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Excess Cement Resulting in Peri-implant Infection Presenting as a Draining Sinus Tract

Tomas Linkevicius

Biological complications caused by undetected cement residue have been receiving much attention. Excess cement might be responsible not only for rapidly developing of peri-implantitis, but also for delayed or chronic manifestations of the disease many years after cementation (Wilson 2009; Linkevicius and coworkers 2013). Invitro and clinical studies have shown that it is very difficult or even impossible to completely clean up excess cement at subgingival margins, so popular in cemented restorations (Agar and coworkers 1997; Linkevicius and coworkers 2011, 2012). Possible outcomes of biological complications due to excess cement range from temporary inflammation of the peri-implant soft tissues without any serious esthetic and functional consequences all the way to implant loss. This report describes a case of peri-implantitis caused by residual cement; as well as the management and quite unusual resolution of the complication. The patient presented in 2009 with a draining sinus tract, tenderness on chewing, and tissue contact above the implant-supported restoration. The implant had been restored approximately three years before.

General information

Case Type Single-Tooth Space
Jaw Maxilla
Area Posterior
# of Teeth 1
# of Implants 1
Type of Implants Two-Piece
Attachment Two-Piece
Bone Augmentation No
Augmentation Materials -
Guided Surgery No
Soft Tissue Grafting None
Abutment Type Standard
Prosthesis Type FDP

Esthetic Risk Assessment

Esthetic Risk Factors Low Medium High
Medical Status Healthy Compromised
Smoking Habit Non-smoker Light smoker (< 10 cigarettes per day) Heavy smoker (≥ 10 cigarettes per day)
Patient's Esthetic Expectations Low Medium High
Lip Line No exposure of papillae Exposure of papillae Full exposure of mucosa margin
Periodontal Phenotype Low-scalloped, thick Medium-scalloped, medium-thick High-scalloped, thin
Shape of Tooth Crowns Rectangular Triangular
Infection at Implant Site None Chronic Acute
Bone Level at Adjacent Teeth ≤ 5 mm to contact point 5.5 to 6.5 mm to contact point > 7 mm to contact point
Prosthodontic Status of Neighboring Teeth Virgin Restored
Width of Edentulous Span 1 tooth (≥ 7 mm) 1 tooth (< 7 mm) 2 teeth or more
Soft Tissue Anatomy Intact Defective
Bone Volume Horizontally and vertically sufficient Horizontally deficient Deficient vertically or deficient vertically AND horizontally
  • * General SAC assessment modifiers that are also part of the ERA. To avoid redundancy they are listed in this section even if no complete ERA has been made.

  • ** Not applicable to the ERA of immediate placement cases and replaced by "Socket Integrity" listed below under "Surgical SAC Classification". For all other placement types this value is a classification determinant and listed here even if no complete ERA has been made.

Surgical SAC classification

SAC Level Straightforward
Defining Characteristics One missing tooth to be replaced by an implant-borne prosthesis
Modality -
Placement Protocol Early or late implant placement
Tooth Site -
Socket Morphology -
Socket Integrity -
Bone Volume Horizontally and vertically sufficient
Anatomic Risk Low
Esthetic Risk Low
Complexity Low
Risk of Complications Low

Prosthodontic SAC classification

SAC Level Straightforward
Defining Characteristics One missing tooth to be replaced by an implant-borne crown
Loading Protocol Conventional or early
Retention Screw-retained Screw-retained
Maxillomandibular Relationship -
Mesio-Distal Space Anatomic space corresponding to the missing tooth +/- 1 mm
Inter-Arch Distance Ideal tooth height +/- 1 mm
Bruxism Absent
Esthetic Risk Low
Provisional Implant-Supported Prosthesis - -
Interim Prosthesis during Healing - -
Occlusion/Articulation -
Occlusal Scheme/Issues -

Surgical SAC Modifiers

Periodontal Status Healthy

Prosthodontic SAC Modifiers

Soft Tissue Contour and Volume -

General SAC Modifiers

Oral Hygiene and Compliance Sufficient
Access Adequate
Craniofacial/Skeletal Growth Completed

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