A Stage-Based Decision Framework to Minimize Excess Cement in Cement-Retained Implant Restorations: A Narrative Review

Residual excess cement (REC) has been identified as an iatrogenic factor associated with peri-implant mucositis and peri-implantitis. The detection and removal of subgingival cement are considered clinically challenging, particularly in cases with deep margins.

This narrative review aims to identify available clinical techniques used to minimize residual excess cement (REC) in cement-retained implant restorations, categorize these techniques according to pre-cementation, cementation, and post-cementation phases, and relate technique selection to clinical risk according to margin depth and clinical accessibility. Low risk (equigingival or ≤1 mm subgingival), moderate risk (1-2 mm subgingival), and high risk (>2 mm subgingival or poor access).

An electronic search of PubMed/MEDLINE, Scopus, and Web of Science was conducted for English-language publications available through 28 February 2026 using seven complementary Boolean search combinations addressing residual/excess cement, peri-implant disease, cementation techniques, margin/abutment design, detection/removal, venting, and barrier techniques. The initial searches identified 929 records. After removal of 435 duplicates, the remaining 494 articles were screened for title and abstract,380 were excluded. 114 full text articles were assessed. Of these, 76 were excluded after full-text assessment and 38 publications were included in this narrative review. Due to heterogeneity in study designs and outcomes, findings were synthesized narratively rather than quantitatively.

Strategies were categorized into pre-cementation, cementation, and post-cementation. Low risk cases were managed with controlled cement volume, accessible margin designs and post cementation verification. Moderate- and high-risk cases favor custom margin design, radiopaque cement, extraoral cement-volume control, and selected barrier and/or venting measures. In high-risk cases,combining multiple techniques may be presented as an evidence informed option rather than validated protocols.

Stage-based risk management offers clinicians an evidence-informed approach to technique selection. Margin depth and accessibility may be considered as a guide for selection of cementation strategies. In high-risk situations, combining multiple techniques may be reasonable, but specific combinations have not been prospectively validated and should not be regarded as definitive clinical protocols.