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Table of Contents
CASE REPORT
Year : 2021  |  Volume : 11  |  Issue : 1  |  Page : 32-35

Prosthodontic management of a clinically short implant abutment due to the deep placement of a single-piece implant – A new approach


Department of Prosthodontics, Government Dental College, Thiruvananthapuram, Kerala, India

Date of Submission13-May-2019
Date of Acceptance29-Jul-2020
Date of Web Publication22-Apr-2021

Correspondence Address:
Dr. C Femil Jilta
No. 4, Implant Clinic, Department of Prosthodontics, Government Dental College, Medical College Campus, Ulloor, Thiruvananthapuram, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jid.jid_24_19

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   Abstract 


Maintaining the integrity of the connection between the prosthetic superstructure and the fixture plays an important role in the success of implant treatment. Implant restorations can be screw retained or cement retained, each having its own advantages and disadvantages. Nowadays, cemented restoration is commonly opted as it has several advantages for use as a fixed implant prosthesis such as passive cast, equal stress distribution, enhanced esthetics, lower cost, and less time-consumting. Despite higher success and survival rates of cement-retained prosthesis due to advanced materials and proven designs, mechanical failures like cementation failures are been reported. This may be due to the compromised retentive form of the abutment or bond failure. Here, a case is documented where the patient reported with frequent dislodgment of cement-retained crown due to compromised height of implant abutment in a deeply placed single-piece implant.

Keywords: Bond failure, cemented restoration, implant abutment, retentive form


How to cite this article:
Jilta C F, Kumar K H, Ravichandran R, Nair VV. Prosthodontic management of a clinically short implant abutment due to the deep placement of a single-piece implant – A new approach. J Interdiscip Dentistry 2021;11:32-5

How to cite this URL:
Jilta C F, Kumar K H, Ravichandran R, Nair VV. Prosthodontic management of a clinically short implant abutment due to the deep placement of a single-piece implant – A new approach. J Interdiscip Dentistry [serial online] 2021 [cited 2021 Oct 26];11:32-5. Available from: https://www.jidonline.com/text.asp?2021/11/1/32/314177




   Clinical Relevance to Interdisciplinary Dentistry Top


Compromised height of implant abutment for crown retention in a deeply placed single-piece implant can be managed through osteoplasty and custom-made titanium coping.


   Introduction Top


Fixed implant prosthesis can be either screw retained or cement retained. Screw-retained prostheses have successful application in completely edentulous patients but have their own limitations. To overcome this, cement-retained prosthesis has become the restoration of choice in implant treatment. The cemented prosthesis has superior occlusion, esthetics, and loading characteristics when compared to the screw-retained prosthesis. However, the main disadvantage is their irretrievability. In spite of being irretrievable, the retention failure rate ranged from 0% to 23.72%.[1] This case report describes a simple and safe technique to lengthen abutment in a deeply placed single-piece implant to overcome cementation failure due to its inadequate length.


   Case Report Top


A 50-year-old female reported to our dental clinic with complaints of frequent dislodgement of implant crown [Figure 1] and [Figure 2]. On clinical examination, the implant in 24 region was associated with short implant abutment, in which only 2 mm of the abutment was exposed outside the mucosa [Figure 3]. Radiographic evaluation showed a single-piece implant in the region of 24, which was deeply placed into supporting bone, with bone covering the abutment to 3 mm of its whole length [Figure 4]. Hence, the treatment was planned to surgically expose the implant abutment by gingivectomy and osteoplasty and lengthen the abutment using custom-made cement-retained abutment coping. On receiving patients' consent, local anesthesia was infiltrated; the abutment was exposed surgically similar to conventional crown lengthening procedure by osteoplasty and gingivectomy [Figure 5]. Bone level impression was made, and custom-made cement-retained titanium abutment coping was fabricated with incorporated 6° taper [Figure 6]. The apical 4 mm of the transmucosal part of the abutment coping was smoothened, and the coronal 6 mm was roughened to achieve retention for the prosthetic crown. This custom-made abutment coping was cemented using GIC over the existing implant abutment [Figure 7]. Abutment level impression was made, and the implant was finally restored using cement-retained crown [Figure 8] and [Figure 9]. The patient was reviewed after 3 months, with 1-year follow-up and checked for its integrity [Figure 10].
Figure 1: Pre-operative extraoral view

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Figure 2: Dislodged crown

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Figure 3: 2 mm of remaining abutment

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Figure 4: Pre-operative OPG

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Figure 5: Surgical exposure of the abutment

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Figure 6: Customized titanium coping

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Figure 7: Titanium coping cemented

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Figure 8: Cemented crown

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Figure 9: Postoperative extra oral view

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Figure 10: IOPA after 1 year

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   Discussion Top


The security of retention is considered to be one of the most important factors affecting implant prostheses longevity.[2] Nowadays, to overcome limitations of the screw-retained prosthesis, cement-retained prosthesis has become the restoration of choice.[3] Cement-retained prosthesis has clinical advantages being compensation of improperly inclined implants, improved esthetic, greater passivity of fit, less incidence of ceramic veneer fracture, intact occlusal table, better stress distribution, reduced cost, and complexity of laboratory procedures.[4] Furthermore, challenges with accessibility in placing the screwdriver of screw-retained restoration in patient with a limited opening and/or in the posterior area can be eliminated using cement-retained prostheses.[5] Cement-retained implant-supported prostheses are widely used as a retention type because abutment preparation designs and cementation techniques mimic conventional fixed prosthodontic procedures.[6] Even though the success rates of single cement-retained implant crowns are greater, literature shows retention failure rate ranged from 0% to 23.72%.[1] There are several factors that affect the retention of cement-retained restorations such as taper, surface area, height, the surface roughness of abutment, and type of cement.[7],[8],[9],[10] The minimum abutment height to use cement-retained restorations with predictable retention was documented to be 5 mm.[7] Thus, we have surgically exposed the implant abutment to 3 mm to get a net height of 5 mm of the abutment for achieving better retention for the custom-made titanium abutment coping. The custom-made titanium abutment coping was fabricated to a height of 10 mm to compensate for the occlusogingival discrepancy and to give superior retention. Another factor that greatly affects the amount of retention in cement-retained restorations is the taper. The concept of ideal tapering proposed by Jorgensen for natural teeth is 6°.[8] Since the implant abutment geometry for cement-retained prosthesis is the same as natural tooth, a taper of 6° is given to the abutment coping also. The case report adopts a new technique to increase the length of the short abutment of a deeply placed single-piece implant by using custom-made abutment coping that ultimately improves the retention of the prosthetic crown. Even though the technique is simple and easy, it also has some disadvantages like retention of excess cement in the peri-implant submucosal region after cementation of the custom-made titanium abutment, and hence to prevent excess cement extrusion, we have followed resin abutment analog technique that might probably reduce the occurrence of peri-implantitis.[11]


   Conclusion Top


Thus, retention failure of cement-retained crown due to compromised implant abutment length is deeply placed single piece implants can be successively managed by custom-made titanium abutment coping.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Jain JK, Sethuraman R, Chauhan S, Javiya P, Srivastava S, Patel R, et al. Retention failures in cement- and screw-retained fixed restorations on dental implants in partially edentulous arches: A systematic review with meta-analysis. J Indian Prosthodont Soc 2018;18:201-11.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Michalakis KX, Hirayama H, Garefis PD. Cement-retained versus screw-retained implant restorations: A critical review. Int J Oral Maxillofac Implants 2003;18:719-28.  Back to cited text no. 2
    
3.
Kapoor R, Singh K, Kaur S, Arora A. Retention of implant supported metal crowns cemented with different luting agents: A comparative in vitro study. J Clin Diagn Res 2016;10:ZC61-4.  Back to cited text no. 3
    
4.
Abou-Obaid A, Al-Khudairy R. Effect of abutment height and cement thickness on the retention of cement-retained implant-supported restorations. Adv Dent Oral Health 2018;9:112-6.  Back to cited text no. 4
    
5.
Hebel KS, Gajjar RC. Cement-retained versus screw-retained implant restorations: achieving optimal occlusion and esthetics in implant dentistry. J Prosthet Dent 1997;77:28-35.  Back to cited text no. 5
    
6.
Mansour A, Ercoli C, Graser G, Tallents R, Moss M. Comparative evaluation of casting retention using the ITI solid abutment with six cements. Clin Oral Implants Res 2002;13:343-8.  Back to cited text no. 6
    
7.
Kaufman EG, Coelho DH, Colin L. Factors influencing the retention of cemented gold castings. J Prosthet Dent 1961;11:487-502.  Back to cited text no. 7
    
8.
Gilboe DB, Teteruck WR. Fundamentals of extracoronal tooth preparation. Part I. Retention and resistance form. J Prosthet Dent 1974;32:651-6.  Back to cited text no. 8
    
9.
Jørgensen KD. The relation between retention and angle of convergence in cemented veneer crowns. Tandlaegebladet 1955;59:94-8.  Back to cited text no. 9
    
10.
Breeding LC, Dixon DL, Bogacki MT, Tietge JD. Use of luting agents with an implant system: Part I. J Prosthet Dent 1992;68:737-41.  Back to cited text no. 10
    
11.
Galván G, Kois JC, Chaiyabutr Y, Kois D. Cemented implant restoration: A technique for minimizing adverse biologic consequences. J Prosthet Dent 2015;114:482-5.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]



 

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