The Impact of Residual Cement On Biological Complications And Crestal Bone Loss Around Dental Implants: A Systematic Review

Objectives: To perform a systematic review on the impact of retained excess cement on peri-implant diseases and crestal bone loss.
Methods: PRISMA criteria were adopted. An electronic search was conducted on the following electronic databases: Medline, SCOPUS, ISI Web of Knowledge and Cochrane Central Register of Controlled Trials (CENTRAL).
Pico Criteria were used as follows:
Participants: participants receiving cement retained implant restorations
Intervention: assessment of peri-implant clinical parameters and bone loss restorations. Only study with clear data on the assessment of residual cement were included
Comparison: when possible comparison between healthy and diseased peri-implant tissues. Additional comparison:different types of cements
Outcome: incidence of peri-implantitis and mucositis. crestal bone loss

Inclusion criteria:
1)Studies on dental implants restored with cement retained restorations
2)Data on the impact of cement on peri-implant clinical parameters, bone loss and incidence of peri-implantitis.
3)Assessment of residual cement
4)Human studies
5)Randomized controlled trials, prospective, longitudinal, retrospective and multicenter studies with a minimum of 18 months mean follow up after implant placement and clear data on replacement implant survival rates.
6)English language
7)Titanium dental implant material
8)No implant type selection

Exclusion criteria:
1)Studies concerning treatment of patients with conditions possibly affecting survival or success rates of implant treatment
2)Studies concerning treatment of patients with non-treated periodontal diseases.
3)Dental implant material different from titanium and studies on orthodontic mini implants.
Results: A total of 6 studies met the inclusion criteria. The studies were heterogeneous and had a moderate to high risk of bias. A positive relationship between excess of cement and peri-implant inflammation was observed. Data on peri-implant probing depths and crestal bone loss was reported only by one research group
Conclusions: Within the limits of the present review it is possible to suggest that the excess of cement:
-increases the risk of onset of peri-implant mucositis
-may be related to increased probing depths, peri-implantitis and crestal bone loss
Zinc oxide eugenol cements should be preferred to resin cements.