. Randomized clinical trials (RCTs) that assessed the incidence of peri-implant disease in cement- and screw-retained prostheses were included. Two authors independently screened the titles and abstracts, and analyzed the full texts, extracted data, and assessed the risk of bias. The findings were summarized using meta-analyses with random effects, and the level of certainty of the evidence was determined using the grading of recommendations, assessments, development, and evaluations (GRADE) approach.
RESULTS
The search yielded 4455 articles that met the inclusion criteria based on the title and/or abstract selection. A total of 6 RCTs were included for analysis. The meta-analysis revealed no significant difference between cement- and screw-retained prostheses for the risk of peri-implant mucositis (RR: 1.36, 95% CI: 0.42-4.38, P=.61). Similarly, no significant difference was observed between cement- and screw-retained prostheses for the incidence of peri-implantitis (RR: 1.00, 95% CI: 0.23-4.31, P=1.00).
CONCLUSIONS
Moderate certainty evidence suggests that cement- and screw-retained prostheses present a similar risk for peri-implant mucositis and peri-implantitis.
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Additional Info
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Incidence of peri-implant disease associated with cement- and screw-retained implant-supported prostheses: A systematic review and meta-analysis
J Prosthet Dent 2023 Oct 02;[EPub Ahead of Print], INRD Reis, GL Fukuoka, BE Nagay, CM Pannuti, R Spin-Neto, EVF da SilvaFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This timely systematic review was well-designed and constructed. This is a thorough analysis of recent clinical trials that specifically documented the type of prosthetic restorations provided and followed over time, with the documentation of peri-implant disease findings. Although numerous authors have advocated screw retention over cement retention and vice versa, the reported outcomes of these two approaches have not been analyzed as a group in an objective manner. This review clearly demonstrates that the means of retention chosen for implant prostheses can be based upon specific clinical indications (and preferences) of the treating dentist, without an increased risk of peri-implant complications, simply based upon the type of retention used. The risk of excess cement trapped below the soft tissue is clearly a substantial risk factor in the use of cement-retained restorations. However, when a proper cementation technique is used to minimize the expression of excess cement beneath the soft tissues, the long-term prognosis of these restorations is comparable to that of screw-retained restorations. The advantages cited for cement-retained implant restorations, including simplicity, reduced overall component cost, and the absence of occlusal screw loosening as an avoidable complication, make cement retention an attractive option for implant-supported restorations. This review puts to rest the concern that cement retention is not a sound approach for implant restoration.