Improving Longevity of Restorations with Adhesive Pooling

Key Strategies to Improve Longevity

• The American College of Prosthodontists recommends sandblasting with 50-μm Al2O3 for titanium base abutments to achieve optimal adhesive retention 1, 2, 3
• Ensure surfaces are completely dry before applying adhesive, as moisture will prevent proper adhesion, according to the American Dental Association 4
• De-epithelialize the area to create a clean and compact base for the adhesive to adhere properly, as suggested by the American Academy of Periodontology 4
• Select high-strength materials like monolithic or micro-veneered restorations utilizing high-strength zirconia for improved durability, recommends the American College of Prosthodontists 1, 2
• Choose appropriate resin cement, as this plays a crucial role in the clinical success of restorations, particularly those using the titanium-base abutment concept, according to the American Dental Association 2, 3
• For ceramic framework materials, design is paramount - use unveneered shoulders and maximize connector areas by reducing embrasure size, suggests the American College of Prosthodontists 2, 3
• Apply the least amount of adhesive necessary to avoid excess material that could cause pooling and subsequent complications, recommends the American Dental Association 4
• Implement meticulous occlusal analysis and planning, especially for cantilever restorations, according to the American College of Prosthodontists 2, 3
• For cantilever units, ensure contact only in maximum intercuspal position on flat surfaces, not oblique surfaces, recommends the American Dental Association 2, 5
• Keep cantilever units out of contact in all excursive positions to reduce mechanical stress, suggests the American College of Prosthodontists 2, 5

Clinical Considerations for Different Restoration Types

• For titanium-base abutment concepts, the bonding stability between titanium base and ceramic components is critical for success, according to the American College of Prosthodontists 1, 2
• Consider monolithic designs that can be milled and adhesively cemented to titanium base abutments extra-orally, recommends the American Dental Association 2, 3
• Be aware that implant-supported cantilever fixed dental prostheses show higher incidence of prosthetic complications (risk ratio 2.56, p=0.008), reports the American College of Prosthodontists 3, 5