Implant intruduction misch contemporary implant dentistry Dr fariborz vafaee

1. Dental Implants
Bring Quality
Back to Life

2. What is a dental implant?
A dental implant is a small
titanium fixture that serves as
the replacement for the root
portion of a missing tooth.
Dental implants can be used to
replace a single lost tooth or
many missing teeth.

3. Improved
Appearance
When teeth are missing an
ongoing shrinkage of the
jawbone occurs making the
face look older. Dental
implants can slow or stop
this process.

4. What are the
Benefits of Dental
Implant Therapy?

5. Eliminates the pain and
discomfort of full
removable or partial
dentures.
Implant supported
replacement teeth are
like natural teeth
because they are
anchored securely to
your jawbone.

8. Confidence &
Convenience

9. Who is a candidate for dental implants?
Adequate bone in your jaw is
needed to support the
implant(s) along with
healthy gum tissues that are
free of periodontal disease.

10. Are dental implants successful?
Documentation studies
have proven the effectiveness
and long lasting results of
dental implants. Good oral
hygiene is one of the most
critical factors to insure the health of your dental
implants.

12. Part 1

16. permucosal
extension (PME)

17. Abutment for cement retention

18. abutment for screw retention

19. Abutment for attachment

21. Analogs
Analogs may represent an
abutment for screw retention, an
implant body (left), and/or an
abutment for attachment (right).

22. Fixed restorations have
three categories: FP-
1, FP-2, and FP-3
ΩFP-1 is ideal
ΩFP-2 is hypercontoured
ΩFP-3 replaces the gingival drape
with pink porcelain or acrylic
Ω The difference between FP-2 and
FP-3 most often is related to the
maxillary high lip position during
smiling or the mandibular lip
position during sibilant sounds of
speech. FP-2 and FP-3 restorations
often require more implant surface
area support by increasing implant
number or size or by adjusting
design considerations.

23. Removable restorations
∂ RP-4 prostheses have complete
implant support anterior and
posterior.
∂ In the mandible the
superstructure bar often is
cantilevered from implants
positioned between the foramens.
The maxillary RP-4 prosthesis
usually has more implants and
little to no cantilever.
∂ An RP-5 restoration has primarily
anterior implant support and
posterior soft tissue support in the
maxilla or mandible.
∂ Often fewer implants are required
and bone grafting is less indicated

25. A tooth exhibits more vertical
movement than an implant. This
may result in higher occlusal loads
on the implant, whether or not it is
connected to the natural
tooth, when in a mouth with both
implants and teeth.

26. Occlusal Considerations for
Implant-Supported Prostheses
light occlusal force heavy bite force

28. The premaxilla loses
40% to 60% bone
width within 3 years
after the loss of teeth. The implant
surgeon often has difficulty
inserting implants when
augmentation does not restore the
region before implant placement.

29. Maxillary Teeth Dimensions
Type of Mesiodistal Mesiodistal Faciolingual Faciolingual Mesiodistal
Teeth Crown (mm) Cervix (mm) Crown (mm) Cervix (mm) CEJ (2 mm)
Central 8.6 6.4 7.1 6.4 5.5
incisor
Lateral 6.6 4.7 6.2 5.8 4.3
incisor
Cuspid 7.6 5.6 8.1 7.6 4.6
First 7.1 4.8 9.2 8.2 4.2
bicuspid
Second 6.6 4.7 9.0 8.1 4.1
bicuspid
First Molar 10.4 7.9 11.5 10.7 7.0
Second 9.8 7.6 11.4 10.7
molar

30. IMPLANT SELECTION

32. Implant Size Selection Criteria in
Posterior Maxilla
 1.5 mm from adjacent
tooth
 3 mm from adjacent
implant
 4 mm diameter
minimum, for posterior
maxilla

33. The minimum mesiodistal
dimension
for two standard 4-mm diameter implants is
1.5 mm + 4 mm + 3 mm + 4 mm + 1.5 mm
= 14 mm.

34. d = 1.5mm +DZ + 3mm +DY + 3mm +DX + 1.5mm

36. Existing Occlusal Vertical
Dimension

37. The minimum crown height space
for a fixed restoration is 8 mm
 The abutment should be at
least 5 mm for cement
retention.
 The margin of the crown
should be at least 2 mm
above the crestal bone level
to allow the connective tissue
and junctional epithelial
attachment zones.
 At least 1 mm occlusal
clearance should be left for an
occlusal metal restoration (2
mm for porcelain).

38. The ideal mesiodistal distance
between an implant and
a tooth is 1.5 mm or more
and 3 mm between each
implant.
B, If bone loss occurs on
the implant, the
horizontal dimension of
the defect is less than 1.5
mm.

39.  PROTECTION OF THE PROSTHESIS
 CEMENT-RETAINED VERSUS SCREW-RETAINED
IMPLANT FIXED PROSTHESES

40. The primary advantage of a screw-
retained prosthesis (right) is
retrievability.

41. CEMENT-RETAINED VERSUS SCREW-
RETAINED IMPLANT FIXED PROSTHESES
 Retrieval of the cement-retained fixed prosthesis
 Protection of the implant

42. ADVANTAGES OF CEMENT-
RETAINED IMPLANT PROSTHESES
 Passive Casting

43. TABLE 23-1 RESCAN

44. A 50 µm misfit may require the
implant to move within the bone
200 µm before the casting fits
passively

45. dimensional change in impression
material , stone, metal wax
 A. The dimensional change of
the stone die in this picture is
0.06% shrinkage of the
impression material and
0.06% expansion of the
stone. This is clinically
acceptable.
 B, The male die does not fit
accurately into the female
stone model. The
dimensional change in this
picture represents a 0.2%
shrinkage of the impression
material and the same stone
expansion as in A.

46. Axial Load
 The ideal occlusal load on an
implant prosthesis is directed
over the implant body and is
accomplished easily with a
cemented prosthesis (f).
When a screw hole is placed
to retain the restoration, the
primary occlusal contact
often is located on the buccal
cusp in the mandible
(fn), which is an offset load
that magnifies the force
applied to the implant
component interfaces (and
the fixation screw), fi, Buccal;
L, Lingual.

47. The ideal primary
occlusal contacts
The ideal primary occlusal
contacts for posterior
single-tooth implant restorations
that are cement retained is directly
over the top of each implant, which
is usually positioned under the
central fossa. When the implants
are splinted together, the occlusal
contacts may include the marginal
ridges, which are between the most
distal and mesial implant (right).
The diagram on the left is for a
screw-retained restoration that is
splinted together. The occlusal
contacts are usually between the
implants. Offset loads to the
buccal contact are not
indicated, since they will increase
the moment force.

48. Esthetics and Hygiene
Occlusal Material Fracture
Access
Fatigue
In the anterior regions of the
mouth a screw-retained restoration
requires a different implant body
position than a cement-retained
restoration. As a result, a facial
porcelain ridge lap is required. This
makes the cervical sulcus of the
implant inac-cessible for hygiene.

49. Abutment screws fatigue and are
prone to fracture. The abutment
crown crevice is not sealed
completely, and bacteria may
proliferate within the components.
Because the environment often has
low oxygen tension, the bacteria
may be anaerobic organisms that
contribute to foul odor and
periimplant disease.

50. 1. Esthetics and Hygiene
2. Occlusal Material Fracture
3. Access
4. Fatigue
5. Progressive Loading
6. Abutment-Crown Crevice
7. Cost and Time

51. 1. Low-profile retention
2. Reduced moments of force
3. Risk of cement in the sulcus

52. A screw-retained device is more
resistant to tensile forces compared
with a cemented abutment inferior
to 5 mm in height. Therefore
overdenture bars are often screw
retained. The lower-profile bar
provides greater space for denture
tooth placement and greater bulk
of acrylic to reduce fracture risks.

54. One-piece Vs.
Two-piece
Abutments
Two categories of abutments are
used for cemented restorations.
The one-piece abutment (far left)
may be used in multiple
restorations when the implant
bodies are within 20 degrees of
ideal. The two-piece abutments
may be used for single
teeth, angled implants, and with
laboratory transfers or for custom
abutments.

55. retaining screws. The head of the
torque wrench is released at a
preset torque level.

57. Advantages and Disadvantages of
One-Piece Abutment for Cement
Advantages Disadvantages
 • No torque wrench needed  • Only for multiple
 • Stronger abutments
 • No screw loosening  • Not for single-tooth
 • Easy complete seating
restoration
 • Not for angled abutments
 • No need to retighten under
restoration  • Weaker to fracture
 • Less expensive
 • Thicker walls to allow great
freedom of preparation

58. A one-piece
abutment for
cement retention
is threaded into the implant body
and bypasses the antirotational
hexagon component.

60. two-piece abutment
for cement
retention
In the two-piece abutment for
cement retention the abutment
engages the antirotational features
of the implant body platform and
the abutment screw that fixates the
components into position.

61. Advantages and Disadvantages Of
Two-Piece Abutment for Cement:
Single-Tooth Implants
Advantages Disadvantages
 • Screw loosening
 • Antirotational under shear  • Abutment loosening under
forces restoration
 • Angled abutments  • Torque and countertorque
devices needed for preload
 • Proper seating with
radiograph must be checked
 • Thinner walls limit freedom
of preparation

62. A hemostat holds the abutment in
position to the implant body. A 30-
N/cm torque wrench is seated into
the abutment screw and rotated.
B, The head of the torque wrench
bends at the approximate torque
value. The hemostat stops the
rotation force on the screw, loading
the implant-to-bone interface with
a rotational force, because the
abutment engages the hexa-gon of
the implant body

63. Angled abutments are
similar to a two-piece The UCLA abutment concept
abutment system permits the laboratory to
ranging from 15 to 30 custom fabricate the
degrees abutment

64. The combination of metal and plastic components offers several
advantages. With the plastic component, cus-tomizing the shape
of the abutment on the implant body transfer impression is easy.
The metal coping ensures a high precision at the implant platform-
abutment connections.

65. Disadvantages of Anatomical
Abutments
 Precise location of implant body and hexagon is
needed.
 Two-piece abutment is needed.
 Facial and lingual overcontours need to be eliminated.
 A "subgingival ridge lap" is created.
 Margin is difficult to capture if intraoral impression is
 made.

66. A custom abutment with pink
porcelain added to the subgingival
region is fabricated to enhance the
cervical esthetics
The custom abutment and crown
are seated. The subgingival pink
porcelain is advantageous in
situations in which the soft tissues
are thin and the grayish color of
the titanium abutment may affect
the esthetic outcome

69. Caries and
Abutments
Because caries is the most
common complication of
crowns on the natural
teeth, guidelines indicate that
the crown margin not only
should be supragingival but
also should be placed on
enamel. This not only facilitates
access for hygiene but also
decreases the risk of
caries, since enamel is more
resistant to decay.

70. Factors Affecting Abutment Retention
Taper
Surface area
Height
Resistance form Surface texture Path of insertion

71. The taper of an implant abutment
 affects the amount
of retention. The
amount of
retention is
significantly
reduced for tapers
greater than 20
degrees. This
concept is more
relevant for
implant
abutments
because of their
reduced diameter
(usually 4 or 5
mm).

72. The greater the diameter of the
abutment, the greater the
retention. Larger-diameter implant
abutments have greater retention
than narrow-diameter implants.

73. Abutment Taper
Abutment Height
Abutment Surface Area
Shear Forces
Resistance and Abutments
Abutment Surface Texture

74. Abutment Height
A, When a crown receives a lateral
force,
it tends to rotate upward on one
side of the implant. The arc of
rotation is related to the diameter
of the implant. The height of the
abutment should be greater than
the arc of rotation. A wider
implant abutment requires greater
height than a smaller-diameter
implant to resist these lateral
forces. B, The arc of rotation may
be decreased when directional
grooves are prepared into the
abutment. Therefore when
abutment height is
questionable, the addition of
vertical grooves decreases the risk
of uncementation

75. In a cantilevered prosthesis, tensile
forces are applied on the crown
farthest from the cantilever. The
height of this implant abutment
should be greater than the arc of
displace-ment of the prosthesis
because compressive forces to the
cement seal are placed on the
abutment above the arc of
displacement. Buccolingual
directional grooves decrease the
rotation arc and place compressive
forces within the grooves.

76. The two implants replacing the
canine and first premolar have
minimal abutment height and will
receive lat-eral forces. Vertical
directional grooves parallel to the
path of inser-tion of the prosthesis
will decrease the risk of
uncementation.

78. Shear Forces
 The crown on a tapered
implant abutment
 (left) may have several
paths of insertion or
removal. This places the
abutment more at risk of
an uncemented
restoration. A directional
groove (right) limits the
path of insertion or
removal.

79.  Directional grooves and
flat surfaces reduce the
arc of displacement and
increase the compressive
forces rather than shear
forces on the cement
seal. These concepts are
most important for a
cantilevered restoration.

82.  Mesial and distal
directional grooves
decrease
 tensile forces on a
prosthesis subjected to
offset loads. These offset
loads more often are
applied on the facial
aspect of maxillary and
mandibular restorations.
B, Buccal; L, lingual.

83. Abutment Surface Texture

85.  When the path of insertion is
similar to the forces of
mastication, sticky food may
place shear and tensile forces on
the restoration and contribute to
uncemented prosthe-ses. The
implant body should receive a
long-axis load to reduce crestal
stress. A path of insertion
different from the occlusal force
direction is selected to decrease
the shear loads to the cement
seal from sticky foods. Angling
the path anteriorly facilitates
prepara-tion of the abutment
and seating of the restoration.

86. | NON PARALLEL ABUTMENTS
 When the abutment
angle needs a correction
of less than 20 degrees, a
straight abutment may
be used and prepared
intraorally (one-piece or
two-piece abutment) or
in the laboratory (using
an implant body transfer
impression and a two-
piece abutment).

87. One-piece abutments for A high-speed handpiece is
cement were placed on used to prepare the
these two implant bodies.
The distal implant is abutment and correct the
angled buccally. path of insertion.

88.  When the implant body
is between 15 and 35
degrees from ideal, a
prefabricated two-piece
angled abutment may be
used to improve the path
of insertion.

89.  The cervical region of an
angled abutment is often
larger in diameter to
increase the metal
thickness on the side of
the abutment screw
hole. This portion of the
abutment is placed
subgingivally but may
become exposed after
gingival recession.

90.  Copings are cemented
over the abutments.
These copings are
prepared in the
laboratory to create a
common path of
insertion for the
prosthesis.

91.  A reverse conical
abutment is wider at the
top than the abutment
connection to the
implants.

92.  The reverse conical
abutment is inserted
into the angled implant
body and prepared to be
parallel to the ideal
implant position.

93.  A two-piece custom
angled abutment may be
fabricated in the
laboratory using a
transfer impression of
the implant body.

95.  The maxillary first molar had
a buccal furca exposed. The
knife-edge preparation
reduced the furcation
under-cut and decreased the
risk of pulpal exposure.

96.  In the interproximal region of
lower anterior teeth, a knife-
edge preparation may be
indicated, especially when
the incisal edge is wide and
the cervical region is narrow
in diameter.

97.  The facial position of two of
these implant abutments
requires a chamfer
preparation to provide greater
room for porcelain.

98. Option 1 (Indirect)
Option 2 (Indirect)
Option 3 (Direct)

99. Steps in Direct and Indirect
(Prosthesis) Fabrication Techniques

100. Steps in Direct and
Indirect (Prosthesis)
Fabrication Techniques

101. Option 1 (Indirect)
 the dentist makes an implant body impression with an
indirect or direct impression transfer coping.

102. Option 2 (Indirect)
 Clinical 1
 Remove healing abutment.
 Place indirect impression transfer.
 Take alginate impression.
 Remove independent impression transfer.
 Replace healing abutments.
 Laboratory 1
 Connect independent impression transfer and implant
 body analog. Reposition in impression. Pour the impression.
Fabricate open custom tray.
 Clinical 2
 Remove healing abutments.
 Place direct impression transfers with hexagon; confirm
 seating with radiograph.
 Make impression (polyether or polyvinyl siloxane). Unscrew
direct impression transfer through tray. Remove impression.
Replace healing abutments. Obtain opposing model, bite
registration, and face-bow
 registration.
 Laboratory 2
 Connect implant body analog to direct impression transfers
 in impression. Pour model in die stone. Mount opposing with
bite and face-bow. Select and prepare all abutments.

103. Option A Option B
  Remove healing abutments.
 Remove healing abutments. Position final
abutments Position final abutment
 with jig. Confirm seating with  with jig. Confirm seating with
 radiograph.  radiograph.
 Torque abutments to 30 N-cm. Metal work
try-in. Radiograph to verify fit. Take bite  Metal work try-in. Radiograph to
registration. Remove all abutment. Replace verify fit. Take bite registration.
healing abutments.
 Laboratory 3 Make pick up impression. Deliver
 Remount model to new bite. Finish temporary restoration.
prosthesis.  Pour pickup impression. Remount
 Clinical 3
 Remove healing abutments.
impression. Finish prosthesis.
 Seat abutment with jig.  Remove temporary
 Torque to 30 N-cm.  restoration. Radiograph to verify
 Seat final prosthesis; deliver prosthesis.
fit.

104. The permucosal extensions are
unthreaded from the implant bodies

105.  A two-piece indirect
impression
transfer, which engages
the hexagon of the
implant body, is
designed with undercuts
to maintain it in proper
position and prevent its
move-ment while the
impression is poured.

106.  The two-piece indirect
impression transfer
copings are threaded
into position. A
radiograph is obtained to
confirm proper seating
of the components.

107. Small bubbles or voids are usually not relevant for indirect An impression is made of the three implant
impression transfer impressions as long as the transfer
undercuts are engaged securely in the impression and the bod-ies and of the four natural teeth
compo-nent is maintained securely prepared on the contralateral side

108.  The component to the far left is
an abutment screw; next is a
two-piece abutment for cement
retention assembled with the
abutment screw; next is a ball
abutment transfer screw; next is
the ball transfer screw
assembled with a two-piece
abutment; next is an implant
body analog; far right is the ball
transfer screw assembled with a
two-piece abutment and the
implant body analog. These last
components are reinserted into
the final impression before
pouring the stone model.

109.  The implant analogs are
reinserted into the
impression, and the
laboratory places a
resilient material around
them to represent the
soft tissue around the
implants.

110.  The cast is separated
from the model, and the
two-piece abutments for
cement retention are
inserted into the body
analogs of the implant. A
marking pen is used to
transfer the tissue height
onto the abutment.

111.  The resilient soft tissue
replica is removed from
the master cast. A
surveyor/handpiece is
used to prepare the
abut-ments parallel to
each other. A flat side on
each abutment and a
knife-edge margin are
common features.

112.  The master model is
complete with the soft
tissue replica and the
prepared abutments
seated on the implant
body analogs.

113.  The laboratory may wax
the substructure of the
final restoration directly
on the prepared
abutments.

114.  61 Castings are
obtained for the natural
teeth and implant
abutments.

115.  The implant abutments
are connected together
with an acrylic jig to
assist in intraoral seating
of the abut-ments in the
proper position.

116.  At the next patient
visit, a try-in for the
metal casting on the
teeth is performed.

117.  The acrylic jig helps seat
the laboratory-prepared
abutments intraorally
before adding the
abutment screws.

118.  The metal try-in for the
implant prosthesis is
 performed.

119.  With metal try-in for the
teeth and the implant
 prosthesis in place, a bite
registration is obtained.

120.  A bite registration is
made over the metal
cast-ings. The laboratory
evaluates this
registration and
compares it to the
occlusal index obtained
after the impression-
making appointment.

121.  At the third
appointment, the
prosthesis is delivered.
The acrylic index used to
reinsert the abutments
also may be used to
countertorque the
abutments while the
torque wrench tightens
the abutment screws to
30 N-cm.

122.  The final restoration is
completed. The chair
time for the indirect
method of implant
restoration was shorter
than for the natural
teeth because no
intraoral abutment
prepara-tion or
transitional prosthesis
fabrication was required.

123.  The final prostheses are
delivered. An indirect
implant prosthesis
fabrication on the
patient's right and
conven-tional direct
procedure on the left
natural teeth were
selected.

124.  The implant prosthesis is
cement retained, and a
heavy bite is used for the
occlusal adjustment with
primary occlusal
contacts in the central
fossae.

125.  The natural three-unit
fixed prosthesis and
crowns are delivered
following a conventional
protocol.

126. transferring the implant body
position in a working cast (Option 1
or 2) has several advantages:
 1. The impression requirements are less demanding because small
bubbles or voids do not affect abutment transfer and margins are not
important to record.
 2. If an angled abutment is required, the laboratory may choose the
right component. A custom abutment may be fabricated (e.g., for a
short crown height when a greater

diameter would help with retention). As a result, less inventory is
required in the doctor's office.
 3. The laboratory can fabricate the transitional prosthesis on the
model.
 4. A framework may be fabricated directly on the implant
abutments, allowing for a more accurate margin fit.
 5. Chair time is decreased because the preparations, metal work, and
transitionals are fabricated by the laboratory.

127. Disadvantages of the laboratory-
assisted approach include
the following:
 1. One-piece implant abutment transfers may not be timed or transferred
accurately. When an impression is made and the abutments are first removed
and inserted into a laboratory model, the rotation of the implant analog may
be different by several degrees than in the implant body in the
mouth, precluding the use of one-piece abutments.
 2. A two-piece abutment post system should be used in the laboratory transfer
because thread timing is more exact; however, this may mean long-term
complications such as abutment screw loosening. A system with excellent
precision is needed.
 3. No fixed transitional prosthesis is used to load the bone gradually during
fabrication of the metal framework. This increases the risk of early bone loss or
early implant failure. This risk can be alleviated by delivering a temporary
prosthesis on a temporary abutment with the added disadvantage of increased
chair time and laboratory cost.
 4. The laboratory decides on the margin location and preparation style.
 5. The laboratory cost is increased.
 6. The casting is made directly on the implant post and may fit the abutment so
accurately as to produce a nonpassive casting.

129. Option 3 (Direct)
 One-piece straight
abutments for cement
retention are inserted
into the implant bodies
 If within 15 degrees of
each other, the
abutments are prepared
intraorally with a #703
crosscut fissure bur
under copious irrigation

130. In the posterior three implants, first-stage cover
screws are exposed. The cover screws are removed The one-piece abutments for cement reten-tion are
with an ASA screwdriver and a 0.035- inch threaded into the implant bodies with an ASA
hexagonal driver (BioHorizons Dental Implants). screwdriver and a 0.050-inch hexagonal driver

131.  A torque wrench is used
to tighten the one-piece
abutments. The torque
applied is transferred to
the implant body.

132.  The crown height space
is evaluated. A 2-mm
clearance is necessary for
porcelain-fused-to-
rnetal restorations with
porcelain oclusal
surfaces. These 8-mm
abutments are too high.

133.  The abutments are
reduced in height with a
high-speed handpiece
and carbide bur with a
copious amount of
irrigation. Parallelism
also is achieved.

134.  The abutment height is
reduced for a porce-lain-
fused-to-metal
restoration.

135.  A coarse diamond high-
speed handpiece is
used to roughen the
surface and increase the
retention of the
cemented restoration.

136.  A final impression is
made of the
abutment, similar to the
direct procedure with
natural teeth.

137.  A transitional restoration
is made. When in soft
bone, the restoration is
left out of occlusion.
Occlusal contacts then
are incorporated on the
transitional restoration
at the metal try-in
appointment.

138.  Stone dies are used for
the direct fabrication
procedure with implants.
The small-diameter
posts may break off
when the impression is
separated from the cast.
Several techniques are of
benefit to minimize this
complication.

139. Definitive Cementation
 A groove may be placed in  As a result, although most
the preparation or the defin-itive cements may
casting to act as an exhibit a cement thickness
additional spacer or vent between 10 and 25 ^m,
for the cement.
 Another method to reduce
film thickness is the timing
of the prosthesis insertion.
Film thickness may
increase by 10 iim or more
for every additional 30
seconds, once the cement
is properly mixed.

140. Zinc oxide/eugenol
 excellent seal
 lowest compressive strength
 high solubil-ity
 often is used as a transitional cement at the initial
delivery of the prosthesis
 addition of EBA modifier increases the compres-sive
strength, almost to the value of polycarboxylate
cement

141. Zinc polycarboxylate
 Zinc polycarboxylate cement may adhere to teeth
because it chelates the calcium ions
 does not adhere to a gold casting or to a titanium
abutment post
 The working time is 50% shorter than zinc phosphate
cement
 This is a problem when cementing multiple abutments

142. Glass ionomer
 Glass ionomer cements may adhere to enamel or
dentine and release fluoride for an anticariogenic
effect. Their prop-erties for luting fixed restorations to
natural teeth are excellent. However, their
performance as luting agents on metallic abutments
has raised controversy

143. Composite resin
 Composite resin cements have the highest compressive
and tensile strengths of all cements, 5 times greater
than zinc phosphate.121'124'130 When these cements are
used in implant dentistry, the intent is to not remove
the restoration in the future.
 . Unlike polycarboxy-late cement, the excess cement
should be removed before final setting; otherwise, a
rotary bur may be required to eliminate any excess.