For a Front Tooth Implant Which is Best? Screw Retained or Cement Retained?

This debate has been raging for decades. There is no right answer. Ideally, you want to limit any cement under the gums, so theoretically if you can achieve implant placement into the jaw in such as way that you can screw in the abutment and crown, this would be ideal. However......this is not always possible due to various limitations (angulation, anatomy, finances due to need for extensive preparatory bone grating). So often times, a cement on crown is your only option. In the past, the screw used to loosen frequently so the profession moved to cement on crowns. Then, we started seeing cement left behind which led to gum boils and we started to move back to the screw. There is no perfect. Find the most experienced dentist or prosthodontist and talk to them about it. 

Having a front tooth replaced by an Implant takes special attention.  You need to see a dentist who will take the time to educate you about your options.  The dentist should take impressions and make a surgical guide for your surgeon so that your Implant is placed correctly when you are ready to replace your missing tooth.  Once the Implant has integrated, which may take 3 or more months,  you should have a temporary crown done to guide your gum into a healthy profile while everything heals.  We do this for almost all front teeth and have many pictures to share so you can see how amazing front Implants can look.  Then(and this may be 6-9 months later) you can have a beautiful screw retained crown done to complete your treatment!  Its all in the planning and attention to detail.  This is also called retrievable dentistry.  You can access the screw hole and tighten the Implant if you need to and can change the color of the tooth as well. Good luck-Dr. Wendy

Screw retained vs. cement retained....... That is the question!

The answer is dependent on so many factors like the amount of available bone, the condition of the adjacent teeth, the length of the adjacent teeth etc. In a "normal" case, I would always opt for a well made ceramic cement on as there are many ways to ensure that there is no excess cement when performed by a trained implant dentist. It is difficult to know who this is. My suggestion is to work with a board certified OMS who can refer you to a Prosthodontist trained in implant restorations to get the best results. Always ask to see real photos (see my web site) of their own patients. 

It all depends on the angulation of the implant in your bone, and the angulation of the abutment and crown in your mouth. If the angles work out so that the screw hole is behind the tooth, then go with the screw-retained. Often, however, that is not possible on a front tooth and you have to go with the cement retained.

Studies have been showing that bone loss can occur if excess implant cement is not removed well when the cement retained crown is not removed well.  On that not the angle of most implants in the front of the mouth sometime make it difficult to restore with a screw retained crown.  Speak to your dentist and see what your options are. 

I generally choose screw-retained implant crowns for the back teeth and cement-retained ones for the front teeth.  This usually has to do with the position of the hole for the screw which is fairly easy to place for a back tooth but not so easy for a front tooth.  However, my preference is to go with screw-retained wherever possible.  This is because some studies have shown gum irritation and even loss of bone around implants that have cement-retained crowns due to excess cement that wasn't cleaned properly around the implant.  This should be determined by your dentist. 

I prefer the screw retained implants whenever possible because there are no margins that other dentists can criticize and find fault.  You can access the implant easily if you ever need to also.  The cement retained many times getting the crown to fit flush is difficult and can create voids were the two meet.  If the abutment ever loosens, you have to drill through the crown to access the screw hole.  Many times the angle of the implant will prevent a screw retained implant since the screw hole will point towards the esthetic portion of the crown.  In these instances a screw retained is not advisable.  Best of luck.  Dr. David Frey

Cement-retained restorations offer a couple advantages including the elimination of un-esthetic screw access holes and greater resistance to porcelain fracture. The main advantage for screw retained is retrievablility.

 

In my practice for the usual when the abutment is at least 5mm and/or of proper retention I usually place cement retained restorations