How Do Screw-Retained and Cemented Crowns Differ?
In a screw-retained restoration, the crown has a small channel through it. A screw goes through this channel and tightens the crown to the implant. The opening is then closed with a tooth-coloured filling.
In a cemented restoration, an abutment is first screwed onto the implant. The crown is then fixed over it with dental cement. There is no opening in the crown, so the chewing surface is one unbroken piece of ceramic.
The practical difference shows later. A screw-retained crown can be unscrewed for cleaning, repair or tightening. A cemented crown usually has to be cut off if it needs to come out, and any cement left under the gum has to be removed carefully when it is fitted.
Removal
Screw-retained: can be unscrewed and put back. Cemented: often has to be cut off and remade.
Chewing surface
Screw-retained: a small filled opening. Cemented: no opening.
Cement near the gum
Screw-retained: none. Cemented: excess cement must be cleaned away completely.
Implant angle
Screw-retained: the screw channel has to come out in a suitable place. Cemented: forgives a less ideal angle.
When Each Method Fits
Many cases can be done either way. These situations tip the balance.
Screw-retained for full-arch and long bridges
All-on-4, All-on-6 and long bridges are usually screw-retained so they can be removed for maintenance.
Screw-retained where the gum is deep
When the edge of the crown lies well under the gum, cement is hard to clean away, so a screw is the safer choice.
Cemented when the implant angle is unfavourable
If the screw channel would come out through the visible front of the tooth, a cemented crown avoids an opening there.
Angled screw channels
Some systems allow the screw channel to be tilted, so a screw-retained crown is possible even when the implant is not perfectly aligned.
Limited height
When there is little space between the jaws, a short abutment may not hold cement well and a screw gives a more reliable hold.
Cemented crowns with a deep margin
The deeper the crown edge sits under the gum, the harder it is to see and remove leftover cement.
Screw-retained crowns with the opening on the front surface
An opening on the visible side of a front tooth affects the appearance and is usually avoided.
What Can Go Wrong With Each Method
Both methods work well in the long term. These are the typical issues.
Leftover cement
Cement left under the gum can irritate the tissue and is linked to inflammation around implants. Careful removal and a check X-ray reduce the risk.
Screw loosening
The screw can loosen and the crown may start to move slightly. It is usually tightened in a short visit.
Chipping around the opening
The ceramic around the screw channel can occasionally chip. The filling in the opening may also wear and need renewing.
Difficult removal
A cemented crown that has to come off for any reason may be damaged in the process.
How the Fixing Method Is Chosen
The decision is usually made at the planning stage, because it depends on where and at what angle the implant will sit.
- 1
Planning the implant position
On the 3D scan your dentist checks whether the screw channel would come out on the chewing surface or on the inner side of the tooth.
- 2
Checking the space
The height between the gum and the opposing tooth is measured. Cement needs enough abutment height to hold the crown.
- 3
Choosing the method
If the channel lands in a good place, screw retention is often preferred. If it would come out on the visible front surface, cementing or an angled screw channel is considered.
- 4
Fitting the crown
The crown is screwed in and the opening is filled, or it is cemented and the excess cement is removed. The bite is then checked.
Related Topics
The fixing method is linked to other choices in an implant plan.
Zirconia or titanium abutment
The abutment material is chosen together with the way the crown is fixed.
All-on-4 or All-on-6
Full-arch bridges on implants are normally screw-retained.
Implant or bridge
A conventional bridge on natural teeth is always cemented and involves no implant.
How Papatya Dental Clinic Plans Implant Treatment
Ask whether your crown will be screw-retained or cemented and why that method suits the position of your implant.
3D CT planning
Bone height, width and nearby structures are measured on a 3D CT (CBCT) scan before the implant is chosen.
In-house laboratory
Crowns are made in the clinic's own CAD/CAM laboratory, so shade and shape can be adjusted during your visit.
Implant card
You receive a card showing the brand and size of your implant, so any dentist can maintain it later.
After the Crown Is Fitted
Whichever method is used, fitting the crown is a short appointment and no healing time is needed in the bone.
- 1
The first days
The gum around the crown can be slightly tender, and the new tooth may feel unfamiliar when you bite.
- 2
The first check-up
Your dentist checks the bite, the gum and, for screw-retained crowns, that the screw is still tight.
- 3
Long term
At regular visits the crown, the filling over the screw and the gum around the implant are examined.
Clean around the implant every day
Brush twice a day and clean between the teeth with interdental brushes or floss, as shown by your dentist.
Keep your check-ups
Regular check-ups and professional cleaning help spot problems around the implant early.
The crown feels loose or clicks
This often means a loose screw. Avoid chewing on it and have it tightened soon.
Swollen or bleeding gum around the crown
Persistent swelling, bleeding or a bad taste around the implant should be checked.
What Shapes This Part of Your Plan
How the crown is fixed is written into your plan together with the implant and abutment.
Position and angle of the implant
This decides where a screw channel would come out.
Type of restoration
A single crown, a bridge and a full-arch restoration have different maintenance needs.
Gum depth
The depth of the crown margin under the gum affects how safely cement can be used.
Implant system
Not every system offers angled screw channels or the same abutment options.
Before / After
Frequently Asked Questions About Fixing Implant Crowns
Which is better, a screw-retained or a cemented implant crown?
Both are reliable. Screw-retained crowns are easier to remove and involve no cement near the gum. Cemented crowns have no opening and cope with a less ideal implant angle.
Can you see the screw hole?
It is closed with a tooth-coloured filling. On back teeth it is on the chewing surface and hard to notice. On front teeth it is placed on the inner side.
Can a cemented crown be removed?
Sometimes it can be loosened, but often it has to be cut off and a new crown made.
Why is leftover cement a problem?
Cement trapped under the gum can cause inflammation around the implant. Dentists remove it carefully and may check with an X-ray.
What happens if the screw comes loose?
The crown may move slightly or click. The dentist removes the filling, tightens or replaces the screw and closes the opening again.
Is an All-on-4 bridge screwed or cemented?
Full-arch implant bridges are normally screw-retained, so the dentist can take them off for cleaning and repairs.