Screw-Retained vs. Cement-Retained Implant Restorations – When to Choose Which System?

The decision between screw-retained and cement-retained restorations depends on patient anatomy, the aesthetic zone, and the treatment plan – not on habit. Below, we've compiled data from laboratory practice to help you make an informed decision.

How the two systems differ

Screw-retained restorations are secured by a screw passing through the crown or abutment directly into the implant. Cement-retained restorations are seated on an abutment with cement – analogous to crowns on natural teeth.

Both systems have over 30 years of clinical documentation. The choice depends on the specific case conditions.

Screw-retained restorations – indications and limitations

Indications for screw-retained restorations:

• Patient with limited hygiene – the restoration is removable, allowing cleaning
• Multi-implant restorations – screws allow precise fitting
• Need for revision – full retrievability
• Implant in a correct axis – the screw-access channel can be masked with composite

Limitations:

• Screw-access channel visible with unfavorable implant axis (above 15°)
• Risk of screw loosening (first 6 months – control recommended)
• Higher laboratory requirements for fitting

Cement-retained restorations – indications and limitations

Indications for cement-retained restorations:

• Aesthetic zone with unfavorable implant axis – no visible screw-access channel
• Single implants in patients with good hygiene
• Cases where screw fitting is technically difficult

Limitations:

• Cannot be removed without destroying the restoration
• Risk of subgingival cement excess – the main cause of peri-implantitis with cementation
• Requires perfect cementation technique (light-body cement, marginal control)

Detailed comparison

How to choose in a specific case

Aesthetic zone with unfavorable implant axis → cement-retained (abutment masks the axis).

Aesthetic zone with correct axis → screw-retained (composite masks the channel).

Multiple implants or a bridge → screw-retained (fitting precision).

Patient with hygiene difficulties → screw-retained (removable).

Single implant, good hygiene, aesthetics secondary → both systems work.

Clinical errors and how to avoid them

Subgingival cement excess – the most common error in cementation. Any excess below the gingival margin is a potential source of inflammation. Use light-body cement and probe the margin after seating.

Screw loosening without control – 2–4 weeks after seating a screw-retained restoration, torque control is recommended. Manufacturer-recommended values: 15–35 Ncm for abutments, 10–15 Ncm for crown screws (varies by system – check manufacturer's instructions).

Incorrect system decision – changing the system after seating is costly. The screw-retained/cement-retained decision should be made before implant planning, not after exposure.