Board Certified Prosthodontist, 23 Main Street, Suite 303, Hilton Head Island, SC, 29926, USA.
J Esthet Restor Dent. 2017 May 6;29(3):161-171. doi: 10.1111/jerd.12283. Epub 2017 Jan 23.
There is a trend toward increased use of screw-retained single-implant restorations. A comprehensive literature review was undertaken to examine the data related to screw- and cement-retention and to objectively evaluate the innovations in implant dentistry that have led to this resurgence.
When comparing the two options, survival and complication rates are similar, bone and soft-tissue levels are comparable, and zirconia offers esthetic advantages for both selections. Zirconia abutments with bonded titanium inserts provide esthetic alternatives to titanium abutments for both choices. Bone- and soft-tissue responses are similar, but residual cement of cement-retained restorations is associated with significant soft- and hard-tissue complications. The potential weakness of ceramic discontinuity of screw-access openings can be lessened by the incorporation of stronger ceramic materials such as zirconia and lithium disilicate. The overriding remaining indication for cement-retained restorations is to compensate for angled implants.
Screw-retained single-implant crowns should be reconsidered for many clinical situations for the following reasons: Predictable retention and retrievability No potential for the biologic consequences associated with residual cement As with cement-retained restorations, the choice between metal ceramics or all ceramics Only one margin, at the implant/abutment interface A single abutment/crown ceramic margin that can extend gingivally to the implant interface Nearly imperceptible blend of a composite resin in ceramic abutment access openings One component instead of two, which may simplify the restorative process CLINICAL SIGNIFICANCE: Innovations in implant and ceramic technology now give screw-retained prostheses the potential for esthetic, functional, and biologic outcomes that are comparable to those for cement-retained prostheses, while providing the advantages of predictable retrievability and avoidance of residual cement. Angled implants, however, remain a major indication for cement-retained single-implant prostheses. (J Esthet Restor Dent 29:161-171, 2017).
使用螺钉固位单颗种植体修复体的趋势逐渐增加。本综述旨在对螺钉固位和黏接固位相关数据进行全面评估，客观评价导致这一趋势的种植体领域的创新。
比较这两种修复方式，其存活率和并发症发生率相似，骨和软组织水平相当，氧化锆在两种选择中均具有美学优势。对于两种选择，黏接固位时使用带钛内连接体的氧化锆基台，可替代钛基台；螺钉固位时，使用黏接固位的修复体时，其残余黏结剂与严重的软硬组织并发症相关。螺钉固位修复体固位螺钉的陶瓷微间隙潜在弱点可通过加入更强的陶瓷材料如氧化锆和锂硅玻璃陶瓷来减轻。黏结固位修复体的主要适应证仍然是补偿倾斜种植体。
由于以下原因，对于许多临床情况，应重新考虑螺钉固位单颗种植体冠：可预测的保留和可取出性无残余黏结剂相关生物学后果的潜在风险与黏结固位修复体一样，可在金属陶瓷或全陶瓷之间选择只有一个边缘，位于种植体/基台界面处单个基台/冠陶瓷边缘可向种植体界面延伸龈方复合树脂在陶瓷基台修复体开口中的几乎不可察觉的混合仅一个部件，而不是两个，这可能简化修复过程临床意义：种植体和陶瓷技术的创新使螺钉固位修复体具有与黏结固位修复体相当的美学、功能和生物学效果的潜力，同时具有可预测的可取出性和避免残余黏结剂的优势。然而，倾斜种植体仍然是黏结固位单颗种植体修复体的主要适应证。（J 修复美学牙科 29:161-171，2017）。
