Screw-Retained vs. Cement-Retained Implant Crowns: How to Choose

Every implant crown is held on by one of two things: a screw through the crown, or cement on an abutment. Both survive about equally well. The difference shows up later: whether a loose screw or a chipped cusp is a quick chairside fix, and whether cement is hiding below the mucosa, where it is hard to see and harder still to spot on a radiograph.

Here is what the reviews, trials and ITI consensus show, turned into a decision guide and an Rx checklist.

Quick Answer

Choose screw retention whenever a straight or angled screw channel can exit through the occlusal surface or the cingulum: it is retrievable, keeps cement away from the peri-implant tissue, and several reviews prefer it. Choose cement retention when the access hole would exit facially beyond what an angled channel corrects, when an intact occlusal surface matters, or for short spans with margins at or above the mucosa. Survival is similar; complications differ.

What Is the Difference Between Screw-Retained and Cement-Retained Crowns?

A screw-retained crown is fastened to the implant, or a multi-unit abutment, by a screw through an access hole that is then sealed. A cement-retained crown is cemented onto an abutment that is screwed into the implant, so the crown has no access hole. A screwmentable (hybrid) crown is cemented to a titanium base (Ti-base) outside the mouth, and the one-piece unit is screwed in.

Which One Lasts Longer?

Neither. A review of 73 studies prepared for the 2013 consensus conference of the International Team for Implantology (ITI) found five-year survival of 96.03% for cemented and 95.55% for screw-retained reconstructions (P = .69), with no difference when single crowns or fixed partial dentures were analyzed separately. An earlier review reported 96.5% for cemented and 89.3% for screw-retained single crowns, but the screw-retained estimate was imprecise (95% CI 64.9% to 97.1%) and the difference was not significant.

Where Do the Complications Differ?

Biological: the excess cement problem

In Wilson's endoscopic study, excess cement was found at 34 of 42 implants with peri-implant disease and at none of 20 healthy controls. In a clinical study of 53 cemented crowns, undetected cement increased the deeper the margin sat. A 2017 systematic review called excess cement a possible risk indicator and recommended margins at the level of the mucosa, with early follow-up.

Not every study finds a difference: a meta-analysis of six randomized trials found similar rates of mucositis and peri-implantitis, and a 2025 AO/AAP review found no significant difference in bone loss. But in a 7.5-year randomized trial of zirconia-based crowns in the esthetic zone, cemented crowns had twice the bleeding on probing (40% vs. 20%) and more total complications (84.2% vs. 38.1%). Cement causes trouble when left behind, and full removal below the mucosa is hard to guarantee.

Technical: screws loosen, cement lets go

Screw loosening is the most frequent technical problem with implant single crowns, at 8.8% over five years, although newer screw designs have cut it by almost half. Loss of retention comes second, in 4.1% of cemented crowns. For single crowns, Sailer et al. estimated five-year technical complications of 24.4% with screw retention and 11.9% with cement; pooled across all reconstruction types, the ITI review found more with cement.

What tips most reviewers is retrieval: problems with a screw-retained crown are easier to treat because it comes off easily, and Sailer et al. judged screw retention preferable for that reason.

What About Esthetics and Screw Access?

A straight screw channel exits wherever the implant points. In the anterior maxilla, where buccal bone is often thin or missing, that can mean a labial access hole: the classic reason to cement.

A 2025 meta-analysis of 167 nonmolar single crowns found angled-channel crowns matched cemented ones for bone levels and pink esthetic scores, with less bleeding on probing; screw loosening and porcelain fracture were slightly, not significantly, more frequent.

What Is a Screwmentable Crown, and When Does It Make Sense?

A systematic review concluded that screwmentable prostheses combine passive fit, retrievability and control of excess cement, but of its 24 studies only one was a randomized trial and 14 were in vitro. For Ti-base hybrid single crowns, a meta-analysis found 100% one-year survival and under 1% complications, and called for five-year trials. It suits screw-retained zirconia or lithium disilicate crowns, especially with deep margins.

Which One Should I Choose? A Decision Guide

The 2013 ITI consensus states that "a universal recommendation cannot be made for either cementation or screw retention." It lists cement as an option for short spans with margins at or above tissue level, for esthetics when the screw access is transocclusal or the implant malpositioned, for an intact occlusal surface and for lower initial cost, and warns that cementation needs great caution. A 2022 review recommends screw retention to limit excess cement.

What Does the Lab Need on the Rx?

If any of these are missing, we have to call before design can start:

• Implant system: manufacturer and line, per site.
• Platform and diameter: per tooth.
• Scan body: brand and type, to match the correct library file; for analog cases, the impression coping.
• Abutment: Ti-base, custom titanium or zirconia, stock, or multi-unit. If you supply the Ti-base, its brand and height.
• Retention: screw-retained, screwmentable or cemented; for cemented crowns, where you want the margin.
• Screw channel: straight only, or angled allowed, with the maximum angle you accept.
• Material and shade: see our zirconia vs. e.max comparison.
• Soft tissue: if a provisional shaped the emergence profile, scan it.

Implant Restorations at Elegant Dental Laboratory

• Implant restorations: see our implant options.
• Warranty: up to 20 years on screw-retained implant abutments and up to 7 years on final restorations. Policies and warranties.
• Made in house: every case, with no outsourcing, in our 7,000 sq. ft. facility at 2308 McDonald Ave, Brooklyn, NY, by more than 35 technicians. Founded in 2007 by Gary Fingerman.
• Scan review: digital scans are reviewed before production. Submit a digital case.
• Turnaround: 5 business days standard on most restorative cases, with rush options available. Send a case or call 877-335-5221.

Related Guides

• Why Implant Screws Loosen, and How to Prevent It
• Implant Abutments Explained: Stock vs. Custom vs. Ti-Base vs. Multi-Unit
• How to Scan Implants: Scan Bodies, Common Mistakes and What to Send the Lab

FAQ

Are screw-retained implant crowns better than cemented ones?

Not for survival: about 96% at five years for both. Screw retention wins on retrievability and cement control; cement wins when the access hole would compromise esthetics or occlusion.

Do screw-retained crowns loosen more often?

For single crowns, some reviews report more technical events with screw retention (24.4% vs. 11.9% over five years), but a loose screw is easy to reach and retighten.

What is a screwmentable crown?

A crown cemented to a titanium base outside the mouth, then screwed in as one unit. Long-term trials are still limited.

Can I screw-retain an anterior crown if the access comes out facially?

Often, with an angled screw channel; one common system corrects up to 25°. Beyond that, cement onto a custom abutment with the margin at or above the mucosa where possible.

Does excess cement really cause peri-implantitis?

It is a risk indicator: in observational studies, 33% to 100% of peri-implant disease at cemented implants was associated with excess cement. Randomized trials found similar rates with both methods, so keep margins shallow and check early.

Reviewed by Gary Fingerman, founder and CEO of Elegant Dental Laboratory, Brooklyn, New York (founded 2007). Last reviewed: September 28, 2026.