Libyan International Medical University

Faculty of Dentistry
Department of Oral and Maxillofacial Surgery
Implantology Course

Screw Retained vs Cement Retained

Implant-Supported FDP, closed-tray vs
open-tray dental implant impression.

Name: Mazen T. Shembesh

Roll no: 1419
Introduction
Implant-supported fixed dental prostheses (FDP) represent a well-established
treatment option that has evolved to become a standard of care in dental medicine
over the past four decades.

An important clinical decision remains the choice of the connection type – cement
or screw retained. This connection can have an impact on the prognosis of the
overall reconstruction. Which retention system is appropriate for the individual
patient depends on diverse factors, including the indication, advantages and
disadvantages, retention provided, retrievability, esthetics and the clinical
performance.

Screw retained vs cement retained implant‐supported fixed dental prosthesis

Both retention types have been applied for single, multiple and cross-arch fixed
dental prostheses.
 Indications of screw retained implant‐supported fixed dental prosthesis:
- In the presence of minimal inter-arch space.
- FDPs with a cantilever design.
- long-span FDPs.
- In the esthetic zone, for provisionalization of implants to enable soft tissue
conditioning and finalization of the emergence and mucosal profile.
- When retrievability is desired.

 Indications of cement retained implant‐supported fixed dental prosthesis:

- Short-span prostheses with margins at or above the mucosa level.

- Cases where an easier control of occlusion without an access hole is desired
- for example, with narrow-diameter crowns.
- To compensate for improperly inclined implants.

Cement retained implant FDPs are the most often used restorations in implant
dentistry. The advantage of cement retention lies in the compensation of
improperly inclined implants, easier achievement of passive fit due to the cement
layer between the implant abutment and reconstruction, lack of a screw access
hole, and thus the presence of an intact occlusal table and easier control of
occlusion, for example in posterior sites with narrow-diameter crowns. (1)

A major disadvantage of cement retention lies in the difficulty of removing excess

cement, which has been associated with the development of peri-implant diseases
such as peri-implant mucositis and peri-implantitis. Consequently, this adds an
additional risk factor to the overall treatment. (1)

Cementation can be achieved with provisional or definitive cement. Provisional

cementation allows retrievability to a certain extent, while the risk for leakage and
loss of retention may be higher compared with definitive cementation. So,
cementation procedure should be carried out with great caution, with the FDP
margins placed at or above the tissue level. (1)

In order to maintain retention during function, basic mechanical parameters are

crucial: these factors include height, diameter, conicity, indexing, surface
roughness of the abutments, number of abutments related to number of teeth to be
replaced, alignment of abutments in the dental arch, straight or angled
configuration and the presence of extensions. (1)

Screw retained FDPs have the advantage of more predictable retrievability. They
require a minimal amount of interocclusal space (min. 4 mm) and are easier to
remove when hygiene maintenance, repairs or surgical interventions are required.
(1)

Disadvantages are the limited indication, the increased fabrication time and costs
for bridge-designed prostheses, and the access hole present in the occlusal table,
which might interfere with occlusion in posterior sites. In the anterior zone, access
to the screw plays no active role in occlusion, and therefore should be no reason to
avoid a screw access. (1)

Closed tray vs Open tray implant impressions

Two different impression techniques are traditionally used for transferring the
impression copings from the implant to the impression: direct (open tray)
technique and indirect (closed tray) technique. (2)

Open‐tray technique uses square copings with long retaining screws and custom
open trays with holes, which lines up with the transfers when the impression is
taken. Next, the copings are unscrewed by removing the retaining screws from the
implants, allowing the copings to be removed along with the impression. After
removing the impression tray, the implant replicas were connected to the copings
and sent to the laboratory. (2)

Open‐tray technique removes the concern for replacing the coping back into its
respective space in the impression. Disadvantages of this technique are some
movements of the impression coping when securing the implant analog. On the
other

hand, blind attachment of the implant analog to the impression coping may result
in a misfit of components. (2)

Impression using closed tray technique typically uses tapered copings and closed
trays that match the height of the transfer. Subsequently, heavy body impression
material is injected around the impression coping and into the tray, performing an
impression that is then separated from the mouth, leaving the copings intraorally.
The copings are then removed from the implants, connected to implant replicas,
and positioned in its corresponding place in the impres- sion. Finally, the
assembled set is sent to the laboratory. (2)

Closed tray technique is used when it is too difficult to access in the posterior
region of the mouth, or when the patient has limited interarch space or tendency to
gag. Advantages of this technique are time saving, easier for the operator, and
more comfortable for the patient compared to the direct technique. The worst
disadvantage of the indirect technique is discrepancy in returning the coping to the
original position. (2)

In general, for single-unit partially edentulous patients, closed tray and open tray
impression copings can be used interchangeably. However, if you have multiple
implants that will be splinted in either partially or fully edentulous patients, open
tray impression copings will be more accurate. (2)

Both techniques may be uncomfortable for the patient and the clinician while the
impression copings are being screwed and unscrewed intraorally. Slight movement
of the copings may result in deformation of the impression material while
unscrewing the guide pins from the impression copings during tray removal or
replacing the coping‐analog assemblies in the impression tray. (2)

The International Team for Implantology (ITI) dental implant system has
introduced the snap‐on (press fit) impression technique. This technique combines
the advantages of both open‐tray and closed tray impression techniques. Although
it is similar to open‐tray technique, there is no need for large tray holes and long
guide screws that are difficult to use in mouths with opening restrictions or in
posterior areas. (2)
References

1. Wittneben J, Joda T, Weber H, Brägger U. Screw retained vs. cement retained

implant-supported fixed dental prosthesis. Periodontology 2000.
2016;73(1):141-151.
2. Moreira A, Rodrigues N, Pinho A, Fonseca J, Vilaça J. Accuracy Comparison
of Implant Impression Techniques: A Systematic Review. Clinical Implant
Dentistry and Related Research. 2015;17:e751-e764.