Mastering Implant Crown Cementation: Why Dual-Cure Temporary Cements Offer a Clinical Advantage

As dental professionals, we understand that implant crown cementation is one of the most critical stages in restorative implant dentistry. Even when surgical placement and osseointegration are ideal, the final prosthetic outcome can fail catastrophically if cementation is mishandled. The choice of cement and the precision of the technique directly influence long-term biological health and mechanical stability.

On one hand, residual cement is one of the leading causes of peri-implantitis, while weak or over-retentive cements can lead to debonding or difficult retrieval. Understanding the chemistry, adhesion, behavior and handling of cements is a must in our field.  

In recent years, dual-cure temporary cements have become increasingly popular for provisional and semi-permanent restorations, as they offer a unique combination of reliable polymerization, controlled retention and easy retrievability. As a result, they make a safe and efficient choice for implant restoration. 

Reviewing Implant Crown Cementation

Biomechanical Principles

Due to the lack of periodontal ligament, dental implants differ fundamentally from natural teeth. Thus, the crown-cement-abutment interface must absorb and distribute occlusal load directly to bone to prevent unwanted moments and tension. This makes the cement layer a critical biomechanical link to assemble our implant systems into functional restorations.

Ideally, every cementation process should: 

• Provide adequate retention and stability.
• Maintain minimal film thickness to preserve a tight fit.
• Permit retrievability when needed for maintenance or screw access. 

Consequences of Cement Mishandling 

Multiple studies, including some systematic reviews, show that even the minimal residual cement can cause chronic inflammation of peri-implant tissues. Research has also shown that particles smaller than 20 µm may trigger peri-implant mucositis and eventual bone loss. 

In consequence, a well-controlled cementation protocol is essential for both functional and biological success.

Types of Cements Used in Implant Restorations

Definitive Cement 

This type includes glass ionomer and resin-modified glass ionomer cements. They provide strong and long-term retention, ideal for multi-unit bridges or cases where retrieval is not expected. However, they also represent a biological risk if excess cement remains undetected in subgingival areas, as removal is almost impossible once polymerized. 

Temporary Cements

Zinc oxide or eugenol-free resin-based temporary cements are designed for short-term use. These cements provide moderate retention and easy retrieval in most scenarios. Their weakness lies in their limited durability and occasional debonding under heavy occlusal load, especially in posterior restorations.

Dual-Cure Temporary Cements 

These cements combine light-activated and chemically activated polymerization. They cure uniformly, even in thick restorations where light cannot reach, and provide stable retention for extended periods. As a result, they’re ideal for provisional restorations, immediate loading and situations where strength and retrievability are needed. 

The Importance of Cementation Protocol 

Current research shows that improper cementation significantly contributes to nearly half of all biological complications in cement-retained implant restorations. Some reviews even find that residual cement in this type of implant restoration directly affects probing depth, crestal bone loss and peri-implantitis.

Some key aspects of an appropriate protocol include:

• Margin Placement: Subgingival depth should not exceed 1 mm to allow for visual inspection and easy removal of excess. Consider that the more apical the residues are, the higher the risk of peri-implantitis.
• Controlled Cement Volume: Clinicians must apply a small, even layer in the coronal half of the crown’s interior. More than this will result in considerable excess.
• Seating Pressure: Maintain steady, vertical pressure to ensure full seating without hydraulic pressure buildup.
• Curing Technique: Light-cure the margins for a few seconds, then allow chemical polymerization to complete the set.
• Cement Removal: Clean during the gel phase, before full hardening, using floss, microbrushes or non-metallic explorers.

A systematic, repeatable protocol, including measuring the amount of cement for each crown, minimizes the risk of inflammation, loss of retention and esthetic compromise.  

Advantages of Dual-Cure Temporary Cements 
 

Polymerization in Limited Light Conditions 

Posterior restorations, especially under zirconia or metal frameworks, light penetration is a challenge. Dual-cure chemistry ensures complete polymerization through both light and chemical reactions, avoiding undercured zones that weaken retention. 

Retrievability Without Damage

Dual-cure temporary cements, such as the GDT Implant Cement, achieve an ideal balance, delivering months of function while being removable without fracturing the restoration or damaging the abutment of retrieval. This feature is essential in immediate loading implants and in cases where maintenance access is required.

Lower Biological Risk

Their smooth film layer and color contrast help identify and remove excess material more easily, significantly lowering the risk of cement-induced peri-implantitis. 

Extended Stability

These cements maintain retention strength longer than conventional provisional materials, making them suitable for long-term temporization or tissue conditioning phases. 

High Compatibility

They adhere to titanium, zirconia, and hybrid alloys abutments without additional primers, simplifying clinical protocols and reducing chair time and complications. 

When to Use Dual-Cure Temporary Cements

Clinicians should consider using dual-cure temporary cements for the following scenarios: 

• Long-term provisional restorations, particularly between 3 and 12 months.
• Opaque or thick restorations, such as zirconia crowns or bridges.
• Immediate loading protocols, where consistent retention is essential during the healing phase.
• Cases with uncertain esthetics or occlusion, allowing for future adjustments.
• Patients requiring maintenance access or hygiene monitoring. 

In case of multi-unit bridges or full–arch restorations, permanent cements remain more suitable. 

Cementation Clinical Protocol  

1. Pre-Cementation Preparation

• Ensure the working area is clean and dry, including abutment and internal crown surfaces.
• Verify marginal adaptation using magnification, preferably x4 or x6.
• Maintain a moisture-free environment with cotton rolls, gauze, or retraction cords. 

2. Cement Application

• Apply a thin, uniform layer of cement, approximately 0.1 mm, on the inner coronal half of the crown.
• Avoid coating the full internal surface to prevent hydraulic pressure and extrusion. 

3. Crown Seating

• Seat the crown under steady vertical pressure.
• Expose each margin to light for 3–5 seconds to initiate polymerization, depending on your lamp specifications.
• Maintain seating pressure for several seconds during the initial set while the chemical phase of cement starts activating. 

4. Excess Removal

• Remove excess material as soon as the cement reaches gel consistency.
• Use floss for interproximal cleaning and microbrushes or implant scalers at the margins.
• Retract soft tissue gently to ensure full visibility. 

5. Final Polymerization and Polishing

• Allow complete chemical curing for approximately 3–5 minutes. 
• Verify occlusion and proximal contacts. 
• Finally, polish margins to minimize plaque retention.

Avoiding Common Cementation Errors

Frequent mistakes include: 

• Applying too much cement: Unlike conventional crown cementation, excess cement leads to extrusion and residual debris that create multiple peri-implant complications. Use minimal quantity while following fabricant recommendations.
• Placing margins too deep: Prevents visibility and impedes complete cement removal. Thus, keep margins within 0.5 – 1 mm subgingival whenever possible.
• Incomplete curing under opaque materials: This mistake leads to soft, weak cement films. As a result, dual-cure materials are always recommended for limited-light conditions.
• Late excess removal: This typically results in hard fragments bonded to tissue, creating small lesions and irritation. Excesses must be cleaned during the gel phase.
• Moisture contamination: It reduces bond strength. As a result, exhaustive isolation is mandatory.

Careful execution of these preventive measures removes improvisations during procedures and improves long-term outcomes drastically.

Practical Clinical Recommendations 

Whenever possible, integrate the following measures:

• Use vent holes in crowns to relieve hydraulic pressure and reduce cement extrusion.
• Perform pull tests after final curing to confirm retention strength.
• Document cement type, brand, and batch number in patient records.
• For zirconia restorations, gently sandblast and apply the appropriate cementation adhesive protocol before placing the crown to enhance micromechanical retention.
• In deep subgingival margins, insert packed Teflon tape or retraction cord around the abutment to protect soft tissue during cementation. 

With these small adjustments, you can improve control, cleanliness and long-term success rates. 

Managing Cement-Retained and Screw-Retained Crowns 

While screw-retained designs eliminate cement-related issues, cement-retained crowns remain indispensable when esthetics or angulation correction is required. Among other things, they offer: 

• A smoother occlusal surface free of screw access holes.
• Easier correction of angulated implants.
• Passive fit in multi-unit frameworks.

Dual-cure temporary cements bridge the gap between both approaches, providing the esthetics of cement-retained crowns and the retrievability advantages of screw-retained designs. 

Material Science of Dual-Cure Temporary Cements 

These cements combine urethane dimethacrylate (UDMA) or bis-GMA resin matrices with fillers that enhance compressive strength and wear resistance. Some of their key characteristics include: 

• Double activation: Light activation initiates the reaction, but chemical curing completes polymerization in shadowed areas.
• Thin film thickness: Cements like GDT Implant Cement require only around 10 µm for a precise marginal fit, increasing marginal adaptation and accuracy.
• Moderate bond strength: It ensures retention without damaging components during removal.
• Eugenol-free formulation: It prevents interference with resin bonding during final cementation while providing antibacterial properties.

The combination of these features ensures a consistent performance under various clinical conditions, making dual-cure temporary material suitable for both provisional and semi-permanent use. 

Long-Term Clinical Evidence

Current evidence strongly supports the safety and reliability of dual-cure temporary cements. A systematic review in 2023 reported significantly fewer peri-implant mucositis cases with dual-cure temporary cement compared to resin-modified glass ionomer. 

Most clinical trials and reviews of cement types for cement-retained implant restorations report that elimination of excess should be the number one priority during cementation protocols, as even minimal excess can lead to multiple inflammatory complications. 

Transition to Definitive Cementation 

Temporary or semi-permanent cements are generally used for 3–12 months, depending on case complexity and soft-tissue stability. Yet, before transitioning to definitive cementation, you must confirm soft-tissue maturation, guarantee occlusal stability, ensure complete removal of previous cement and reassess abutment torque and adaptation. 

Patients with high biological risk or those requiring periodic maintenance may require to maintain a long-term provisional with a long-lasting temporary cement.

 References

1. Linkevicius, T., Puisys, A., Vindasiute, E., Linkeviciene, L., & Apse, P. (2013). Does residual cement around implant-supported restorations cause peri-implant disease? A retrospective case analysis. Clinical oral implants research, 24(11), 1179–1184. https://doi.org/10.1111/j.1600-0501.2012.02570.x

2. Rokaya, D., Srimaneepong, V., Wisitrasameewon, W., Humagain, M., & Thunyakitpisal, P. (2020). Peri-implantitis Update: Risk Indicators, Diagnosis, and Treatment. European journal of dentistry, 14(4), 672–682. https://doi.org/10.1055/s-0040-1715779

3. Mehl, C., Harder, S., Wolfart, M., Kern, M., & Wolfart, S. (2008). Retrievability of implant-retained crowns following cementation. Clinical oral implants research, 19(12), 1304–1311. https://doi.org/10.1111/j.1600-0501.2008.01587.x

4. Ghodsi, S., Shekarian, M., Aghamohseni, M. M., Rasaeipour, S., & Arzani, S. (2023). Resin cement selection for different types of fixed partial coverage restorations: A narrative systematic review. Clinical and experimental dental research, 9(6), 1096–1111. https://doi.org/10.1002/cre2.761

5. Guerrero-Gironés, J., López-García, S., Pecci-Lloret, M. R., Pecci-Lloret, M. P., & García-Bernal, D. (2022). Influence of dual-cure and self-cure abutment cements for crown implants on human gingival fibroblasts biological properties. Annals of anatomy = Anatomischer Anzeiger : official organ of the Anatomische Gesellschaft, 239, 151829. https://doi.org/10.1016/j.aanat.2021.151829

6. Mehta, S., Kesari, A., Tomar, M., Sharma, U., Sagar, P., Nakum, P., & Rao, K. (2023). An Evaluation of the Effectiveness of Various Luting Cements on the Retention of Implant-Supported Metal Crowns. Cureus, 15(7), e41691. https://doi.org/10.7759/cureus.41691

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