Screw-retained vs cement-retained implant crowns

Do screw-retained or cement-retained implant crowns last longer?

Neither, on current evidence. The systematic review by Wittneben, Millen and Brägger, prepared for the 5th ITI Consensus Conference in 2013, pooled 73 studies. Five-year survival was 96.03% for cemented reconstructions and 95.55% for screw-retained ones, with no significant difference. The result held when single crowns and partial bridges were analyzed separately.

The consensus statement puts it plainly: both retention types can achieve high survival, and neither one prevents failure or complications on its own. Where they differ is in the kind of trouble each tends to cause.

Pros and cons of each retention type

According to the ITI consensus, cemented reconstructions had more technical complications overall, while screw-retained ones had more ceramic chipping. On the biological side, fistulas and suppuration were more common with cement. The review’s conclusion was that screw-retained restorations had fewer technical and biological complications overall.

One finding matters for material choice. Among cemented restorations, all-ceramic ones failed more often than metal-ceramic; among screw-retained restorations, that gap did not appear.

How strong is the link between excess cement and peri-implantitis?

In endoscopic studies, residual cement turns up at most inflamed cemented implants. In a 2009 endoscopic study in the Journal of Periodontology, Wilson found excess cement at 34 of 42 implants with signs of peri-implant disease and at none of the 20 healthy controls. Thirty days after the cement was removed, 74% of treated sites showed no clinical or endoscopic signs of inflammation.

A 2025 cross-sectional study in the same journal repeated the endoscopy in 46 patients with cemented implant crowns and peri-implant disease. Cement residue was present in 80.4% of them, mostly on the buccal and lingual aspects (88%). In peri-implantitis cases the residue sat more apically than in mucositis.

Does margin depth matter?

Yes, and radiographs will not catch the problem. Linkevicius and colleagues cemented 53 single implant crowns with margins ranging from tissue level to 3 mm submucosal (Clinical Oral Implants Research, 2013). After cleanup, they unscrewed each abutment-crown unit and measured what was left. The deeper the margin, the more undetected cement, with significant differences between every group.

In the same sample, the radiograph showed residual cement mesially in only 7.5% of cases and distally in 11.3%. The buccal and lingual surfaces, where the 2025 study found most of the cement, do not show in profile on a periapical.

When is cement retention still the better call?

When the screw access would land in the wrong place. The ITI consensus recommends cement retention in three situations. The first is short-span prostheses with margins at or above tissue level. The second is esthetics, when the access would pass through the occlusal or incisal surface or the implant is malpositioned. The third is when an intact occlusal surface is wanted. The same statement warns that cementing on implants is not a simple procedure and calls for great caution.

At the design stage, implant position drives the discussion. An implant whose axis exits through the cingulum or the central fossa takes a screw-retained crown with no esthetic cost. A facially inclined implant puts the access on the visible surface, and that is when a cemented crown on a custom abutment with a shallow margin comes into play.

What about angled screw channels?

They are the third option: a component that lets the screw be tightened through an access hole tilted away from the implant axis. A 2025 meta-analysis in the Journal of Esthetic and Restorative Dentistry compared angled-channel crowns (up to 25°) with cemented crowns in non-molar sites. It included four studies and 167 crowns followed for 12 to 44 months. Clinical, radiographic and esthetic outcomes were comparable, with less bleeding on probing in the angled group.

The evidence is still short-term, and the option exists only if the implant system offers the component. Where it does, it keeps a screw-retained crown retrievable in a case that would otherwise need cement.

What to put on the lab Rx

Retention type changes both the design and the components, so it belongs on the prescription. Include:

• screw-retained (on a titanium base) or cemented on an abutment;
• for cemented crowns, where you want the abutment margin relative to the mucosa;
• implant brand, system and platform;
• a clean scan-body capture, or an impression with the impression coping;
• your fallback if the access exits facially: a cemented crown on an abutment, or an angled channel if the system has one.

At case check-in we confirm the implant components are in stock before the case moves to design. If the access lands on a visible surface, the design can go to you for approval in the dentist portal before milling. See how we make a zirconia implant crown or a metal-ceramic implant coping, use the guide to sending a case for the file checklist, and read monolithic vs multilayer zirconia vs e.max for material choice.