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Treatment Algorithm · Module
Screw or cement: how to retain it
Selecting implant-crown retention from restorative space, screw-access angulation, and retrievability needs. The modern default favors screw retention where access allows — it avoids subgingival cement, a known driver of peri-implantitis.
Use: Restorative design decision
Default: Screw if access permits
Watch: Residual cement
01 — Trade-offs
What each option buys you
Neither is universally superior; the choice is case-specific. Retrievability and the absence of cement favor screw retention; esthetics in steep angulations and minimal-space cases can favor cement.
Screw-retained
- Retrievable — unscrew & re-seat
- No subgingival cement risk
- Needs less vertical space
- Requires favorable screw-access position
- Preferred for splinted / full-arch
Cement-retained
- Better esthetics in steep angulations
- Passive fit, no occlusal access hole
- Needs ≥ 4 mm abutment height for retention
- Total restorative space ≈ 5.5–7 mm
- Risk: residual cement → peri-implantitis
02 — Decision Pathway
Interactive retention selector
Run the case through restorative space, then screw-access angulation. Modern angulated screw channels (ASC, up to ~25°) rescue many cases that previously defaulted to cement.
Tap the scenario matching your restorative assessment.
Step 1 — Restorative space & screw-access position
FAVORABLE ACCESS
Screw exits cingulum / occlusal table
Any restorative space; access non-esthetic.
MODERATE ANGLE
Access toward facial but ≤ ~25°
Correctable with angulated screw channel.
STEEP / LIMITED
Access through facial/incisal & ≥ 4 mm height
Angle uncorrectable; adequate space for cement.
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03 — Quick Reference
Factor-by-factor
| Factor | Favors | Why |
|---|
| Restorative space < 5.5 mm | Screw | Cement needs ≥ 4 mm abutment for retention |
| Screw exits facial/incisal | Cement / ASC | Access hole would wreck esthetics |
| Splinted / multi-unit / full-arch | Screw | Retrievability for maintenance |
| Single anterior, steep angle | Cement / ASC | Esthetic emergence |
| Deep subgingival margin | Screw | Cement removal unreliable; peri-implantitis risk |
| History of peri-implant disease | Screw | Eliminates cement as a factor |
Reference
Sources & clinical disclaimer
For licensed clinicians — educational use only. This algorithm summarizes published consensus and is not a substitute for individual clinical judgment, examination, or the standard of care in your jurisdiction. If cement retention is chosen, keep margins as supragingival as possible and verify complete cement removal radiographically.
- Wittneben JG, Millen C, Brägger U. Clinical performance of screw- versus cement-retained fixed implant-supported reconstructions — systematic review. Int J Oral Maxillofac Implants. 2014;29(Suppl):84–98.
- Wilson TG. The positive relationship between excess cement and peri-implant disease. J Periodontol. 2009;80(9):1388–1392.
- Sailer I, et al. Cemented and screw-retained implant reconstructions — systematic review of survival and complications. Clin Oral Implants Res. 2012.
Last reviewed: June 2026 · Next review due: June 2027 · Version 1.0