Screw-Retained vs Cement-Retained Implant Crowns: The 2026 Decision
Last updated: May 2026 · Authored by Dr. Kellen McWhorter, Prosthodontist · Peak Dental Studio, an independent U.S. dental laboratory based in Pleasant Grove, Utah serving practices nationwide.
The screw-retained-versus-cement-retained question has shifted decisively in the past decade. Cement-retained implant crowns dominated the early 2000s; screw-retained restorations now dominate modern prosthodontic literature, primarily because of peri-implantitis risk associated with residual subgingival cement. From the lab’s side, both options are routine. The choice is clinical and should be driven by access angle, esthetics, retrievability requirements, and the practice’s tolerance for cement-related complications.
This is a practical decision framework for restorative dentists making the call — case by case, not by blanket policy.
Quick Decision Table
| Factor | Favors Screw-Retained | Favors Cement-Retained |
|---|---|---|
| Screw access angle | Through cingulum or occlusal table | Access exits facial or incisal edge |
| Single vs multi-unit | Multi-unit splinted cases (retrievability) | Single units in some esthetic-zone scenarios |
| Esthetic priority | Posterior cases, screw access hideable | Anterior cases where screw access compromises esthetics |
| Retrievability priority | Always favored | Lower priority cases |
| Soft tissue health concern | Strongly favored (no cement excess risk) | Avoid in subgingival margin scenarios |
| Implant angulation | Within 15° of restorable axis | Angled implants >15° off axis where screw access cannot be redirected |
Why Screw-Retained Is the Modern Default
Three factors have moved restorative consensus toward screw-retained implant crowns:
1. Peri-Implantitis Risk from Residual Cement
Multiple published case series have linked sub-gingival cement excess to peri-implant mucositis and peri-implantitis. The mechanism: cement extruded below the gingival margin during seating is not visible to the clinician, doesn’t get cleaned out, and supports a biofilm directly adjacent to the implant. Even careful protocols (try-in, retraction cord during cementation, radiographs post-seating) cannot fully eliminate this risk. Screw-retained restorations have no cement to leave behind.
2. Retrievability
Implant restorations require periodic maintenance: screw retightening, abutment exchange, prosthesis modification, repair of porcelain fractures. Screw-retained restorations can be unscrewed and re-seated; cement-retained restorations typically require destruction of the crown to remove for service. Retrievability is especially valuable on multi-unit splinted cases and full-arch prostheses.
3. Improved Esthetic Solutions for Screw Access
Tooth-colored screw access channels with composite restoration are now esthetically reliable in most clinical scenarios. The “visible screw hole” problem that drove anterior cases to cement-retention historically is largely solved with current materials.
When Cement-Retained Still Makes Sense
The legitimate indications for cement-retained implant crowns in 2026:
Screw Access Exits an Esthetically Critical Surface
If the implant angulation routes the screw access through the facial of an anterior tooth, or through the incisal edge where occlusion would expose the composite repair, cement-retained may be the only acceptable solution. Note that this scenario is largely avoidable with surgical guides during implant placement — the better surgical planning becomes, the rarer this scenario gets.
Single Posterior Crown With Limited Inter-Occlusal Space
A screw-retained single-unit crown requires sufficient vertical space for the screw access channel and the threaded screw beneath it. In limited inter-occlusal scenarios, cement-retained may be the only viable solution.
Custom Abutment + Crown Separation Required
Some clinical scenarios require fabricating a custom abutment and a separate cement-retained crown as two distinct components — for example, where the abutment is delivered first, the tissue is allowed to mature around the abutment, and the crown is fabricated and cemented at a later appointment.
Cement Selection (When Cement Is Used)
If cement-retention is the chosen path, cement selection matters as much as cementation technique.
- Resin-modified glass ionomer (RMGI) — current preference for many clinicians. Reasonable retention with minimal compressive strength, which allows future retrieval.
- Resin cements — provide maximum retention but make future retrieval difficult or impossible.
- Zinc oxide-eugenol provisional cements — appropriate for short-term retention only.
- Acrylic urethane “implant cements” — designed for implant restorations specifically, formulated for cleanup and retrievability.
Whichever cement is used, careful cement application protocols matter: minimum effective volume, retraction cord during seating to prevent subgingival extrusion, immediate cleanup of excess, post-seating radiographs to verify no residual cement.
Lab-Side Differences Between the Two Workflows
Screw-Retained Fabrication
The lab fabricates a single-piece restoration (the screw-retained “monoblock”) or a Ti-base hybrid where a zirconia crown is bonded to a titanium base that interfaces with the implant. The screw access channel is integrated into the design, with a vented channel for the screw and a sealed access port for clinician access. Lab fee ranges from $215–$385 for the single-piece screw-retained crown.
Cement-Retained Fabrication
The lab fabricates two separate components: a custom abutment that screws into the implant and a separate crown that cements onto the abutment. The combined lab fee is typically $250–$450 depending on materials. The crown can be made in any standard crown material (zirconia, lithium disilicate, layered porcelain over zirconia).
Screw-Retained vs Cement-Retained FAQ
What’s the main difference between screw-retained and cement-retained implant crowns?
Screw-retained crowns are mechanically held to the implant by a screw that passes through an access channel in the crown itself, allowing the crown to be unscrewed and removed for service. Cement-retained crowns are cemented to a custom abutment using dental cement; removal requires destruction of the crown.
Why are screw-retained implant crowns preferred in modern dentistry?
Two main reasons: (1) the elimination of residual subgingival cement reduces peri-implantitis risk, and (2) retrievability allows future maintenance, repair, or modification without crown destruction. Improved esthetic solutions for screw access have also reduced the historical anterior-zone disadvantage.
When should I use a cement-retained implant crown instead of screw-retained?
Use cement-retained when the implant angulation routes the screw access through an esthetically critical surface (facial of anterior tooth, incisal edge), when limited inter-occlusal space precludes a screw-retained workflow, or when clinical sequence requires the abutment and crown to be delivered separately.
What is the risk of residual cement around dental implants?
Residual subgingival cement supports biofilm formation directly adjacent to the implant surface, which can cause peri-implant mucositis (reversible inflammation) or peri-implantitis (bone loss around the implant). Multiple case series have linked cement-retained implant crowns to peri-implantitis when cement excess is not fully removed.
Does the screw access hole show on a screw-retained crown?
The screw access channel is sealed with a composite restoration that matches the crown material color. With current materials and technique, the access is rarely visible in normal clinical use. The composite can be removed and re-placed when the crown needs to be unscrewed for service.
Is one type more expensive than the other at the lab level?
Screw-retained single-piece crowns typically run $215–$385 at the lab. Cement-retained workflows (custom abutment + crown) total $250–$450. Pricing overlap is substantial. Long-term cost favors screw-retained because retrievability reduces lifetime maintenance cost.
Can a cement-retained crown be converted to screw-retained later?
Not directly. Converting workflows requires fabricating a new crown specifically designed for screw-retention. If the original case is failing, the abutment is generally retained and only the crown is replaced — not converted between workflows.
What about angled implants — can they be screw-retained?
Yes, in many cases. Angled screw channel (ASC) technology and angulated custom abutment design can redirect the screw access channel up to 25° off the implant axis, allowing screw-retention on implants placed at angles that historically would have forced cement-retention. For implants placed more than 25° off-axis, cement-retention may remain the only solution.
The Lab Perspective: What We Recommend
Peak’s default recommendation on every implant crown case is screw-retained unless a specific clinical reason indicates cement-retention. The reason is straightforward: the long-term cost of peri-implantitis from residual cement is dramatically higher than any short-term esthetic or fabrication advantage of cement-retention. Modern composite materials make the screw access invisible in most cases. Modern surgical guides put implants in restorable positions where screw access is achievable.
For complex cases — anterior single units, full-arch prostheses, cases with angled implants — we recommend a case-planning consultation at the impression appointment to confirm the right retention choice. For straightforward posterior implant crowns, default to screw-retained.
For full implant crown cost ranges and how to charge patients, see our dental implant crown cost guide. For abutment-specific cost and options, see the custom abutment cost guide.
About the author: Dr. Kellen McWhorter is a board-trained prosthodontist and the chief clinician at Peak Dental Studio in Pleasant Grove, Utah. Peak is an independent U.S. dental laboratory serving implant, full-arch, and cosmetic dentists nationwide. No subscription, no minimums, prosthodontist-led clinical oversight.
