Screw-retained and cement-retained restorations are two common pathways in implant dentistry—but selecting the right option depends on far more than preference. From retrievability and peri-implantitis prevention to esthetics and lab design, this guide explores when screw-retained implants truly offer superior outcomes.
Screw-retained implants eliminate excess cement risks and simplify future maintenance, while cemented restorations may offer esthetic flexibility—clinical conditions should determine which is best.
What Are the Key Differences Between Screw-Retained and Cemented Implants?
While both designs can be successful, their retention methods create meaningful differences in clinical workflow, complications, and long-term management.
Diagram showing cemented vs screw-retained crown retention
Retention Mechanism and Restoration Design
Retention governs how the final prosthesis is secured and affects how it’s repaired or adjusted later.
- Screw-retained: The crown is fastened directly onto the abutment or implant with a central screw, offering secure fixation and easy retrievability.
- Cemented: The crown is bonded onto a prepared abutment using resin cement, often chosen for esthetic areas.
- Screw-retained crowns have visible access holes, while cemented crowns can be shaped to blend naturally with adjacent teeth.
Clinical implication: Screw designs excel when frequent retrieval or minimal soft tissue disruption is prioritized.
Placement Workflow and Chair Time
The placement sequence influences appointment length, technique sensitivity, and rework options.
| Workflow Step | Screw-Retained | Cemented |
|---|---|---|
| Try-in & occlusion check | Easily repeatable | Cement set may limit changes |
| Restoration seating | Can be verified dynamically | Once bonded, no reversibility |
| Final torque & polish | Completed intraorally | Requires cement cleanup time |
| Cement control | Not needed | Crucial to prevent inflammation |
- Cemented procedures often involve longer chair time due to cleaning and verification.
- Screw-retained delivery may be faster, especially in digital workflows.
Retrievability and Maintenance
Maintenance protocols differ dramatically.
- Screw-retained prostheses can be removed non-invasively for hygiene, repairs, or diagnostics.
- Cemented crowns require cutting or destruction for removal, risking damage to adjacent tissue or implants.
- Retrieval becomes vital for bruxism, chipping, or emergent peri-implant inflammation.
Real-world value: Easy retrievability improves long-term implant serviceability.
Esthetic vs. Functional Zone Use
Each design serves different zone priorities.
- In anterior regions, screw holes may affect esthetics unless masked skillfully.
- Posterior regions benefit from screw retention for strength and access.
- Cemented crowns can be placed with subgingival margins, improving gingival transition and esthetic finish.
✅ Screw-retained implants provide clinical control and lower long-term risk – TRUE
Explanation: They offer reliable fit, lower biological risk, and retrievability.
❌ Cemented implants outperform screws in all cases – FALSE
Explanation: Cement increases peri-implantitis risk and retrieval difficulty.
In What Clinical Scenarios Are Screw-Retained Implants Preferred?
Clinical complexity, anatomic constraints, and patient risk factors often make screw-retained implants the superior option.
Clinical scenarios favoring screw-retained implants
Limited Interocclusal Space
Vertical height affects margin visibility, cement extrusion, and restoration bulk.
- Screw retention eliminates the need for space-consuming cement gaps.
- Ideal for molars with reduced vertical clearance.
- Minimizes over-contouring and pressure on soft tissues.
- Prevents margin location compromises that lead to inflammation.
- Allows passive fit even in tight zones.
Scenario: Posterior molars with high opposing occlusion—tight vertical room makes cement removal unreliable.
Angled Implants with Multi-Unit Frameworks
Complex implant paths require precision and reversibility.
- Screw-retained prostheses can accommodate angulated screw channels.
- Prevents misfit in tilted posterior segments.
- Essential in All-on-X and immediate-load hybrids.
- Passive fit improves framework longevity.
- Simplifies repair in full-arch conversions.
Clinical pearl: ASC systems allow screw access in esthetic zones without sacrificing design.
Patients at High Risk for Peri-Implantitis
Biologic risk demands minimal inflammation sources.
| Risk Factor | Impact on Cemented Restorations |
|---|---|
| Poor hygiene | Missed cement = chronic inflammation |
| Deep tissue depth | Hard to access margins |
| History of periodontitis | Increases breakdown from cement residue |
| Limited follow-up visits | Delayed detection of cement complications |
- Screw retention removes excess cement from the equation.
- Safer for patients with compromised periodontal history.
- Easier follow-up in community or aging populations.
Immediate Loading and Full-Arch Cases
Speed, predictability, and flexibility are critical.
- Avoids delay due to cement set time.
- Supports intraoral torque verification.
- Allows easy removal for soft tissue access.
- Enables modifications during provisionalization.
- Favored for All-on-4 or full-arch temporization.
✅ Screw retention is ideal in constrained, risky, or complex clinical conditions – TRUE
Explanation: It offers precision, safety, and reversibility.
❌ These cases are best served by cementation – FALSE
Explanation: Cement increases technical risk in complex workflows.
What Risks Are Associated with Cementable Implant Restorations?
Despite wide use, cementable crowns carry significant risks that can compromise outcomes if not managed precisely.
Cement-related complications in implant prosthetics
Excess Cement Causing Inflammation
Cement residue is a primary cause of biological failure.
- Radiolucent cements often go undetected on x-rays.
- Even microscopic remnants can trigger inflammation.
- Subgingival margins make cement detection nearly impossible.
- Bone loss may occur before clinical signs emerge.
- Often misdiagnosed as implant failure or occlusal trauma.
Case example: Anterior implant crown with clean esthetics, but post-placement tissue swelling revealed hidden cement at 6-month follow-up.
Difficulty Retrieving for Maintenance or Rework
Once cemented, retrieval becomes destructive.
| Scenario | Screw-Retained | Cemented |
|---|---|---|
| Loose crown reattachment | Easily retorqued | Must be cut and replaced |
| Abutment screw check | Accessible | Often impossible |
| Occlusal modification | Reversible | May require remake |
| Crown fracture | Crown removable | Entire unit destroyed |
- Routine maintenance becomes surgery in cemented restorations.
- Risk of damaging internal threads or bone interface.
- Complex when abutment fractures under the cement.
Variable Margins in Deep Subgingival Zones
Margin location dictates success or failure.
- Subgingival margins are esthetically pleasing but risky.
- Difficult or impossible to isolate during cementation.
- Tissue may heal over cement remnants.
- Impacts probe depth accuracy and bleeding diagnostics.
Post-Delivery Complication Rates
Long-term biological risk is statistically higher.
- Studies show 25–40% of peri-implantitis linked to cement.
- Especially problematic in esthetic zones where margins are deep.
- Cemented molar crowns show more late-stage revisions.
- Hygienists have limited tools to clean beneath margins.
✅ Cement increases biological risk, especially in deep tissue or low visibility zones – TRUE
Explanation: Even small amounts of cement can initiate long-term breakdown.
❌ Cemented restorations are complication-free if done well – FALSE
Explanation: Risks persist even with meticulous delivery.
How Do Esthetics Compare Between the Two Retention Types?
Esthetics often drive decision-making—but proper technique can deliver beautiful results with either design.
Screw-retained and cemented anterior crowns
Anterior Zone Considerations
Visibility is the #1 esthetic concern.
- Cemented crowns hide all hardware—ideal for smile zones.
- Screw access holes may appear through incisal edge.
- ASC can redirect access to lingual surfaces.
- Use of zirconia abutments improves light reflection.
- Gum health must remain stable for both designs.
Access Hole Visibility and Composite Fill Techniques
Composite techniques have improved, but limitations remain.
- Use nano-filled, shade-matched composites.
- Polish to avoid halo or matte finish.
- Round bevel access hole to blend visually.
- Mask edges with pink composite in subgingival areas.
- Use ASC for better access path alignment.
Soft Tissue Management Around Emergence Profile
Gingival health affects long-term esthetics.
| Feature | Cemented Crown | Screw-Retained Crown |
|---|---|---|
| Margin control | Subgingival | Limited to screw path |
| Papilla sculpting | Easier | Requires more customization |
| Tissue rebound | More predictable | Must use custom healing caps |
- Cemented allows gradual soft tissue training.
- Screw requires precise healing abutments to match emergence.
Abutment Angulation and Gingival Contour Control
Design flexibility influences esthetics.
- Cemented abutments can be angled for ideal emergence.
- Screw access may limit facial contour in tight angles.
- Custom abutments reduce discrepancy, but require time.
- Zirconia abutments with cemented crowns remain gold standard in highly visible zones.
✅ Cemented crowns offer more freedom in the esthetic zone – TRUE
Explanation: Subgingival margins and abutment angulation improve visual outcomes.
❌ Screw-retained crowns always look worse – FALSE
Explanation: ASC, custom abutments, and composites now enable esthetic success.
What Lab and Design Factors Influence Retention Choice?
Even the best plan fails if lab tools or systems can’t support it.
CAD design of screw-retained and cemented restoration
Implant Brand Compatibility with Screw Channels
Not all platforms are equal.
- Some brands limit screw-retained options due to internal geometry.
- Narrow implants may lack adequate thread depth.
- ASC kits vary in compatibility.
- Confirm seating torque requirements and component interchange.
- Always verify with lab before restoring non-native systems.
CAD/CAM Custom Abutment Capabilities
Digital workflows enhance precision.
- Custom abutments allow optimal margin design.
- Ideal emergence profile for tissue shaping.
- Enable precise screw access path.
- Reduce seat time and minimize occlusal adjustments.
- Help simulate cement gap thickness and reduce overflow.
Use of Multi-Unit Abutments for Hybrid Cases
Full-arch restorations require different engineering.
| Prosthesis Type | Preferred Retention |
|---|---|
| All-on-4 or 6 Hybrid | Screw-retained via MUAs |
| Individual posterior | Case-dependent |
| Temporary bridges | Screw for removability |
- MUAs improve retrievability and protect fixture interfaces.
- Cemented hybrids rarely used in modern protocols.
Cost and Turnaround Time Differences
Efficiency vs. long-term value.
- Screw-retained may involve more design steps, but fewer remakes.
- Cemented easier for labs with analog workflows.
- Digital labs favor screw due to design repeatability.
- Screw designs often reduce post-delivery adjustments.
✅ Lab compatibility and system design determine retention feasibility – TRUE
Explanation: Some labs and platforms support one method better than the other.
❌ You can always choose based on preference alone – FALSE
Explanation: Workflow, design tools, and platform shape limit that freedom.
Conclusion
The decision between screw-retained and cemented implant restorations is not just about preference—it’s about clinical suitability, long-term predictability, and risk control. While screw-retained designs offer significant advantages in retrievability and biological safety, cemented crowns still play a role in anterior esthetics and margin management. An informed, case-by-case decision ensures better outcomes for both clinicians and patients.
- Understand the structural and workflow differences
- Learn which clinical scenarios favor screw-retained options
- Recognize the biological and maintenance risks of cement
- Compare esthetic challenges and contour control
- Ensure your lab and system support the right choice
Take the Next Step
Want to reduce complications and improve restoration consistency? Talk to us about integrating screw-retained workflows into your practice or upgrading lab collaboration for hybrid protocols.
