Screw- Versus Cement-Retained Implant Prostheses:

A Systematic Review of Prosthodontic

Maintenance and Complications
Sunyoung Ma, BDS, DClinDenta/Aaron Fenton, DDS, MSb

Purpose: This systematic review aimed to identify different prosthodontic outcomes

between screw- and cement-retained implant prostheses. Materials and Methods:
The relevant articles were retrieved from the following electronic databases: MEDLINE,
EMBASE, PubMed (using medical subject headings), and the Cochrane Central
Register of Controlled Trials (CENTRAL). The search was performed up to December
31, 2013, and was restricted to studies on human subjects reported in English. A
further search was conducted through the reference lists of the articles found as well
as from early online articles. Reviewed studies were those on fixed implant prostheses
using different retention mechanisms such as screws or cement. Information on types
of screws and mechanisms of preloading, as well as different luting cements, was
collected in correlation with prosthodontic maintenance/complication issues seen in
the clinical studies. Results: Sixty-two papers met the review criteria. There were only
six randomized controlled trials and none of them included an equivalent number
of screw- and cement-retained single implant crowns for comparison. Studies used
different types of screws and only a few reported the preloading procedure for the
prosthetic screws. Other studies involving cement-retained implant prostheses used
a range of dental cements; however, some did not specify the type used. Studies
reported various prosthodontic maintenance/complication issues such as screw
loosening, porcelain fracture, loss of retention, and esthetic concerns. Five studies did
not report any prosthodontic maintenance issues during their observation periods.
More recent studies also did not report any incidence of screw loosening. Only two
studies stated the standardized criteria for reporting their prosthodontic maintenance/
complication issues. Conclusions: With inadequate information and various study
designs, it was difficult to compare the prosthodontic outcomes between screw-
and cement-retained fixed implant prostheses. Both retention mechanisms showed
prosthodontic maintenance/complication issues that must be considered and this
review showed that the introduction of newer implant components may assist in
minimizing these issues. It is also recommended that standardized criteria be used
when reporting prosthodontic maintenance/complication issues to allow better
comparison of data. Int J Prosthodont 2015;28:127–145. doi: 10.11607/ijp.3947

Implant prostheses are frequently used to rehabili-

tate partially and completely edentulous patients.
Published data endorse high and long-term suc-
cessful treatment outcomes and excellent patient ac-
ceptance.1–3 Although successful clinical outcomes
aSenior Lecturer in Prosthodontics, Sir John Walsh
Research Institute, Faculty of Dentistry, University of Otago,
Dunedin, New Zealand.
bEmeritus Professor of Prosthodontics, University of Toronto,
Toronto, Ontario, Canada.
Correspondence to: Dr Sunyoung Ma, Sir John Walsh
Research Institute, Faculty of Dentistry, University of Otago,
Dunedin, New Zealand. Fax: +64 3 479 5079.
Email: sunyoung.ma@otago.ac.nz
©2015 by Quintessence Publishing Co Inc.
depend on an optimal biologic response, the amount
of prosthodontic interventions to address mainte-
nance/complication requirements needs to be kept to
a minimum.3–5 Implant dentistry has experienced am-
ple development in producing more esthetically pleas-
ing and mechanically stronger materials. This ongoing
improvement of the manufacturing process and bet-
ter understanding of biologic outcomes will no doubt
contribute to even longer-term clinical outcomes.
Scrupulous treatment planning is crucial in implant
dentistry. Although different treatment methodologies
are employed to achieve presumed ideal patient out-
comes, specific concerns about esthetics, function,
and biologic and prosthodontic prognoses must be
addressed.6,7 Different types of retention mechanisms
also may influence these outcomes as the mechanical

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Screw- Versus Cement-Retained Implant Prostheses: Review of Maintenance and Complications
stability of prostheses relies on the engineering of
implant-abutment interfaces. Two main types of re-
tention mechanisms have been employed in securing
the prosthetic superstructure: screws and cement.
Although there are several reports on the mechani-
cal procedures involved in these two retention mecha-
nisms, there is a lack of evidence-based guidelines to
assist the dentist.8 It appears that the choice of reten-
tion in implant prostheses still mainly depends on the
individual’s preference and experience.9–11
Clinical criteria such as prosthesis retrievability and
maintenance, esthetics, occlusion, ease of fabrication,
and cost may influence the retention mechanism de-
cision of fixed implant prostheses. Implant positioning
also can influence the choice of retention mechanism
because non-ideal implant angulation may affect the
final esthetic result if the screw access opening is
visible. Retrievability is one of the major advantages
of screw-retained implant prostheses because it al-
lows for easy access to carry out prosthodontic main-
tenance issues such as tightening loose prosthetic
screws or repairing chipped porcelain.12 However,
there is anecdotal support for the notion that screw
retention may result in more of these types of mainte-
nance issues and that retrievability is not crucial when
using cement retention.
It is clear that there are insufficient guidelines
based on evidence-based clinical data to recommend
a certain type of retention mechanism when restoring
fixed implant prostheses.13 Therefore, this systematic
review assessed published clinical data on prosth-
odontic outcomes of screw- and cement-retained
fixed implant prostheses.
Materials and Methods
The systematic review was conducted using a popu-
lation, intervention, comparison, and outcome (PICO)
format14 to identify the objectives and the inclusion
criteria. The essential four elements were summarized
as below:
1. Population: patients that require fixed implant
prostheses
2. Intervention: screw-retained fixed implant
prostheses
3. Comparison: cement-retained fixed implant
prostheses
4. Outcome: prosthodontic outcomes
Inclusion Criteria
Inclusion criteria included
•• Human subjects
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•• Clinical studies on fixed implant prostheses
•• Randomized controlled trials, controlled trials,
prospective trials, and retrospective trials
•• Clinical studies reporting prosthodontic outcomes
involving definitive restorations
•• Observation period of at least 12 months
•• English language only
Exclusion Criteria
Exclusion criteria included
•• In vitro studies
•• Animal studies
•• Case series and case reports
•• Clinical trials that did not clearly define clinical
parameters to assess prosthodontic outcomes
and/or failed to report the type of implant
prostheses and retention mechanism
•• One-piece implants or mini-implants
Search Strategy
The relevant articles were retrieved from the fol-
lowing electronic databases: MEDLINE, EMBASE,
and The Cochrane Central Register of Controlled
Trials (CENTRAL). The search was performed up to
December 31, 2013. The search was restricted to
studies on human subjects reported in English. An
appropriate combination of the following medical
subject heading (MeSH) terms were used: “dental im-
plants,” “dental prosthesis, implant-supported,” “den-
tal implants, single-tooth,” “dental implant-abutment
design,” “prosthesis retention,” “dental prosthe-
sis retention,” and “dental prosthesis repair.” The
bibliographies of potentially selected papers were
scrutinized for additional material. A manual search
of the following journals’ most recent 10 years also
was conducted: Clinical Oral Implants Research,
Implant Dentistry, International Journal of Periodontics
& Restorative Dentistry, International Journal of
Prosthodontics, Journal of Oral Implantology, Journal
of Oral Rehabilitation, Journal of Prosthetic Dentistry,
and Journal of Prosthodontics. Two reviewers (SM and
AF) performed the search independently, in duplicate,
and any disagreement was solved by consensus.
Data Collection
The following information was retrieved from the
selected studies: (1) publication details, (2) type of
study, (3) participant details, (4) areas where the oral
implants were placed, (5) observation period, (5) oral
implant/prosthesis details, (6) retention mechanism,
and (7) prosthodontic outcomes.

Results
A total of 1,432 studies were identified from the data-
bases and, of these, 103 studies were eligible for full-
text evaluation. Of these, 49 papers were excluded
and 54 papers15–68 were included in the systematic
review. Manual searching provided 8 additional stud-
ies.69–76 The data were divided according to the type
of retention mechanisms. The characteristics of the
included studies are summarized in Tables 1 to 3.
There were six randomized controlled tri-
als,57,61–63,67,71 of which only two studies57,71 includ-
ed both screw- and cement-retained single implant
crowns. However, these studies did not have the
equivalent number of participants with each retention
mechanism to be able to compare the prosthodontic
outcomes between screw- and cement-retained sin-
gle implant crowns. The remaining studies were either
prospective,15,20–24,26,28,33,36,42–44,46,49,50,59,60,66,68,75,76
retrospective,16,25,30,32,34,55,58,69,72–74 or longitudinal.41,70
The majority of studies included only one retention
mechanism for the single implant crowns and empha-
sized implant survival and biologic outcomes. Only
one study32 used different types of screw retention
mechanism, including cross-pinning and traditional
vertical screws.
There were five studies involving both single im-
plant crowns and fixed partial prostheses.19,37,39,47,52
They were either retrospective or prospective stud-
ies. Four studies used a cement-retained mechanism
and only one study37 compared the different retention
mechanisms.
Eighteen studies analyzed the prosthodontic out-
comes of full-arch fixed implant prostheses and none
of them were randomized controlled trials. Most stud-
ies used only one type of retention mechanism except
one study,64 which investigated the outcomes of all-
ceramic crowns cemented onto a titanium framework
compared to screw-retained zirconia copings with
ceramic veneering.
The number of participants and implants varied
among the studies, ranging from 12 participants with
24 single implant crowns to 471 participants with 671
single implant crowns. The largest cohort was from
a retrospective, multicenter study.34 Some studies
focused on specific regions such as maxillary an-
terior sites20,61,63 or maxillary and mandibular molar
sites.16,34
Observation Period
The observation period of studies involving single im-
plant crowns ranged from 1 to 10 years. One study44
with the longest observation period included an im-
plant system that is no longer commercially available.
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Ma/Fenton
There were several studies that used Brånemark
implants with the external hex connection, many of
which were restored using CeraOne abutments and
cement-retained crowns. Studies involving single im-
plant crowns as well as fixed partial prostheses had
a shorter observation period of up to 8 years. On the
other hand, studies analyzing full-arch implant pros-
theses had the longest observation period of up to
23 years.38
Types of Prostheses
There was a mixture of different types of crowns such
as all-ceramic, all-metal, gold-acrylic, and porcelain-
fused-to-metal crowns. Only two older studies25,26
used gold-acrylic crowns as part of their rehabili-
tation method. Three studies16,34,41 did not specify
the type of crown used but did report on the type
of retention mechanisms. All fixed partial prostheses
were made of porcelain-fused-to-metal except one
study,52 which did not state the material. Studies in-
volving full-arch fixed implant prostheses included
various framework materials such as type III gold al-
loy, silver-palladium alloy, and titanium, which were
fabricated according to different methods. Veneering
materials included acrylic resin teeth and ceramic.
One study64 used zirconia copings with Nobel Rondo
zirconia ceramic and pink acrylic resin.
Retention Mechanism
Twenty-one studies used screw-retained sin-
gle implant crowns. Seven studies16,22,25,33,43,49,58
specified the type of screws used and seven stud-
ies22,41,43,49,57,68,71,73 subsequently identified the
mechanism of screw tightening. One study41 followed
a manual hand tightening procedure for securing the
prosthetic screws. However, the authors subsequent-
ly used a torque driver for any implant crowns that
suffered screw loosening. An earlier study16 report-
ed a high incidence of screw loosening over 2 years
(38% of implants) with screw-retained implant
crowns. Recent studies60,61,66 with shorter observa-
tion periods showed no incidence of screw loosen-
ing regardless of retention mechanism for the single
implant crowns.
Two studies37,39 involving both single implant
crowns and partial prostheses followed the screw-
retained method. None of the studies included the
information on the type of screws used. The majority
of studies (14 out of 16) investigating full-arch fixed
implant prostheses used the screw-retained mecha-
nism; however, only two studies17,53 specified the type
of screws used.
Volume 28, Number 2, 2015 129
Screw- Versus Cement-Retained Implant Prostheses: Review of Maintenance and Complications

Table 1   C
 linical Studies Reporting Prosthodontic Maintenance/Complication Issues Involving
Screw-Retained Prostheses
Original
number of
participants; Observation Type of implant
Study Type of study implants Region period and connection
Single implant crowns
Jemt et al15 (1991) Prospective 92; 107 Maxilla and mandible 1y Brånemark

Becker and Becker16 (1995) Retrospective 22; 24 Maxilla and mandible 2y NS (NobelPharma);
(molar sites only) (mean) external hex
Deporter et al22 (1998) Prospective 20; 20 Maxilla 1y Endopore (Innova)

Levine et al69 (1999)† Retrospective, 110; 157 Maxilla and mandible 40.1 mo ITI (Straumann)
multicenter (mean)
Scholander25 (1999)† Retrospective 135; 259 Maxilla and mandible 1–9 y Brånemark

Wannfors and Smedberg26 (1999)† Prospective 69; 80 Maxilla and mandible 3y Brånemark

Andersson et al28 (2001)* Prospective, 75; 89 Maxilla and mandible 1–3 y Brånemark
multicenter

Mericske-Stern et al70 (2001)* Longitudinal 72; 109 Maxilla and mandible 4.2 y ITI (Straumann)
(mean)

Gibbard and Zarb33 (2002)† Prospective 42; 49 Maxilla and mandible 5y Brånemark
Krennmair et al32 (2002)† Retrospective 112; 146 Maxilla and mandible 7y Frialit-2 (Friatec)

Levine et al34 (2002)† Retrospective, 471; 671 Maxilla and mandible 21.3 mo Solid-screw ITI,
multicenter (molar sites only) (mean) (Straumann);
internal connection
Cho et al41 (2004) Longitudinal NS; 39 Maxilla and mandible 3–7 y 3i, Implant Innovations

Vigolo et al43 (2004)† Prospective 12; 24 4y 3i, Implant Innovations

Brägger et al44 (2005)† Prospective 48; 69 NS 10 y ITI Bonefit

(ITI Straumann)
Schropp et al71 (2005)† RCT 43; 43 Maxilla and mandible 2y OsseoTite
(3i, Implant Innovations)
Kreissl et al49 (2007) Prospective NS; 46 NS 5y OsseoTite
(3i, Implant Innovations)

Jemt55 (2009)† Retrospective 35; 41 Maxilla 10 y Brånemark

Sailer et al57 (2009)† RCT 22; 40 Maxilla and mandible 1y Brånemark
(canine, premolar, and (Nobel Biocare);
molar sites only) external hex
Brown and Payne60 (2011) Prospective 25; 26 Maxilla 1y Co-Axis 12d
(anterior region only, (Southern Implants);
including second external hex
premolars)
RCT = randomized controlled trial; NS = not specified; AC = all ceramic; AM = all metal; PFM = porcelain fused to metal; Ti = titanium;
× = number of event(s); (pts) = number of patients affected by the maintenance issues; Au = gold; (C) = control group; (T) = test group;
comp resin = composite resin; CNC = computer numeric controlled.
*Data combined with other retention mechanism.
†Data separated from other retention mechanism.

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 Ma/Fenton

Retention mechanism
Type of crown (screw-retained) Prosthodontic outcomes

Veneering material: NS Abutment screw loosening: 29/106

Acrylic resin (35/106) Prosthetic screw loosening: 34×
Porcelain (61/106) Crown repair/remake: 6×
Comp resin (10/106)
NS Gold screws Screw loosening: 16× (38% of implants)

PFM Ti alloy, “maximum” None

tightening with a manual
wrench
NS NS (81) Abutment screw (Octa abutment) loosening: 1×
Prosthetic screw loosening: 18×
AC (175) Gold screw (2) None
PFM (79)
Gold-acrylic (4)
AC (9) NS (44) Abutment screw loosening: 13×
Gold-acrylic (36) New abutment screws: 2×
PFM (35) Esthetics: 12×
New crowns: 12×
Porcelain fracture: 1×
Loss of screw access material: 1×
AC (15) using NS (15) Abutment fracture during preparation/placement: 5×
CerAdapt abutment Abutment fracture (after loading): 2×
Porcelain fracture: 2×
PFM NS (102) Prosthetic screw loosening: 19×
Porcelain fracture: 1×
Abutment fracture: 3×(Octa abutment, now withdrawn from the market)
NS Gold screw (47) Screw loosening: 13%
AC (27) NS (22) Porcelain/crown fracture: 1×
PFM (119)
NS NS (71) Screw loosening: 16.9% (1× occasion)
Screw loosening: 1.4% (multiple occasions)
Abutment screw loosening: 1.4%
NS NS Screw loosening: 4×
Hand-tightened, torque
driver only in the case of
screw loosening
PFM GoldTite (3i, Implant None
Innovation) (12);
torque at 30 Ncm
PFM NS (2) None

PFM GoldTite screw (2); torque None

at 32 Ncm
PFM Gold-coated square head Screw loosening: 6(9)/36
screws; torque at 32 Ncm Screw fracture: 2/36
Porcelain fracture: 2/36
Event-free survival: 77.6%
PFM NS (18) Abutment screw loosening: 2/18
AC (19) NS (2); torque at 32 Ncm None
PFM (21)

AC NS Porcelain fracture: 2×
Abutment fracture: 2× (zirconia)
Esthetics: 10×
(Walton75 [1998])

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Screw- Versus Cement-Retained Implant Prostheses: Review of Maintenance and Complications

Table 1 (continued)  Clinical Studies Reporting Prosthodontic Maintenance/Complication Issues Involving

Screw-Retained Prostheses
Original
number of
participants; Observation Type of implant
Study Type of study implants Region period and connection
Gallucci et al61 (2011) RCT 20; 20 Maxilla 2y Standard Plus
(anterior region only) (Straumann)
Atieh et al68 (2013) Prospective 24; 24 Mandible 1y MAX (Southern Implants)
(molar region only)

Fixed dental prostheses (partial)

Wennerberg and Jemt73 (1999) Retrospective 133; 422 Maxilla 5y Brånemark

Duncan et al37 (2003)† Prospective 32; 83 NS 3y ITI (Straumann)

Jemt et al76 (2003) Prospective, 42; 170 Maxilla and mandible 5y Brånemark
multicenter

Astrand et al39 (2004) Prospective 28; 150 Maxilla 3y Brånemark or ITI

Fixed dental prostheses (complete)

Brånemark et al17 (1995) Retrospective 156; 579 Maxilla and mandible 10 y Brånemark

Lindquist et al18 (1996) Prospective Group 1 (G1): Mandible G1: 15 y Brånemark; external hex
26; 150

Group 2 (G2): G2: 12 y

21; 123

Friberg et al27 (2000) Retrospective 45 Mandible 8 y (mean) Brånemark

Zitzmann and Marinello74 (2000) Prospective 10; 84 Maxilla 39 mo Brånemark
(mean)

Hellem et al29 (2001) Prospective, 28; NS Mandible 5y ITI hollow-screw

longitudinal
Tinsley et al31 (2001) Prospective 21; 104 Mandible 4–6 y Calcitek Integral

Murphy et al35 (2002) Prospective 26; 131 Mandible 5y Astra Tech

Duncan et al37 (2003) Prospective 9; 103 Mandible 3y ITI (Straumann)

RCT = randomized controlled trial; NS = not specified; AC = all ceramic; AM = all metal; PFM = porcelain fused to metal; Ti = titanium;
× = number of event(s); (pts) = number of patients affected by the maintenance issues; Au = gold; (C) = control group; (T) = test group;
comp resin = composite resin; CNC = computer numeric controlled.
*Data combined with other retention mechanism.
†Data separated from other retention mechanism.

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Type of crown
AC (10)
PFM (10)
AC
Multiple:
Cast-gold alloy framework with
resin (74%) or PFM (23%)
Ti framework with resin
Single (22) or multiple (19):
Porcelain-fused to metal
Cast Au alloy framework with
porcelain or laser-welded Ti
framework with
low-fusing porcelain
Multiple: gold-ceramic
Gold with acrylic veneering
Type III gold alloy with
resin teeth and bilateral
posterior cantilever units
Fixed prostheses
Acrylic (5)/porcelain (5)
veneering
Gold-acrylic
Fixed prostheses
(a) Chicago IV gold alloy
superstructures and
acrylic resin teeth or
(b) Palliag M silver-palladium
alloy superstructures and
acrylic resin teeth
NS
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Ma/Fenton
Retention mechanism
(screw-retained) Prosthodontic outcomes
NS (20) Porcelain fracture: 2× (AC)
NS; Porcelain fracture: 6×
torque at 20 Ncm Screw loosening: 1×
(Walton75 [1998]); Payne et al76 [2001])
Gold screws Veneering fracture: 55×
Abutment screw fracture: 16×
Abutment/prosthetic screw loosening: 22×
Framework fracture: 1×
Prosthetic screw fracture: 1×
Peri-implant mucosal complications: 17×
Esthetics: 12×
Phonetics: 3×
Stomatognathic: 5×
NS (14) Screw loosening and loss of screw access plug
(comp resin): 5/14 (pts)
NS Abutment screw fracture: 2× (Ti)
Framework fracture: 1× (Ti)
Porcelain fracture: 3× (Au); 15× (Ti)
Abutment screw loosening: 1× (Au); 2× (Ti)
Prosthetic screw loosening: 2× (Au); 4× (Ti)
Soft tissue complication: 1× (Au); 3× (Ti)
NS Screw loosening
Porcelain fracture
Gold screws Acrylic resin veneering fracture
Screw loosening/fracture
NS G1 15/26; G2 8/21: screw loosening
G1 3/26: screw fracture
G1 2/26: remake
G1 1/26; G2 2/21: replacement of acrylic teeth
G1 2/26; G2 3/21: fracture of acrylic tooth
G1 14/26; G2 18/21: loss of acrylic in screw access
NS Screw fracture: 2×
NS Abutment screw loosening: 1×
Porcelain fracture: 2×
Acrylic resin veneering fracture: 3×
NS Acrylic resin veneering fracture
NS Loss of screw access plug (Fermit): 9/21
Remake: 5/21
Opposing complete denture:
Repair: 3/21
Reline: 7/21
Remake: 6/21
NS Screw fracture: 2/26 (pts)
Abutment fracture: (b) 1/13 (pts)
Screw loosening: (a) 11×, (b) 13×
Fracture of acrylic teeth: 4/26 (pts)
NS Screw loosening: 2×
Fracture of opposing complete denture: 5×
Fracture of denture teeth (either opposing complete denture or
mandibular implant prosthesis): 22×
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Screw- Versus Cement-Retained Implant Prostheses: Review of Maintenance and Complications

Table 1 (continued)  Clinical Studies Reporting Prosthodontic Maintenance/Complication Issues Involving

Screw-Retained Prostheses
Original
number of
participants; Observation Type of implant
Study Type of study implants Region period and connection
Ekelund et al38 (2003) Prospective 47; 273 Mandible 20–23 y Brånemark

Attard and Zarb40 (2004) Prospective 45; 265 Maxilla and mandible 20 y Brånemark
(mean)

Rasmusson et al45 (2005) Prospective 36; 199 Maxilla and mandible 10 y TiOblast (Astra Tech)
Astrand et al51 (2008) Prospective 48; 111 Maxilla and mandible 20 y Brånemark

Purcell et al53 (2008) Retrospective 46; 233 Mandible 7.9 y Steri-Oss; external hex
(mean)

Gallucci et al54 (2009) Prospective, 45; 237 Mandible 5y Straumann

multicenter

Örtorp and Jemt56 (2009) Retrospective 155; 1,099 Mandible 15 y Brånemark

Maló et al64 (2012)† Prospective 108; 634 Maxilla and mandible Up to Brånemark
10 y (Nobel Speedy)

Örtorp and Jemt65 (2012) Prospective 126; 728 Maxilla and mandible 10 y Brånemark

RCT = randomized controlled trial; NS = not specified; AC = all ceramic; AM = all metal; PFM = porcelain fused to metal; Ti = titanium;
× = number of event(s); (pts) = number of patients affected by the maintenance issues; Au = gold; (C) = control group; (T) = test group;
comp resin = composite resin; CNC = computer numeric controlled.
*Data combined with other retention mechanism.
†Data separated from other retention mechanism.

Studies reported various types of luting ce- glass-ionomer cement, and resin cement (Panavia,
ment, such as temporary cement (Temp Bond, Kerr; Kuraray; RelyX, 3M ESPE) for cement-retained im-
Dycal, LD Caulk Division), IRM, zinc phosphate cement, plant crowns. The most common type of temporary

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Retention mechanism
Type of crown
Type III gold alloy with resin teeth
and bilateral cantilever units
Metal alloy and acrylic resin
denture teeth
NS
Gold alloy framework and
acrylic resin teeth
Framework:
(a) Type III or IV gold alloy
(b) Gold-palladium alloy
(c) High palladium alloy
(d) Silver-palladium alloy
Veneering:
acrylic resin denture teeth
Hybrid-type with distal cantilever
Acrylic base and prosthetic teeth
mounted on a metallic framework
(41/45)
Metal-ceramic (4/45)
(C) Cast gold alloy frameworks and
acrylic resin teeth
(T) Laser-welded Ti frameworks
and acrylic resin teeth
Alumina copings (Procera) with
Allceram ceramics cemented onto
a Ti framework (Procera) with
pink ceramic
Zirconia copings with Nobel Rondo
zirconia ceramic and pink acrylic
(C): Au alloy frameworks and
acrylic resin teeth
(T): CNC-milled grade 2 Ti
frameworks with acrylic resin teeth
cement was Temp Bond. There was no mention of
mixing the temporary cement with petroleum jelly.
The studies failed to identify the rationale behind the
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(screw-retained) Prosthodontic outcomes
NS New prosthesis: 2/47
Screw loosening: 2/47
Loss of screw access plug: 1/4 1/47
NS Tissue hyperplasia/inflammation: 47×
Fractured gold screw: 78×
Fractured abutment screw: 25×
Fractured acrylic denture teeth: 22×
Reline of opposing complete denture: 5×
Fractured framework: 16×
Remake of prosthesis: 57×
Remake of opposing complete denture: 27×
NS Porcelain fractures: 1/36
NS Screw loosening (abutment/prosthetic): 3/48
New prosthesis: 1/48
Replacement of acrylic resin teeth: 4/48
Ti alloy Abutment screw loosening: 5×
Abutment screw fracture: 2×
Retaining screw loosening: 13×
Retaining screw fracture: 8×
Stripped screws: 8×
Fractured acrylic resin teeth: 28×
Replacement of acrylic resin teeth: 24×
Fractured acrylic resin: 5×
NS Screw loosening: 2×
Screw fracture: 5×
Fractured acrylic resin tooth or denture base: 20×
Porcelain fracture: 1×
Fracture opposing complete denture: 12×
Inflammation under opposing complete denture: 2×
Framework fracture: 2×
Loss of screw access plug: 4× (comp resin)
Esthetics, remake: 1×
NS New prosthesis: 4× (C); 7× (T)
Framework fracture: 17× (C); 23× (T)
Implant component fracture: 6× (T)
Screw loosening: 3× (T)
Acrylic resin veneer fracture: 12× (C); 41× (T)
New acrylic resin veneers due to wear: 7× (T)
Loss of screw access plug: 11× (C); 27× (T)
NS Crown fracture: 14/59
Abutment screw loosening: 1/56 (pts)
Abutment replacement: 1/56 (pts)
NS Screw loosening: 1× (C)
Implant component fracture: 1× (C), 2× (T)
Framework fracture: 2× (C)
Veneer fracture (uncomplicated): 9× (C), 7× (T); (severe): 37× (C), 26× (T)
Wear of acrylic resin teeth 3× (C), 2× (T)
Loss of screw access plug: 25× (C), 5× (T)
choice of luting cement. There was no report on the
explanation of procedures involving placing the luting
cement and removing the excess material.
Volume 28, Number 2, 2015 135
Screw- Versus Cement-Retained Implant Prostheses: Review of Maintenance and Complications

Table 2   C
 linical Studies Reporting Prosthodontic Maintenance/Complication Issues Involving
Cement-Retained Prostheses
Original
number of
participants; Observation Type of implant
Study Type of study implants Region period and connection
Single implant crowns
Palmer et al20 (1997) Prospective 15; 15 Maxilla 2y Astra Tech
(anterior sites only)
Andersson et al21 (1998) Prospective 57; 62 Maxilla and mandible 5y Nobel Biocare

Scheller et al23 (1998) Prospective, 82; 99 Maxilla and mandible 5y Brånemark

multicenter

Levine et al69 (1999)† Retrospective, 110; 157 Maxilla and mandible 40.1 mo ITI (Straumann)
multicenter (mean)
Polizzi et al24 (1999) Prospective 21; 30 Maxilla and mandible 3–7 y Brånemark
(incisor sites only)
Scholander25 (1999)† Retrospective 135; 259 Maxilla and mandible 1–9 y Brånemark

Wannfors and Smedberg26 (1999)† Prospective 69; 80 Maxilla and mandible 3y Brånemark

Andersson et al28 (2001)* Prospective, 75; 89 Maxilla and mandible 1–3 y Brånemark
multicenter

Mangano and Bartolucci30 (2001) Retrospective 69; 80 NS 3.5 y MAC System (Carbon)
(mean)
Mericske-Stern et al70 (2001)* Longitudinal 72; 109 Maxilla and mandible 4.2 y ITI
(mean)

Gibbard and Zarb33 (2002)† Prospective 42; 49 Maxilla and mandible 5y Brånemark
Krennmair et al32 (2002)† Retrospective 112; 146 Maxilla and mandible 7y Frialit-2 (Friatec)

Levine et al34 (2002)† Retrospective, 471; 671 Maxilla and mandible 21.3 mo Solid-screw ITI
multicenter (molar sites only) (mean) (Straumann);
internal connection

Drago36 (2003) Prospective 73; 110 Maxilla and mandible 1y Osseotite

(3i, Implant Innovations)
Gotfredsen42 (2004) Prospective 20; 20 Maxilla 5y Astra Tech ST
(anterior region) (Astra Tech)

Vigolo et al43 (2004)† Prospective 12; 24 4y 3i, Implant Innovations

Bragger et al44 (2005)† Prospective 48; 69 NS 10 y ITI Bonefit

(ITI Straumann)

Schropp et al71 (2005)† RCT 43; 43 Maxilla and mandible 2y Osseotite

(3i, Implant Innovations)
Wennström et al46 (2005) Prospective 40; 45 Maxilla and mandible 5y Astra ST-implants,
Astra Tech
RCT = randomized controlled trial; NS= not specified; AC = all ceramic, AM = all metal; PFM = porcelain fused to metal; Ti = titanium;
× = number of event(s); (pts) = number of patients affected by the maintenance issues; Au = gold; (C) = control group; (T) = test group;
comp resin = composite resin; CNC = computer numeric controlled.
*Data combined with other retention mechanism.
†Data separated from the other retention mechanism.

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 Ma/Fenton

Retention mechanism
Type of crown (cement-retained) Prosthodontic outcomes

PFM Temporary cement Cement loss: 1×

(Temp Bond, Kerr) Porcelain fracture: 1×
AC (n = 62) NS Abutment screw loosening: 1×
PFM (n = 3)
AC (81) Zinc phosphate (69) Crown fracture: 7×
PFM (16) Glass-ionomer (5) Esthetics: 1×
Temporary cement (22) Abutment screw loosening: 4×
NS (1) Cement loss: 3×
NS NS (76) Abutment screw (solid conical abutment)
loosening: 4×
PFM NS Cement loss: 1×

AC (175) Zinc phosphate (160) Loose abutment screws: 10×

PFM (79) Temporary cement (73) Cement loss: 4×
Gold-acrylic (4) Glass-ionomer (23) Crown fracture: 3×
Porcelain fracture: 1×
Remake: 8×
AC (9) Zinc phosphate (36) Abutment screw loosening: 1×
Gold-acrylic (36) Esthetics: 2×
PFM (35) Porcelain fracture: 1×
AC (70) Zinc phosphate (54) Abutment fracture during preparation/
Glass-ionomer (7) placement: 5×
Zinc oxide eugenol (6) Abutment fracture (after loading): 2×
Resin (3) Porcelain fracture: 2×
Crown fracture: 1×
AC Temporary cement Crown fracture: 2×
Abutment screw loosening: 1×
PFM NS (7) Cement loss: 1×
Porcelain fracture: 1×
Abutment fracture: 3× (Octa abutment,
withdrawn from the market)
NS NS (2) Screw loosening: 13%
AC (27) Temporary cement Cement loss: 9×
PFM (119) (Temp Bond, Kerr) (93) Abutment screw loosening: 4×
Porcelain/crown fracture: 2×
NS NS (600) Abutment screw loosening: 0.3%
Abutment fracture: 0.5%
Cement loss: 0.6%
Porcelain fracture: 0.2%
AM Temporary cement Abutment screw loosening: 1×
PFM (Dycal, LD Caulk Division)
PFM NS Abutment screw loosening: 2×
Porcelain fracture: 2×
Cement loss: 2×
PFM Temporary cement None
(Temp Bond NE, Kerr) (12)
PFM Zinc phosphate (67) Prosthetic screw loosening: 1×
Abutment screw loosening: 2×
Porcelain fracture: 3×
PFM NS (41) Cement loss: 5×

PFM Zinc phosphate Abutment screw loosening: 4×

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Screw- Versus Cement-Retained Implant Prostheses: Review of Maintenance and Complications

Table 2 (continued)  Clinical Studies Reporting Prosthodontic Maintenance/Complication Issues Involving

Cement-Retained Prostheses
Original
number of
participants; Observation Type of implant
Study Type of study implants Region period and connection
Norton72 (2006) Retrospective 54; 181 Maxilla and mandible 3y Astra Tech
(mean)

Levine et al73 (2007) Retrospective, 410; 499 Maxilla and mandible 23 mo Straumann
multicenter (molar sites only) (mean)
Turkyilmaz et al50 (2007) Prospective 29; 59 Maxilla 4y MK III TiUnite
(Nobel Biocare); external
hex

Jemt55 (2009)† Retrospective 35; 41 Maxilla 10 y Brånemark

Sailer et al57 (2009)† RCT 22; 40 Maxilla and mandible 1y Brånemark
(canine, premolar, and (Nobel Biocare); external
molar sites only) hex

Krennmair et al58 (2010) Retrospective NS; 112 Maxilla and mandible 5y Camlog

Mangano et al59 (2010) Prospective 295; 307 Maxilla and mandible 4y Leone Implant System
(Inta)
Hosseini et al62 (2011) RCT 36; 75 Maxilla and mandible 1y Astra Tech
(premolar region only)

Visser et al63 (2011) RCT 93; 92 Maxilla (anterior 5y ITI-Esthetic Plus

region) (ITI Straumann)
Oyama et al66 (2012) Prospective 13; 17 Maxilla and mandible 1y Xive S (Dentsply)
(incisor region only)

Vigolo et al67 (2012) RCT 18; 18 Maxilla (canine and 10 y 3i, Implant Innovations;
premolar region) and external hex
mandible (premolar
and molar region)
Fixed dental prostheses (partial)
Singer and Serfaty19 (1996) Retrospective 70; 225 Maxilla and mandible Up to 3 y Spectra System, Integral,
Integral-Omniloc

Duncan et al37 (2003)† Prospective 32; 83 NS 3y ITI implants (Straumann)

Nedir et al47 (2006) Prospective NS; 383 Maxilla and mandible Up to 8 y Straumann
(posterior region only)

Khraisat et al52 (2008) Retrospective, 49; 87 Maxilla and mandible Minimum Solid-screw implants
multicenter (anterior region 1y (Straumann)
including first
premolars)
Crespi et al48 (2007) Prospective 27; 160 Maxilla and mandible 18 mo Outlink,
Sweden & Martina;
internal hex
Fixed dental prostheses (complete)
RCT = randomized controlled trial; NS= not specified; AC = all ceramic, AM = all metal; PFM = porcelain fused to metal; Ti = titanium;
× = number of event(s); (pts) = number of patients affected by the maintenance issues; Au = gold; (C) = control group; (T) = test group;
comp resin = composite resin; CNC = computer numeric controlled.
*Data combined with other retention mechanism.
†Data separated from the other retention mechanism.

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 Ma/Fenton

Retention mechanism
Type of crown (cement-retained) Prosthodontic outcomes
NS Temporary cement Cement loss: 32×
(Temp Bond, Kerr) Porcelain fracture: 13×
Abutment screw loosening: 4×
NS Solid abutment torqued to Cement loss: 2×
35 Ncm with a torque wrench
PFM Temporary cement Porcelain fracture: 3×
(Temp Bond NE, Kerr)
CeraOne abutments
(Nobel Biocare)
PFM NS (23) Abutment screw loosening: 3/23
AC (19) Resin cement Porcelain fracture: 2× PFM
PFM (21) (Panavia or RelyX)
Glass-ionomer
(Ketac Cem) (38)
AC Temporary cement Screw loosening: 5/112
PFM (Temp Bond, Kerr) Cement loss: 11/112
Porcelain fracture: 5/112
AC (65) NS Abutment screw loosening: 0.66%
PFM (42)
AC (38) Zinc phosphate Porcelain fracture: 1× PFM
PFM (37) (35 AC, 36 PFM) Cement loss: 1× PFM
Resin cement
(Panavia, Kuraray)
(3 AC, 1 PFM)
AC NS Remake: 11/93

PFM Temporary cement None

(Temp Bond, Kerr);
Type IV gold customized abutment
PFM Temporary cement None
(Temp Bond NE, Kerr)

Single or multiple: Temp Bond or IRM Out of 92 arches

PFM Cement loss: 0.02%
Porcelain fracture: 0.02%
Abutment screw loosening: 0.02%
Single (22) or Zinc phosphate (18) None
multiple (19): PFM
Multiple: Zinc phosphate Out of 265 prostheses
PFM Abutment screw loosening: 0.0075%
Abutment fracture: 0.0038%
Cement loss: 0.011%
Porcelain fracture: 0.023% (minor), 0.045%
(major)
Prosthesis remake: 0.034%
Single or multiple (2 units) Polycarboxylate Cement loss: 3×

Metal-ceramic NS None

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Screw- Versus Cement-Retained Implant Prostheses: Review of Maintenance and Complications

Table 2 (continued)  Clinical Studies Reporting Prosthodontic Maintenance/Complication Issues Involving

Cement-Retained Prostheses
Original
number of
participants; Observation Type of implant
Study Type of study implants Region period and connection
Maló et al64 (2012)† Prospective 108; 634 Maxilla and mandible Up to 10 y Brånemark,
Nobel Speedy

RCT = randomized controlled trial; NS= not specified; AC = all ceramic, AM = all metal; PFM = porcelain fused to metal; Ti = titanium;
× = number of event(s); (pts) = number of patients affected by the maintenance issues; Au = gold; (C) = control group; (T) = test group;
comp resin = composite resin; CNC = computer numeric controlled.
*Data combined with other retention mechanism.
†Data separated from the other retention mechanism.

Table 3   C
 linical Studies Reporting Prosthodontic Maintenance/Complication Issues Involving
Horizontal Screw-Retained Prostheses
Original
number of Type of
participants; Observation implant and Type of Retention Prosthodontic
Study Type of study implants Region period connection crown mechanism outcomes
Single implant crowns
Krennmair Retrospective 112; 146 Maxilla and 7y Frialit-2 AC (27) Horizontal Screw (horizontal)
et al32 mandible (Friatec) PFM (119) screw (31) loosening: 3×
(2002)* Abutment screw
loosening: 1×
Porcelain/crown
fracture*: 1×
AC = all ceramic; PFM = porcelain fused to metal; × = number of event(s).
*Data combined with other retention mechanism.

Prosthodontic Maintenance/Complications Discussion

Various types of prosthodontic maintenance/compli-
cations were reported. The common types of main-
tenance/complications included screw loosening
(crowns or abutments), luting cement loss, veneering
or porcelain fracture, and esthetic concerns (Table 4).
Several studies involving screw-retained implant
prostheses, with the majority being full-arch fixed
implant prostheses, mentioned the maintenance is-
sues of losing restorative materials used as screw
access plugs. Ten studies22,25,37,43,44,48,57,66,67,71 did
not have any prosthodontic maintenance/complica-
tion during the observation period. Several studies
that included screw-retained and cement-retained
prostheses made it difficult to separate their prosth-
odontic maintenance/complication data according
to the retention mechanism because they did not
distinguish them in their studies. Only two stud-
ies60,68 specified the prosthodontic maintenance/
complication criteria77,78 used to report their prosth-
odontic outcomes.
The aim of this systematic review was to analyze evi-
dence regarding prosthodontic outcomes between
screw- and cement-retained fixed implant pros-
theses. Although single implant crowns have been
promoted as a successful rehabilitation option for
partially dentate patients, it appears that this drive
has been based more on the biologic outcomes than
the long-term data on the prosthodontic mainte-
nance/complications issues. On the other hand, full-
arch fixed implant prostheses have well-documented
long-term data because this treatment modality in-
troduced the clinical protocol for contemporary im-
plant dentistry. In regard to guidelines on choosing
the retention mechanisms for fixed implant prosthe-
ses, this issue also has never been resolved because
the choice has been based on individual preference
or anecdotal evidence.
Retrievability is the main advantage of screw-
retained implant prostheses. It is important when
managing prosthodontic maintenance issues such as
screw loosening or repair of superstructures. Various

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Retention mechanism
Type of crown (cement-retained)
Alumina copings (Procera) NS
with Allceram ceramics
cemented onto a titanium
framework (Procera) with pink
ceramic
Zirconia copings with Nobel
Rondo zirconia ceramic and
pink acrylic
Table 4   S
 ummary of Commonly Reported Prosthodontic Maintenance/Complication Issues According to the
Selected Prosthetic Retention Method
Screw-retained
1. Patient objection to visible screw access sites
2. Loosening of accessible crown/fixed partial denture/abutment screws
3. Loss of renewable screw sealant material
4. Fracture of veneering material
reports of screw loosening for single implant crowns
(as high as 65%) have surfaced.6,15 One older study16
using gold prosthetic screws to retain single implant
crowns did not specify the tightening procedure and
also reported 38% of implants being affected by
screw loosening. Although frequency of this clinical
mishap appears to have occurred frequently, recent
ongoing changes in implant components must be
taken into consideration. The mechanics of prosthetic
screws have evolved enormously in regard to preload
and better torque controllers.36 Application of the cor-
rect torque is translated into a preload, producing a
clamping force and preventing a one-sided lift-off of
the abutment.79 This positive impact on maintenance
events is clearly evident in the newer studies43,60; al-
though it may still be argued that cement retention is
a viable option for single implant crowns. However, it
must be considered that there are other pros­thodontic
maintenance issues such as repair of chipped veneer-
ing porcelain or loosening of abutments supporting
the implant crowns. In order to manage these long-
term prosthodontic maintenance issues, it is essen-
tial that the superstructure can be readily removed
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Prosthodontic outcomes
Recurrent crown fractures ➞ replaced by
acrylic resin prostheses: 5/66
Crown fracture: 33/66
Abutment screw loosening: 2/29 (pts)
Porcelain fracture (gingival region): 3/36
Cement-retained
1. Inadequate seating during cementation
2. Subgingival cement retention causing inflammation
3. Loosening of prosthetic screws with difficult accessibility
4. Loss of retention
5. Need for recementation and cement reselection
6. Fracture of veneering material
without damage occurring to the oral implants as well
as the prostheses. Temporary cements such as Temp
Bond can be used to retain single implant crowns to
provide “easier” retrieval of the prostheses. However,
due to the close fitting between the abutment and
crown, it is difficult to remove the prostheses intact.
Any damages made to the restorations may result in
remaking of the prostheses, which would be an ad-
ditional financial burden to the patients. There have
been innovative ways to achieve retrievability with
cement-retained prostheses by including a palatal/
lingual screw to cause shear force that can disrupt
the cement layer.80–84
Studies using screw-retained mechanisms re-
ported loss of restorative materials in the screw ac-
cess.18,26,27,31,38,54,56,65 The common material of choice
was composite resin except in one study,18 which
used acrylic. While this is a minor prosthodontic
maintenance issue that can be easily managed, it can
become a nuisance for patients and clinicians alike.
Loss of retention is a major disadvantage for
cement-retained prostheses because they de-
pend on the dimension of abutments. Several
Volume 28, Number 2, 2015 141
Screw- Versus Cement-Retained Implant Prostheses: Review of Maintenance and Complications
studies20,23–25,32,34,42,58,62 in this review reported loss of
retention when using cement-retained single implant
crowns. However, authors did not associate this main-
tenance issue with the type of luting cement. While in
vitro studies have shown that the convergence and
height of abutments are crucial in maintaining the sta-
bility of implant prostheses,85 there are no guidelines
for the selection of luting cement. Studies suggest us-
ing provisional cement such as zinc oxide eugenol for
the ease of retrievability, although clinical experience
has shown that with the ideal abutment dimension, it
is still difficult to remove the prostheses.86 The prin-
ciple of progressive cementation has been suggested
for recurrent loss of retention, whereby cements with
better adhesion are progressively used until adequate
retention is achieved.6 Three studies19,47,52 involving
either single implant crowns or fixed partial prosthe-
ses showed cement loss, whereas studies involving
full-arch fixed implant prostheses using cement re-
tention did not report any debonding of the prosthe-
ses.48,64 This is not surprising as the full-arch fixed
implant prostheses can rely on multiple implants for
retention and any individual debonding may not be
clinically detectable. However, a recent paper85 has
reported equal frequencies (16% to 17%) of repeated
abutment screw loosening between screw- and ce-
ment-retained single implant crowns.
Fracture of the veneering acrylic or porcelain has
shown to be a common maintenance/complication
issue for implant prostheses. This occurred for both
all-ceramic and porcelain-fused-to-metal crowns
regardless of retention mechanism. A recent retro-
spective study showed that a screw-retained supra-
structure was the only significant risk factor when
assessing for fracture of veneering material.88 Another
study89 reported the differences in the incidence of
porcelain chipping when comparing cement-retained
single metal-ceramic to all-ceramic single implant
crowns. The authors stated that because the chipping
was more frequent with all-ceramic single implant
crowns, these crowns should be recommended with
care. The majority of studies in this systematic review
indicate that the chipping was minor and thus did not
require remakes of prostheses. While only two stud-
ies used cement-retained full-arch fixed implant pros-
theses and only one of them reported maintenance
issues, this study64 did not explain the procedure
involved in the repair of the veneering chipping and
whether the prostheses were retrievable. This study
also failed to specify the type of cement used. With
the improvement of ceramic technology and better
understanding of the fabrication process, the inci-
dence of porcelain chipping may improve.
Studies26,54,60 have reported esthetics as one of
prosthodontic maintenance/complication issues
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whereby the participants were not satisfied with the
final esthetic outcomes and the crowns either had to
be adjusted or remade. However, this was not due
to the retention mechanism. Esthetics is driven by
the implant position, and proper planning is essential
for achieving satisfactory outcomes. The position of
the screw access can dictate the esthetic outcomes,
especially in the anterior maxillary region, and clini-
cians would prefer to mask the unfavorable screw
access opening by fabricating cement-retained pros-
theses.90 One study offered a different technique to
improve the esthetics when restoring the screw ac-
cess,84 while other authors suggested cross-pinning
so that the prostheses are still retrievable but avoid
the direct screw access.32,80,91 There was only one
study 32 from this systematic review that investigated
the prosthodontic outcomes when using horizontal
screws. It showed that for 31 horizontal screws over
7 years, these screws loosened three times while
the abutment screw loosened only once. Only one
crown that suffered porcelain chipping. This type of
retention mechanism will allow for easy prosthodon-
tic maintenance without causing any damage to the
prostheses. Whether the esthetics was affected due
to the retention mechanism could not be identified in
this review as the studies did not provide any guide-
lines for how each participant was chosen for the
particular retention mechanism.
Maintaining an optimal occlusion is also crucial for
implant prostheses. As screw-retained single implant
crowns require the prosthetic screw access through
the occlusal surfaces, this may actually interfere with
the occlusion.6 However, the dimension of screw ac-
cess depends on the size of the prosthetic screw, and,
unless this increased dramatically according to the
size of the implant, there would be minimal impact to
the occlusion. Studies included in this systematic re-
view did not discuss any impact of different retention
mechanisms on occlusion.
Cement-retained implant crowns require attention
to the removal of excess cement so that any associat-
ed peri-implant complications can be avoided.67,92–96
Although delivery of cement-retained single implant
crowns may be more ideal in situations involving lim-
ited mouth opening and the posterior region of the
oral cavity,6 any oral implant placed too subgingivally
may cause difficulties during excess cement removal
and any remaining cement may cause peri-implant in-
flammation,93,95,96 as shown by a recent retrospective
study.96 Therefore, careful planning of the abutment
design must be carried out to assist in easy removal
of excess cement. There is also a lack of consensus
regarding the type of cement, the appropriate quan-
tity of cement, and the placement method for cement-
retained implant prostheses.97

The passive fit of implant prostheses is a controver-
sial topic, and there have been no conclusive data on
the necessity for or appropriate dimension involved
in a passive fit. Non-passively fitting prostheses have
been cautioned as causing undue implant stress
leading to biologic and prosthetic implant failure.7
Cement retention, therefore, has been encouraged to
provide passively fitting implant crowns because the
cement space may compensate for a lack of passive
fit and serve as a shock absorber. None of the in-
cluded studies investigated the passivity of the fixed
implant prostheses and its impact on the ongoing
prosthodontic maintenance.
There was a lack of standardized reporting protocol
for prosthodontic maintenance associated with fixed
implant prostheses. Only two studies60,68 specified
the criteria used for their data collection, and several
studies did not specify the type of screws or screw
tightening procedure, while others did not state the
type of cement used to retain the implant prosthe-
ses. However, recent studies, albeit with short-term
prosthodontic data, suggest that more improved de-
signs of implant components and controlled protocol
of screw tightening have contributed positively to
minimizing the amount of prosthodontic maintenance/
complication burden.
Conclusions
The inadequacy of available information and diversity
of reported study designs precluded a comparison
of prosthodontic outcomes between screw- and ce-
ment-retained fixed implant prostheses. Both reten-
tion mechanisms showed prosthodontic maintenance/
complication issues that must be considered, al-
though the introduction of newer implant components
may assist in minimizing these clinical concerns. It is
also recommended that standardized criteria are used
when reporting prosthodontic maintenance/compli-
cation issues to permit better future data comparison.
Acknowledgments
The authors would like to thank the support from the Foundation
for Oral Rehabilitation. The authors reported no conflicts of inter-
est related to this study.
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