Excess cement and peri-implant disease: A cross-sectional clinical endoscopic study

BackgroundCrown cementation is a common technique for implant-supported prosthodontics. However, for possible slipping of the cement below the mucosal margin, its thorough removal poses some issues. The objective of this study was to evaluate the presence of submucosal cement residues in patients with peri-implant disease by endoscopic visualization and to investigate the potential correlation between the pathological scenario and the spatial position of cement residues.MethodsThe study sample comprised 46 consecutive patients exhibiting clinical and radiographic signs of peri-implant disease around cement-retained crowns. When at first visit bleeding on probing was the only pathological sign, the area was debrided and then treated with antiseptic agents for 30 days. Only those patients for whom bleeding was still found at re-evaluation were included in the study. All implants were therefore endoscopically evaluated to identify possible submucosal cement residues. For all implants showing residual cement, the spatial position of the residual cement was recorded with respect to predefined points.ResultsCement residues were detected in 80.4% of the patients and were predominantly located in the vestibular and lingual areas (88%). Analysis of the distances between the apical portion of the residues and anatomical landmarks revealed significant differences between mucositis and peri-implantitis patients (p = 0.001). In cases of peri-implantitis, the cement residue was more apically located than in mucositis.ConclusionThe presence of cement residue was associated with peri-implant disorders in the majority of patients. A potential correlation between the position of residues and the peri-implant disease scenario is here suggested.Plain language summaryA common method for fixing the crown on the dental implant is the use of specific cements. However, these products can slip below the gum line resulting in difficulties in their removal, which could cause peri-implant disease. This study aimed to evaluate the presence and location of residual cement hidden under the gums in patients with peri-implant disease, characterized by symptoms such as bleeding gums and, in some cases, bone loss around the dental implant. Using a small fiber-optic camera (endoscope), 46 patients were examined for any cement residue under the gums. The study showed that more than 80% of patients had cement residues, especially in the areas facing the cheeks and tongue. It was also found that in patients with a more severe form of inflammation (peri-implantitis), the cement was placed deeper than in those with a milder form (mucositis). This confirms that residual cement is common in patients with peri-implant disease, but also suggests that its location could influence the severity of the pathological manifestation. This finding highlights the importance of carefully removing all cement to prevent such complications.