Cement remnants removal in implant restorations: A preliminary in vitro study

Treball Final de Grau d'Odontologia, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Curs: 2016-2017, Director: Rui Pedro Barbosa De FigueiredoObjectives: To evaluate the efficacy of stainless steel explorers, waxed dental floss and teflon scalers in removing cement remnants from fixed implant restorations; To evaluate if these instruments produce surface alterations in the abutment surface. Materials and Methods: A preliminary in vitro study, involving 9 identical single-unit implant-supported crowns (upper central incisor), manufactured with CAD/CAM technology, was perfomed. After cementation with a zinc oxide eugenol cement, each crown was randomly allocated into 3 study groups, according to the instrument used to remove the cement remnants (teflon scaler, stainless steel explorer and waxed dental floss). An experienced professional removed the cement remnants. Afterwards, a blinded researcher evaluated the presence of cement using direct visual observation, standardized digital photographs and Scanning Electron Microscopy (SEM) images. In the latter analysis (SEM 75x), surface alterations in the abutment surface caused by the employed instruments were also registered. A descriptive analysis of the data was performed. Results: After cementation, cement remnants were observed in all samples. The instrument that eliminated a higher percentage of cement remnants was the stainless steel explorer (59.4%) and the worst, the waxed dental floss (27.6%). The stainless steel explorer produced scratches in 100% of the samples (5 to 10 scratches in each sample). Conclusions: Even though cement debris was observed in all samples, stainless steel explorers and teflon scalers seem to be the most effective instruments in the removal of cement remnants in implant-supported restorations. Since stainless steel explorers scratched the abutment surface, teflon scalers seem to be the best option for this particular indication. Dental floss is not a suitable alternative since it removed less cement than the other 2 instruments, and also left some material debris (small threads) over the abutment. A larger sample is required to confirm the present findings