What is the difference between screw-retained and cemented teeth on implants?
A crown or bridge can be joined to an implant in two ways. According to the patient information of Leeds Teaching Hospitals NHS Trust, fixed crowns and bridges are either screwed or cemented onto the implant; in both cases you cannot take the teeth out yourself for cleaning.
- Screw-retained: the crown is tightened onto the implant or its abutment with a screw that passes through the crown. The screw access hole lies on the chewing surface or the inner side of the tooth and is sealed with a tooth-coloured filling after tightening.
- Cemented: an abutment is first screwed onto the implant; the crown is then glued onto this abutment with cement, much like a crown on a natural tooth.
| Topic | Screw-retained | Cemented |
|---|---|---|
| Removal by a dentist | Possible by undoing the screw | Limited; the crown sometimes has to be cut off |
| Cement under the gum | None | Risk present |
| Opening on the chewing surface | Yes, sealed with a filling | No |
| Implant position | Must be precise so the hole emerges in a suitable place | Angle deviations can be corrected through the abutment |
| Common technical complication | Chipping of the ceramic | Crown coming loose, abutment loosening |
How do the two compare in studies?
The systematic review by Wittneben and colleagues (2014) for the 2013 ITI Consensus Conference analysed 73 studies with around 5,800 implant-supported restorations. After five years, 96.03 percent of cemented and 95.55 percent of screw-retained restorations were still in function; the difference was not significant.
The differences lie in the type of complication. The review calculated, among others, the following rates per 100 years of wear:
| Complication | Cemented | Screw-retained |
|---|---|---|
| Crown coming loose | 5.44 | 0.61 |
| Abutment loosening | 2.31 | 0.62 |
| Chipping of the ceramic | 1.02 | 3.56 |
| Fistula or pus | 1.65 | 0.22 |
Overall, cemented restorations had more technical and more biological events. The ITI consensus statement stresses at the same time that with both variants up to 10 percent technical and up to 7 percent biological complications can occur per year, and that problems cannot be avoided entirely through the choice of fixation.
Can excess cement cause inflammation around the implant?
Yes, it is possible; studies show the link, but the evidence is limited. The 2023 S3 guideline of the European Federation of Periodontology (EFP) speaks of limited evidence that cement remnants under the gum are associated with inflammation around the implant (peri-implantitis). Wittneben and colleagues name the difficulty of removing excess cement as the main problem of cemented fixation.
The deeper the crown margin lies below the gum, the greater the problem, because excess cement is easily missed there. In the study by Montevecchi and colleagues (2025), cement remnants were found under the gum in 37 of 46 patients with a cemented single crown and inflammation around the implant (80.4 percent), mainly on the tongue or palate side (59.5 percent) and on the cheek side. Because the study had no comparison group without inflammation, the proportion cannot be applied to all cemented crowns. The signs and treatment of peri-implantitis are described in our guide peri-implantitis.
Why does retrievability matter when you are treated abroad?
It is normal for teeth on implants to need maintenance over the years: a screw can loosen, ceramic can chip, or inflammation around the implant may need treating. According to Wittneben and colleagues, screw-retained restorations can be removed predictably, which makes cleaning, repair and surgical procedures easier. Because of the limited options for intervention after permanent cementation, the authors see an overall preference for screw retention. With bridges on several implants and fixed full-arch teeth this weighs even more heavily, because a problem at one implant may mean removing the whole restoration.
If you are treated in Türkiye and live abroad, a practical point is added: small maintenance jobs often arise years later, when a journey to retighten a screw would be out of proportion. The General Dental Council recommends telling your own dentist about your plans in case of later complications, and the NHS treatment abroad checklist advises being clear about how your aftercare will be coordinated. Screw-retained teeth can in principle be opened at another practice; the practice needs details of the implant system and matching instruments. So speak to your dentist at home before treatment, and take your implant card and written treatment plan, which name the make and model of your implants. What to do if teeth on implants feel loose is in our guide caring for teeth on implants.
Does the screw access hole spoil the appearance?
On back teeth the access hole lies on the chewing surface and is usually hardly noticeable once sealed with tooth-coloured material. On front teeth, where the hole emerges depends on the angle of the implant: on the inner side it is invisible, on the front surface it would show.
The ITI consensus statement notes that cemented fixation may be preferred when the hole would emerge on a visible surface or the implant is not ideally positioned. Wittneben and colleagues stress that screw retention requires precise positioning of the implant relative to the planned tooth; the rate of aesthetic complications in the review was similar for both variants. Careful planning of the implant position is therefore a prerequisite; how it is done with CBCT and a surgical guide is explained in our guide guided implant surgery.
When is which fixation chosen?
The ITI consensus statement says explicitly that neither variant can be recommended across the board. The criteria named in the sources can be summarised like this:
| Situation | Tendency | Reason |
|---|---|---|
| Crown margin deep below the gum | Screw-retained | Risk of cement remnants (Montevecchi and colleagues) |
| Short bridge or single crown, margin at or above gum level | Cemented possible | Simplifies fabrication (ITI) |
| Access hole would emerge on a visible surface | Cemented possible | Aesthetics (ITI) |
| Bridge on several implants or fixed full-arch teeth | Screw-retained | Retrievability for maintenance and repair (Wittneben and colleagues) |
| Hard-to-clean area or history of gum disease | Screw-retained | The EFP recommends choosing screw retention where possible |
| Limited mouth opening, last tooth in the row | Cemented may be easier | Screw retention needs room for instruments (Dental Update) |
The table shows general tendencies only; the decision is made at the examination. Our implant-supported dentures page gives an overview of the types of restoration.
What should you check with cemented teeth?
- Ask how deep the crown margin will lie below the gum; according to the ITI, cementing implant crowns is not a simple task and demands great care.
- Have it explained how excess cement is checked after fitting.
- If you notice bleeding, swelling, pus or a small blister on the gum (fistula), do not wait for your next check-up; at home, a dentist near you is the first port of call, and you can also send us photos on WhatsApp (see aftercare and follow-up).
- Keep your check-up appointments.
How do we decide between screw-retained and cemented at Rönesans?
At our clinic the implant position is planned with a cone-beam CT (CBCT) scan; whether the teeth are screw-retained or cemented follows from the position of the implant, the state of the gums and the type of restoration. Before treatment begins you receive a written treatment and cost plan that lists, for each tooth, the treatment, the materials and, for implants, the make and model.
When you leave, you receive copies of your treatment summary and X-rays and an implant card carrying the manufacturer’s official label for each implant. Our treatments carry a guarantee on set conditions for problems not caused by the patient; we explain the scope and exclusions at the examination. You can send questions about planning on WhatsApp to +90 532 363 49 54 or call +90 264 606 09 43.