Screw retained vs. cement retained implant‐supported fixed dental prosthesis

Abstract

A fixed dental prosthesis can be secured to an endosseous implant via cementation (using a provisional or definitive cement) on an implant abutment that is screw retained to the implant or directly in the implant via screw retention. The clinical decision as to which retention system best suits the individual patient depends on several factors. The aim of this review is to present a detailed overview of the factors potentially influencing whether to choose screw retention or cement retention. These factors include the individual indication, advantages and disadvantages of the different retention mechanisms, the retention provided, retrievability, provisionalization, esthetics and clinical performance, including failures and complications. The results of recently published systematic reviews on this topic are discussed and an overview is provided. A decision tree is presented to facilitate the clinical selection of the retention type. This overview concludes that the choice of retention type (screw retained or cement retained) might not influence the overall survival of the implant-supported fixed dental prosthesis, but may be responsible for the development of certain complications. The decision may depend on technical feasibility and on weighing the pros and cons.

Use of extracted anterior teeth as provisional restorations and surgical guide for immediate multiple implant placement: A clinical case report

“…When provisional restoration is cemented there is a higher risk of gingival inflammation at the abutment‐cement‐restoration interface, as well as cement debonding . In this clinical report, screw‐retained restorations were selected to improve the soft tissue contour according to Wittneben et al they described as ideally, that implants must be placed in a position with the access hole of the planned crown below the planned incisal edge to facilitate screw retention; in addition, to avoid the problems associated with residual cement and benefit from the technical and biological complications exhibit by screw retained prostheses …”

Effect of screw access hole design on the fracture resistance of implant‐supported zirconia‐based restorations

“…Although the type of retention system may not influence the overall survival of the implant‐supported fixed restorations, it may be responsible for the progress of definite complications . Therefore, choosing a retention system may depend on technical viability and on weighing the advantages and disadvantages .…”

The Effect of CAD/CAM Crown Material and Cement Type on Retention to Implant Abutments

“…Typically, two‐piece implants can be either screw‐ or cement‐retained on standard or customized abutments. Advantages and disadvantages of both prosthesis retention systems have been addressed in several studies . The advantages of using cement‐retained restorations are primarily esthetics, passive fit of the crown, reduced laboratory technique sensitivity, and the potentially improved load distribution during function.…”

“…The advantages of using cement‐retained restorations are primarily esthetics, passive fit of the crown, reduced laboratory technique sensitivity, and the potentially improved load distribution during function. Nonetheless, a major disadvantage of cement retention lies in the difficulty of removing excess cement in the gingival sulcus that could lead to peri‐implant soft tissue inflammation . Cemented prostheses are also indicated to correct implant improper positioning and for improved control of occlusion, for instance, in narrow implants .…”

“…On the other hand, the advantages of screw‐retained restorations include retrievability, which prevents the need for complex procedures during prosthesis removal for maintenance, evaluation of oral hygiene and peri‐implant probing, repairs, or abutment screw tightening . Some indications for screw retention include inadequate interocclusal space (minimum 4 mm height) and the necessity of soft tissue conditioning and individualization of emergence profile during provisionalization . Among the prosthetic complications reported for implant‐supported restorations, abutment screw loosening is the most common and is more frequently observed in screw‐retained than in cement‐retained single crowns …”