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CLINICAL GUIDE · IMPLANTS AND PROSTHODONTICS

Retaining implant-supported fixed restorations: screw or cement?

Dr. Ferit Çiftçi · Last updated: 5 November 2026 · Sources checked: 5 November 2026

CLINICAL SUMMARY

No significant difference in five-year restoration survival has been shown between screw- and cement-retained implant restorations; the difference lies in the type of complication.1, 2 One review reports more serious biological complications with cemented restorations and more technical problems with screw-retained single crowns; the retrievability of a screw-retained restoration makes those problems easier to manage.2 In the other large review, screw-retained restorations showed fewer technical and biological complications overall, so the direction of complications should be read separately for each type of restoration.1 When cement is chosen, residual cement is a possible risk indicator: keep the margin close to the mucosal level and do not treat a radiograph as proof of clean-up.3, 4

This article is written for dentists; it is not patient information or a treatment recommendation. It is not a peer-reviewed publication; it is a literature-based clinical guide by Dr. Ferit Çiftçi. References and a methods note are at the end.

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Complication profiles of the two methods

In a systematic review of 73 studies, five-year survival was 96.03% for cemented and 95.55% for screw-retained restorations (P = .69). Screw-retained restorations showed fewer technical and biological complications overall. For cemented restorations, the type of cement did not affect the failure rate, but it did affect loss of retention.1

In another review of 59 studies, the five-year incidence of technical complications for single crowns was 11.9% when cemented and 24.4% when screw-retained; for partial and full-arch prostheses the trend favoured screw retention. Bone loss of more than 2 mm was more frequent with cemented crowns (2.8% against 0%). The authors report that neither method was clearly superior and that screw-retained restorations seem preferable because they are retrievable and appear more biologically compatible.2

Bone loss findings vary with the scope of the study. A 2016 meta-analysis found a small difference in favour of cemented restorations (mean difference -0.19 mm), which the authors note may not be clinically significant.5 A 2026 meta-analysis of eight randomised trials found no significant difference for single crowns,6 and the AO/AAP meta-analysis found no significant difference in bone loss between the two methods.7 A meta-analysis of six randomised trials found no significant difference between the two methods in the risk of peri-implant mucositis or peri-implantitis, with wide confidence intervals; the authors rate the evidence as moderate certainty.8

For single crowns on zirconia abutments in the aesthetic zone, there was no significant difference between the two methods in peri-implant parameters or aesthetic scores at 3 and 4 years.9 For full-arch fixed prostheses, screw retention was associated with fewer complications; bone loss of more than 2 mm was reported more often with cemented prostheses, and screw loosening and screw fracture more often with screw-retained ones.10

Which one, when?

The evidence does not show one method to be superior in every case. Three questions stand out when choosing retention: might the restoration need to come off later, how far below the mucosa is the margin, and where does the screw channel emerge? Whichever method is chosen, access for cleaning and probing and a follow-up plan are part of planning.

  • For multi-unit and full-arch prostheses, where retrievability matters, screw retention makes technical and biological problems easier to manage.2, 10
  • When the margin lies deep below the mucosa, the amount of undetected cement rises; consider screw retention or an abutment that brings the margin up towards the mucosal level.3, 4
  • When the screw channel would emerge on the buccal surface, an angled screw channel abutment is an option. In a meta-analysis of ten studies on single crowns, implant survival was 99% and no prosthesis failures were reported, with no statistically significant difference from cemented crowns in bone loss, probing depth, complications or aesthetics. Follow-up ranged from 14 days to more than 3 years.11 A 2025 meta-analysis of four studies with 167 single crowns in non-molar sites found no significant difference from cemented crowns in marginal bone level, probing depth, aesthetics, technical complications or implant failure; the authors conclude that less bleeding on probing can be expected with angled channel crowns, describe the outcomes as short term and state that superiority was not shown.12
  • Clinical data on screwmentable restorations (cemented, yet retrievable through a screw channel), which aim to combine the advantages of screw and cement, are limited: of 24 studies, one was a randomised trial and two were prospective clinical studies.13
  • Plan the emergence profile with either method: in the AO/AAP meta-analysis, emergence angles below 30° and a concave or straight emergence profile were associated with a lower risk of peri-implantitis; each finding rests on two studies.7 For baseline records and maintenance, see the section below.

Step-by-step protocol

Screw-retained restoration

  1. Assess where the screw channel will emerge at the planning stage; plan an angled channel in advance if needed.11
  2. Decide the abutment strategy before impressions and try-ins; avoid removing and replacing the abutment repeatedly. A one abutment-one time approach is associated with less bone loss than repeated disconnection.7
  3. In single-implant restorations, use a connection with antirotational features and tighten the screw to the manufacturer's recommended torque. Under these conditions, abutment screw loosening was rare; the three-year rate free of screw-loosening complications was 97.3% for external and 97.6% for internal connections. The review covers single-implant restorations only, and the result cannot be generalised to multi-unit restorations.14
  4. Ask about screw loosening at reviews; a five-year cumulative screw loosening rate of 8.8% has been reported for implant-supported single crowns in general, not for screw-retained crowns alone.15

Cement-retained restoration

  1. Place the margin close to the mucosal level, with access for cleaning; the deeper the margin, the more cement goes undetected.3, 4
  2. Allow the soft tissue to mature. Residual cement was seen more often with healing periods shorter than four weeks, and immediate loading or cementation after re-entry was associated with a higher prevalence of peri-implant disease.3
  3. Use a technique that limits excess cement. In a randomised trial with a crossover design on 30 posterior single crowns, a retraction cord combined with a copy abutment left less residual cement than rubber dam (median residual area 0.58% against 1.39%). Undetected residual cement was found with both methods, and the authors state that neither should be considered reliable in clinical applications. The outcome measured was residual cement area, not peri-implant disease.16
  4. Do not treat a radiograph as confirmation of clean-up. In a clinical study of 53 patients, radiographs showed residual cement in 4 cases mesially and 6 distally, and the authors concluded that radiographs are not a reliable way to assess excess cement.4
  5. Book the first review early and continue with the maintenance described below. In studies with early and regular recalls, peri-implant disease was mostly found at an early stage.3 In an endoscopic study of 39 consecutive patients with signs of peri-implant disease in a private periodontal practice, residual cement was found at 34 of 42 test implants (81%); 30 days after removal, 25 of the 33 sites cleared of cement showed no clinical or endoscopic signs of inflammation. The group was selected for signs of disease and follow-up was short.17

Both methods: baseline records and maintenance

  1. Take a baseline radiograph and probing measurements when the prosthesis is completed; the 2017 World Workshop consensus report recommends these records.18
  2. At reviews, check for bleeding on probing, erythema, swelling and suppuration; the same consensus report characterises peri-implant health by the absence of these signs.18
  3. Consider peri-implant maintenance at the planning stage. According to the European Federation of Periodontology S3 guideline, prevention of peri-implant diseases begins when implants are planned, and once they are loaded a supportive peri-implant care programme with periodic assessment of peri-implant tissue health should be set up.19

Common errors and fixes

ErrorFix
Cementing a restoration with a deep subgingival margin.Bring the margin towards the mucosal level or choose screw retention.3, 4
Confirming cement clean-up with a check radiograph.Radiographs may not reliably show residual cement; clean carefully and book an early review.3, 4
Cementing before the soft tissue has healed.Wait for tissue maturation; residual cement was more frequent with healing shorter than four weeks.3
Removing the abutment many times for try-ins and impressions.A one abutment-one time approach is associated with less bone loss.7
Applying torque by feel.Use the manufacturer's torque; in single-implant restorations with antirotational features and proper torque, abutment screw loosening was rare.14
Treating a screw-retained restoration as maintenance-free.Technical complications have been reported more often with screw-retained single crowns, and screw loosening and fracture more often with screw-retained full-arch prostheses; record the state of screws and porcelain at reviews.2, 10

Level of evidence

What is known

No statistically significant difference in five-year restoration survival has been shown between the two methods; this does not prove that they are equivalent. Their complication profiles differ and vary with the type of restoration.1, 2 Differences in bone loss are either small or not shown.5, 6, 7 For zirconia single crowns, a 2026 meta-analysis of nine randomised trials found a slight difference in favour of cemented crowns (mean difference -0.04 mm, moderate certainty), with no meaningful difference in other biological or mechanical outcomes.20 Another 2026 meta-analysis of 31 studies, 17 of them randomised, found no significant difference in marginal bone change between cemented and screw-retained crowns.21 In randomised trials, no significant difference in the risk of peri-implant disease has been shown (moderate certainty).8 Residual cement is a possible risk indicator and increases as the margin gets deeper.3, 4

What is not known

The two large reviews cover the literature up to 2012; one of them includes prospective and retrospective studies alongside randomised trials.1, 2 Randomised trials are few and heterogeneous.6 Follow-up for angled screw channels is short,11, 12 and clinical data on screwmentable restorations are limited.13 In two reviews, cement type did not affect failure rate or the prevalence of peri-implant disease but did affect loss of retention;1, 3 this cannot be generalised to other outcomes. In a 2026 meta-regression, glass ionomer, zinc phosphate, polycarboxylate and resin cements were associated with less bone loss than zinc oxide cement.21 In a review of ten studies, nine of them in vitro, resin-containing cements left more residual cement and zinc oxide-based cements the least; the authors advise caution with direct clinical recommendations.22 The two findings rest on different outcomes. A direct clinical comparison of which cement to choose was outside the scope of this article.

At the chair

  • Might the restoration need to come off later?
  • How far below the mucosa is the margin?
  • Where does the screw channel emerge; is an angled channel needed?
  • Have access for cleaning and probing and the emergence profile been assessed?
  • If cemented: is the soft tissue mature, and how will excess cement be limited?
  • For a single implant: were an antirotational connection and the manufacturer's torque checked?
  • How many times has the abutment been removed?
  • Has the first review been booked, and were a baseline radiograph and probing record taken?
  • Has a supportive maintenance programme been planned?

References

  1. Wittneben JG, Millen C, Brägger U. Clinical performance of screw- versus cement-retained fixed implant-supported reconstructions--a systematic review. Int J Oral Maxillofac Implants. 2014;29 Suppl:84-98. PMID: 24660192 · DOI: 10.11607/jomi.2014suppl.g2.1
  2. Sailer I, Mühlemann S, Zwahlen M, Hämmerle CH, Schneider D. Cemented and screw-retained implant reconstructions: a systematic review of the survival and complication rates. Clin Oral Implants Res. 2012;23 Suppl 6:163-201. PMID: 23062142 · DOI: 10.1111/j.1600-0501.2012.02538.x
  3. Staubli N, Walter C, Schmidt JC, Weiger R, Zitzmann NU. Excess cement and the risk of peri-implant disease - a systematic review. Clin Oral Implants Res. 2017;28(10):1278-1290. PMID: 27647536 · DOI: 10.1111/clr.12954
  4. Linkevicius T, Vindasiute E, Puisys A, Linkeviciene L, Maslova N, Puriene A. The influence of the cementation margin position on the amount of undetected cement. A prospective clinical study. Clin Oral Implants Res. 2013;24(1):71-6. PMID: 22487018 · DOI: 10.1111/j.1600-0501.2012.02453.x
  5. Lemos CA, de Souza Batista VE, Almeida DA, Santiago Júnior JF, Verri FR, Pellizzer EP. Evaluation of cement-retained versus screw-retained implant-supported restorations for marginal bone loss: A systematic review and meta-analysis. J Prosthet Dent. 2016;115(4):419-27. PMID: 26589441 · DOI: 10.1016/j.prosdent.2015.08.026
  6. Tabrizi R, Biabanaki E, Seyedan K, Davarpanah M, Nematollahi Z, Khanzadeh H. Marginal Bone Loss around Cement-Retained versus Screw‑Retained Single Implant-Supported Crowns: A Systematic Review and Meta‑Analysis of Randomized Clinical Trials. Int J Oral Maxillofac Implants. 2026. Epub ahead of print. PMID: 42837477 · DOI: 10.11607/jomi.11918
  7. Lin GH, Lee E, Barootchi S, Rosen PS, Curtis D, Kan J, et al. The influence of prosthetic designs on peri-implant bone loss: An AO/AAP systematic review and meta-analysis. J Periodontol. 2025;96(6):634-651. PMID: 40489290 · DOI: 10.1002/JPER.24-0144
  8. Reis INRD, Fukuoka GL, Nagay BE, Pannuti CM, Spin-Neto R, da Silva EVF. Incidence of peri-implant disease associated with cement- and screw-retained implant-supported prostheses: A systematic review and meta-analysis. J Prosthet Dent. 2025;134(1):100-108. PMID: 37793953 · DOI: 10.1016/j.prosdent.2023.08.030
  9. Dini C, Borges GA, Costa RC, Magno MB, Maia LC, Barão VAR. Peri-implant and esthetic outcomes of cemented and screw-retained crowns using zirconia abutments in single implant-supported restorations-A systematic review and meta-analysis. Clin Oral Implants Res. 2021;32(10):1143-1158. PMID: 34352144 · DOI: 10.1111/clr.13824
  10. Gaddale R, Mishra SK, Chowdhary R. Complications of screw- and cement-retained implant-supported full-arch restorations: a systematic review and meta-analysis. Int J Oral Implantol (Berl). 2020;13(1):11-40. PMID: 32186285 · DOI: not listed in PubMed
  11. De Angelis P, Rella E, Liguori MG, Piccirillo D, Palmieri A, D'addona A, et al. Angulated titanium bases screw channel abutments for single implant restorations: A systematic review and meta-analysis. J Prosthodont. 2025;34(3):240-251. PMID: 39871463 · DOI: 10.1111/jopr.14032
  12. Atieh MA, Shah M, Hakam A, Albalushi A, Abdulmunim A, AlAli F, et al. Angled Screw Channel-Retained vs. Cement-Retained Implant Crowns in Nonmolar Sites: A Systematic Review and Meta-Analysis. J Esthet Restor Dent. 2025;37(7):1706-1720. PMID: 40108886 · DOI: 10.1111/jerd.13463
  13. Sarafidou K, Vasileiadi G, Louvrou MK, Moldovani E, Koidis P, Kokoti M, et al. Screwmentable implant-supported prostheses: A systematic review. J Prosthet Dent. 2023;130(1):35-47. PMID: 34740460 · DOI: 10.1016/j.prosdent.2021.08.027
  14. Theoharidou A, Petridis HP, Tzannas K, Garefis P. Abutment screw loosening in single-implant restorations: a systematic review. Int J Oral Maxillofac Implants. 2008;23(4):681-90. PMID: 18807565 · DOI: not listed in PubMed
  15. Jung RE, Zembic A, Pjetursson BE, Zwahlen M, Thoma DS. Systematic review of the survival rate and the incidence of biological, technical, and aesthetic complications of single crowns on implants reported in longitudinal studies with a mean follow-up of 5 years. Clin Oral Implants Res. 2012;23 Suppl 6:2-21. PMID: 23062124 · DOI: 10.1111/j.1600-0501.2012.02547.x
  16. Andrijauskas P, Zukauskas S, Alkimavicius J, Peciuliene V, Linkevicius T. Comparing effectiveness of rubber dam and gingival displacement cord with copy abutment in reducing residual cement in cement-retained implant crowns: A crossover RCT. Clin Oral Implants Res. 2021;32(5):549-558. PMID: 33595848 · DOI: 10.1111/clr.13724
  17. Wilson TG Jr. The positive relationship between excess cement and peri-implant disease: a prospective clinical endoscopic study. J Periodontol. 2009;80(9):1388-92. PMID: 19722787 · DOI: 10.1902/jop.2009.090115
  18. Berglundh T, Armitage G, Araujo MG, Avila-Ortiz G, Blanco J, Camargo PM, et al. Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Clin Periodontol. 2018;45 Suppl 20:S286-S291. PMID: 29926491 · DOI: 10.1111/jcpe.12957
  19. Herrera D, Berglundh T, Schwarz F, Chapple I, Jepsen S, Sculean A, et al. Prevention and treatment of peri-implant diseases-The EFP S3 level clinical practice guideline. J Clin Periodontol. 2023;50 Suppl 26:4-76. PMID: 37271498 · DOI: 10.1111/jcpe.13823
  20. Mayta-Tovalino F, Espinoza-Carhuancho F, Alvitez-Temoche D, Calderon-Cortez I, Cabanillas-Lazo M, Barboza JJ, et al. Clinical Efficacy of Cemented Versus Screw-Retained Zirconia Single Crowns: A Systematic Review and Meta-Analysis. Int J Dent. 2026;2026:5497447. PMID: 42293808 · DOI: 10.1155/ijod/5497447
  21. Doolgindachbaporn G, Ongthiemsak C, Ruengrungsom C. Marginal bone changes in cement-retained implant-supported crowns: A systematic review and meta-analysis. J Prosthet Dent. 2026;135(3):506-517. PMID: 40393900 · DOI: 10.1016/j.prosdent.2025.04.032
  22. Moradianlotfi S, Abbasanfar Z, Mortazavizadeh E, Moradipour Z, Djalalinia S, Kasaeian A, et al. Effect of luting materials on residual cement around cement-retained implant-supported dental restorations: A systematic review. Int J Oral Implantol (Berl). 2026;19(3):257-264. PMID: 42746821 · DOI: not listed in PubMed

Methods note

Sources were searched in PubMed (NCBI E-utilities) on 5 November 2026. The search covered survival, complications and bone loss of screw- and cement-retained implant restorations, residual cement, margin position, techniques to limit excess cement, angled screw channels, screwmentable restorations and screw loosening. Systematic reviews, meta-analyses and randomised trials were given priority; for residual cement, two primary clinical studies and one randomised trial were added. After an external review (5 November 2026), five further sources were added on baseline records, maintenance, bone loss and cement type; from the guideline and the consensus report, only recommendations stated in the abstracts are reported. After a second external review (5 November 2026), one meta-analysis on angled screw channels was added. Author, title, journal, year and DOI of every source were checked against its PubMed record; findings were taken from abstracts only, and full texts were not read. No product or brand names are given. This is not a systematic review; it was prepared from one database by one reader.

Author: Dr. Ferit Çiftçi · Dentist · Author page · Last updated: 5 November 2026

This text is not patient information. Treatment decisions are made after an examination and for each person individually.

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