If you’re considering a dental implant at Rudra Dental – Smilelature (Suramanagalam, Salem), you’ll likely discuss important choices beyond just the implant itself. After your consultation, selecting the implant system and crown material, your dentist may ask one final question: would you prefer a screw-retained crown or a cemented crown?
Many patients visiting Rudra Dental – Smilelature (Suramanagalam, Salem) are unfamiliar with this option, yet the decision can significantly affect the longevity of the restoration, ease of maintenance, and the cost and complexity of future repairs if any issues arise. Understanding these differences can help you make a more informed choice for long-term oral health.
Let’s explore what the two options really mean. We’ll review the clinical research and shed some light on why screw retained crowns have a distinct advantage in most cases.
What Is a Screw Retained Crown?
Screw retained implant crowns clip onto the implant or abutment screw threaded post. There’s a tiny fixation screw that passes through an access hole all the way through the body of the crown. The access hole is then sealed with composite resin to recreate the bite surface.
They aren’t glued into place. The crown is retained only by the screw(s). Should the dentist ever need to remove the crown to inspect the implant, tighten a loose screw, repair a chip, accommodate periodontal treatment, etc., the access hole is unsealed, the screw is unscrewed, and the crown is simply lifted off intact.
What Is a Cement Retained Crown?
A cement retained implant crown is made to sit over its own abutment, which screws into the implant. The crown is then cemented onto the abutment just as if it were cemented onto tooth preparation.
It looks great to the dentist and patient alike. There is no screw access hole to mar the biting surface, so you get a fully intact occlusal table. Because of this, cement retained crowns offer an aesthetic advantage in certain cases, especially in the front teeth.
But the downside, proven by clinical studies, is considerable.
Screw Retained vs Cement Retained: The Key Differences
| Screw Retained | Cement Retained | |
| Retention method | Fixation screw through crown | Dental cement on abutment |
| Retrievable? | Yes, easily | Difficult without damaging crown |
| Cement risk below gumline | None | Present and documented |
| Peri-implant tissue risk | Lower | Higher if excess cement remains |
| Occlusal surface | Access hole (sealed) | Intact, no hole |
| Aesthetics | Slight compromise at access hole | Better for anterior cases |
| Vertical space needed | Less | More |
| Repair access | Straightforward | Often requires crown removal |
| Preferred for full-arch cases | Yes | Not standard |
The Problem With Cement Retained Crowns: Subgingival Cement
This is where the conversation shifts from preference to patient safety.
When patients choose implant-supported restorations at Rudra Dental (Fairlands, Salem), screw-retained crowns offer a significant advantage by eliminating the risks associated with dental cement. When a crown is cemented onto an implant abutment, excess cement can squeeze out from beneath the margin and travel below the gumline. The problem is not the cement itself. The problem is that subgingival cement is extraordinarily difficult to remove completely, and residual cement below the gumline acts as a surface for bacterial colonisation. That bacteria triggers peri-implant inflammation, which can destroy the bone supporting the implant. By recommending screw-retained crowns whenever appropriate, Rudra Dental (Fairlands, Salem) helps reduce the risk of cement-related complications and supports the long-term success of dental implants.
The clinical evidence on this is not ambiguous.
A landmark study by Wilson, published and cited across the implant literature, used a dental endoscope to examine 42 implants being treated for peri-implantitis (infection around the implant). Subgingival cement residues were found in 80 percent of those implants with cemented prostheses. After cement removal, 75 percent of those implants showed healthy peri-implant tissues within one month.
A 2025 cross-sectional endoscopic study published in the Journal of Periodontology examined 46 patients with peri-implant disease under a fibre-optic endoscope. More than 80 percent had cement residues hidden beneath the gumline, predominantly on the buccal (cheek-side) and lingual (tongue-side) surfaces where routine probing and X-rays cannot detect them.
A systematic review published in Clinical Oral Implants Research concluded that excess cement is a possible risk indicator for peri-implant diseases, with higher disease prevalence observed in cemented versus screw retained restorations. The same review noted that cements used in implant prosthetics generally have low radiographic density, meaning they often cannot be detected on X-rays.
Here is why that matters. If the only way to confirm cement removal is visual inspection, and the cement cannot be seen on an X-ray, and routine probing cannot reach the buccal or lingual subgingival areas, then residual cement can remain undetected for months or years while peri-implant bone quietly deteriorates.
A screw retained crown eliminates this risk entirely. No cement, no subgingival residue, no peri-implantitis driven by retained luting material.
The Retrievability Advantage: Why It Matters Long-Term
Retrievability is not just a technical convenience. It is a clinical safeguard.
A Journal of Dental Education survey of prosthodontists cited in a 2024 Wiley publication noted that the major advantage of screw retained restorations is retrievability without damage to the crown, allowing for restoration repair, soft tissue visualisation underneath, and abutment screw tightening.
Here is what that means across a patient’s lifetime with an implant.
- Abutment screw loosening: This is one of the more common mechanical complications with any implant crown. With a screw retained crown, tightening the screw takes a few minutes chairside. With a cemented crown, removing the crown to access the screw typically means destroying the crown in the process.
- Ceramic chip or fracture: Porcelain chips happen with normal use over time. On a screw retained crown, the crown is removed, repaired or replaced, and reseated. The abutment stays in place. On a cemented crown, the crown must be cut off, potentially damaging the abutment, and a new crown must be fabricated.
- Periodontal maintenance needs: Some patients, especially those with a history of gum disease, need periodic access to the tissues around the implant for deeper cleaning. A screw retained crown can be temporarily removed, allowing full access. A cemented crown cannot.
- Implant inspection: If there is a question about the integrity of the implant connection over time, or if imaging suggests marginal bone changes, the ability to remove the crown and inspect directly changes the clinical options available. With cemented crowns, that access is not readily available.
When Is Cement Retention Still Justified?
Being fair matters here. Cement retained crowns are not categorically wrong. There are clinical situations where they remain a reasonable choice.
- Anterior aesthetics: The access hole on a screw retained crown sits on the biting surface or, for front teeth, on the back of the tooth. When the implant is positioned well, this is manageable. When the implant angle places the access hole on the visible labial surface, cement retention may preserve the aesthetic outcome better, or an angulated screw channel (ASC) system is used instead.
- Implant angulation: If an implant is placed at a non-ideal angle, the screw access channel may emerge in an aesthetically or functionally inconvenient position. Cement retention can manage implant angulation more flexibly. Modern angulated screw channel technology increasingly resolves this limitation for screw retained designs, but not every clinic has this capability.
- Short clinical crowns and limited vertical space: In some cases, the vertical distance between the implant and the opposing teeth is insufficient for a screw retained design with conventional components. Cement retained crowns can fit within a smaller vertical envelope in certain situations, though evidence-based guidance notes that screw retained designs can succeed with less vertical space because there is no cemented interface adding height.
- Patient preference and cost: Some patients and clinicians factor in the slightly simpler fabrication of cement retained crowns. Cost considerations do influence decisions in private practice settings, as confirmed by the 2024 Journal of Dental Education survey.
Screw Retained vs Cement Retained: Which Suits Your Case?
Here is a practical decision guide.
Choose screw retention when:
- The implant is in the posterior (back) region of the mouth
- You have a history of gum disease or peri-implant tissue risk
- A full-arch or multi-unit restoration is planned
- You want a restoration that can be maintained without destruction
- Vertical space is limited
- Long-term retrievability matters to you
Cement retention may be considered when:
- The case involves a single front tooth with demanding aesthetic requirements
- Implant angulation makes screw access problematic and angulated screw channel technology is unavailable
- The adjacent teeth framework demands an uninterrupted occlusal surface
Implant Restorations at Rudra Dental Smilelature
One of the areas of practice in which Rudra Dental Smilelature specializes is Dental Implants. Dr. Rhoopesh Venkatraman (BDS, FDS, ADS, MFM in Restorative Dentistry and Implantology) performs single tooth implants and multiple teeth implants as well as Immediate implants and Full arch treatments like All-on-4 or All-on-6/8. Full mouth reconstructions/rehabilitations with implant supported restorations are also performed at Rudra Dental Smilelature.
At Rudra Dental Smilelature, the choice of how each crown/bridge will be retained becomes part of your restorative treatment plan from the beginning. It’s never an afterthought. If you are wondering about screw vs cement retention or just want to know the details about your restoration design ask us at your consultation. The more you know about your treatment, the better you can decide what’s best for you and how you can take care of your implants for life.
FAQs
1. What is the main advantage of a screw retained implant crown over a cemented one?
The primary advantage is retrievability. A screw retained crown can be removed cleanly for repairs, inspections, or maintenance without destroying it. It also eliminates the risk of residual cement below the gumline, which clinical studies have linked to peri-implant inflammation and bone loss.
2. Can residual cement under an implant crown really cause bone loss?
Yes. A systematic review published in Clinical Oral Implants Research identified excess cement as a possible risk indicator for peri-implant diseases. The cement creates a rough subgingival surface where bacteria accumulate, triggering inflammation.
3. Is a cemented crown easier to repair if it breaks?
No. This is one of cement retention’s most overlooked drawbacks. If a cemented crown chips or the abutment screw loosens, the cemented crown must typically be cut off to access the underlying connection, often destroying it in the process. A screw retained crown is simply unsealed, unscrewed, repaired, and reseated. The repair process is faster, less destructive, and less costly.
4. Does a screw retained crown look different from a cemented one?
In most posterior cases, the difference is not noticeable. The access hole sits on the occlusal (biting) surface and is sealed with tooth-coloured composite resin. For front teeth, the hole is on the lingual (back) surface. When implant positioning is correct, neither the patient nor others can detect the access hole during normal function or smiling.
5. Do all dentists offer screw retained implant crowns?
Most dentists who place implants can offer both options. The choice depends on implant positioning, available components, restorative space, and clinical preference. If your dentist proposes cement retention, it is reasonable to ask whether screw retention is feasible for your case and what the rationale is for the recommended approach.