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When choosing whether to supply cement-retained implant crowns or screw-retained implant crowns, there are various factors you will need to consider. These factors include retrievability, how well it will maintain the peri-implant tissues, how easy it will be to use, whether it is suitable for use with angled implants, and last but not least, the cost.
Sometimes it is necessary to temporarily remove an implant crown. There are certain cements on the market that are made specifically for implant restorations which claim the implant crown will be easy to retrieve. Some dentists may also use temporary cement to hold implant crowns in position. This can be a good solution but it does mean that the crown will be less retentive which is less than ideal. In comparison, a screw-retained implant crown is far more predictable if the crown needs to be retrieved, particularly when a greater number of abutments are required. A multi unit restoration that is cemented in place will be far more difficult to predictably remove.
Maintaining Peri-Implant Tissues
When a crown is cemented into place there is always the danger that excess cement could be extruded into the sulcus. When this is the case, it can damage the peri-implant tissues unless the cement is fully removed. When subgingival cement is present around an implant, it can increase the risk of peri-implant mucositis and peri-implantitis. While there are good techniques for removing subgingival cement when placing an implant crown, there is still a risk that some cement may be missed. In comparison, a screw-retained crown doesn’t carry this risk and may be easily removed for maintenance and cleaning.
Inserting a screw-retained implant crown can be more challenging compared to a cement-retained crown. This is particularly the case when fitting multiple unit restorations. With a cement-retained restoration where multiple abutments are required, the procedure to fit the restoration is still quite similar to a routine bridge placement. In comparison, placing a screw retained restoration requires a number of extra steps to ensure the framework has passive fit, and ideally, the restoration should induce no stress on the implant.
Suitability For Use with Angled Implants
For esthetic reasons, it is not possible to place screw holes in the incisal or facial contours of implant crowns. If the implant angle is slightly incorrect, then it is necessary to use an angled, screw-retained abutment which increases the cost. In this case, it is much easier to rely on a cement-retained crown using either a custom abutment for a stock angled abutment.