Screw Retained Vs Cement Retained Prosthesis

Screw vs cement retained
prosthesis
Contents
 Introduction
 Screw retained prosthesis
• Advantages
• Disadvantages
• Screw loosening
 Cement retained prosthesis

• One piece abutment
• Two piece abutment
Screw retained versus cement retained prosthesis

2
 Screw versus cement retained prosthesis
 Ease of fabrication and cost
 Passivity of the framework
 Retention
 Occlusion
 Esthetics
 Delivery
 Retrievability

3
• Summary
• Conclusion
• References and Bibiliography

4
Introduction

5
Screw retained implant prosthesis:
 Screw-retained prostheses have a well-documented history of

successful application in completely edentulous patients.
 As noted in the literature, “Screw-retained implant restorations
have an advantage of predictable retrievability but demand
precise placement of the implant.

6
 However, with the increase in treatment of partially edentulous
patients, new restorative concepts have evolved in the field of
implant Prosthodontics.
 In screw-retained restorations, the fastening screw provides a
solid joint between the restoration and the implant abutment
which can be easily retrivable.

7
Advantages
 Easy
 Safe efficient
 Retrievable
 No cement in soft tissue periimplant area
 Retention even for small dimensions
Carl E. Misch; Contemporary implant dentistry; 3 rd Edition.

8
Disadvantages
 Screw loosening under final cemented prosthesis
 Fracture
 Device not sealed(bacterial growth)

9
Causes of screw loosening
•Forces:Occlusion interferences
•Cantilever:offset loads
•Non passive fit of prosthesis

10
11
Cement retained prosthesis

12
Cement retained implant restorations:
 Cement-retained prostheses have become, the restoration of
choice for the treatment of implant patients.
 This evolution started after a modification of the UCLA
abutment, i.e. fabrication of customized abutments to
overcome esthetic and angulation problems.

13
 Lewis and coworkers in 1988 were the first to describe a new
technique for the fabrication of implant-supported restorations
made directly on Brånemark System implants (Nobel Biocare,
Göteborg, Sweden), without the use of traditional transmucosal
abutment cylinders, so as to overcome limited interocclusal
space problems.

14
 In 1989, Lewis and associates described the fabrication of
telescopic crowns on customized abutments made from UCLA
abutments to solve problems with implant angulation.

15
 Currently, there are numerous pre-machined cement-retained
abutments, as well as preparable titanium and ceramic
abutments.
 These abutments can be further modified in the mouth to
accommodate soft tissue changes.

16
 Two broad categories of abutments are used for cement
retained restorations.
• A single unit abutment (one piece abutment)
• Two piece abutment.

17
One piece abutment for cement
retention:
 The one piece abutment for cement is often the abutment of
choice for multiple splinted implants, provided no transfer
done with the laboratory.

18
Advantages of one piece abutment:
 No torque wrench needed.
 Stronger.
 No screw loosening.
 Easy complete seating.
 No need to retighten under restoration.
 Less expensive.
 Thicker walls to allow great freedom of
preparation.

19
Disadvantages:
 Only for multiple abutments.
 Not for single tooth restoration.
 Not for angled abutments.
 Weaker for fracture.

20
Two piece abutment for cement retention:
 An independent single tooth implant should be restored with
an anti rotational, two-piece abutment and abutment screw
screw system.
 The abutment should engage the hexagon or anti rotational
feature of implant body.

21
 Advantages:
• Anti rotational under shear forces.
• Angled abutments.

22
 Disadvantages:
• Screw loosening.
• Abutment loosening under restoration.
• Torque and counter torque devices needed for preload.
• Proper seating with radiograph must be checked.
• Thinner walls limits freedom of preparation.

23
Screw Vs Cement implant restorations:

24
 The factors that are influenced by different methods of fixation
of the prostheses to the implants are:
• Ease of fabrication and cost

• Passivity of the framework
• Retention
• Occlusion
• Esthetics
• Delivery
• Retrievability

25
Ease of fabrication and cost:
 The fabrication of cement-retained prostheses is easier than
that for screw-retained prostheses.
 The components used for this type of restoration are less
expensive and does not require special training for technician.
 Restoration of implants with a divergence of less than 17
degrees is also easier with cement-retained prostheses.

26
 The screw retained restorations for same incidence is not
simple as it requires the fabrication of customized abutments, a
procedure that is technique-sensitive and demanding.
W.Chee, Screw versus cemented implant supported Restoration, British dental journal volume 201 no. 8 Oct 21 2006 501

27
Passitivity of frame work:
 The possible complications of non-passively fitting
frameworks can be categorized into 2 groups:
• Biologic complications: increased transfer of load to the
bone, bone loss, and development of micro flora at the gap

between the implant and the abutment.
• Prosthetic complications: loosening or fracture of the
fastening screw and implant fracture

28
 The fabrication of implant-supported restorations requires
many clinical and laboratory procedures that must be very
precise. Each stage in the fabrication procedure can
incorporate a small error, which will contribute to a positional
distortion of the prosthesis.

29
 Possible distortion can occur during the impression procedure,
during fabrication of the master cast, during fabrication of wax
patterns, during investing and casting procedures, during firing
of the porcelain, or during delivery of the prosthesis.

30
 A truly passive screw retained dental restoration is virtually
impossible to fabricate.
 Screwed restorations may create permanent strain on implants
that can be 2to3 times greater than that of cemented
prosthesis.
 A passive fit is easier to accomplish in cemented restorations
due to die spacers.

31
 The die spacer creates an approximately 40 μm cement space,
which compensates for laboratory distortions and permits a
more passive casting.
 If the laboratory is utilizing CAD/CAM technology, the cement
space can be adjusted based on the substructure.

32
Occlusal material fracture:
 Occlusal material fracture is more common with implants than
natural teeth because of lack of periodontal stress relief with
implants.
 A decreased incidence of porcelain or acrylic fracture of
prosthesis has been observed with cement retained restorations
compared with screw retained restorations.

33
 In screw retained restorations, screw holes may increase stress
concentration to the restoring material and more often leads to
un supported porcelain.
 A cement retained prosthesis does not have a weak link
through the surface of the material.

34
Accessibility:
 Access is more challenging in the posterior regions of mouth
for insertion of screw retained restorations.
 The manipulation of small screws and screw drivers is far
more time consuming and challenging than the preparation and
cementation of restoration.

35
Fatigue:
 A long term complication of screw retained prosthesis is
fatigue failure of screw components.
 The narrow diameter of prosthesis screws reduces its long term
strength.
 Cemented prosthesis have no small diameter components and
no metal to metal wearing and such similar complications were
not observed.

36
Abutment –Crown crevice:
 A screw retained prosthesis does not seal the abutment to

crown interface or margin, which harbors bacteria in the
crevice.
 The crevice may act as endotoxin pump, encouraging the
proliferation of microorganisms in the sulcular region.
 A cemented crown seals the crown abutment connection and
impairs bacterial penetration.

37
:
 Retention certainly influences the lack of complications as well

as the longevity of implant prostheses.
 The factors that influence retention of the cement retained
restorations are convergence of axial walls, surface area and
height, roughness of the surface, and type of cement.

38
Roughness of surface:
 Roughness of axial walls offers greater retention to cemented
prosthesis.
 Implant abutments can be roughened by using diamond bur or
air borne particle abrasion.

39
Path of insertion:
 In ideal conditions the path of insertion of restoration should
be slightly different from direction of occlusal load.

 If the fixed partial denture path of insertion is identical to
direction of occlusal force then grater tensile forces were

placed on the cement.
 So, ideal suggestion is that the path of insertion should be
about 10 degrees divergent from the axial load of implant

during occlusion to prevent uncementation.

40
Type of cement:
 The cements used in fixed prosthodontics are either definitive
or provisional.
 The definitive cements are used to increase retention and
provide good marginal seal for the restorations. Provisional

cements are used primarily for interim restorations to facilitate
their removal.
 As no risk of decay for the abutments, provisional cements can
also be used for the cementation of implant restorations, for

easy retrivability.

41
 Zinc phosphate cements have excellent properties for
definitive implant restorative cement because they cannot
cause pulpal sensitivity on implants , have adequate working
time and excess material can be removed without starching the
surface of abutment.

42
 For screw-retained restorations, retention is obtained by the
fastening screw, which connects the implant with the abutment
and the abutment with the prosthesis.
 The screws most commonly used are the gold and the titanium.
 Retention is obtained by the friction resistance developed
between the internal threads of the implant and those of the
fastening screws.

43
 In the case of titanium abutment screws, there can be slight
damage of both the implant and the fastening screw threads,
which results in their joining. This phenomenon is called
galling.
 Gold abutment screws have a smaller coefficient of friction,
allowing them to be tightened more effectively than the
titanium without risking galling between the threads.

44
n:
 Occlusion is another factor affecting the selection of the

restoration type-screw- or cement-retained.
 The bucco-lingual dimension of maxillary premolars and
maxillary 1st and 2nd molars would be 9mm and 11mm. The
occlusal table for above mentioned teeth is 4.5mm & 5-6mm.
 The heads of fastening screws have a diameter of 3mm, thus
requiring screw access hole diameter of 3mm.

45
Esthetics:
 Esthetics is another factor to consider when deciding between
screw-retained and cement-retained crowns.
 In anterior screw-retained crowns, the implant is placed
lingually to allow screw emergence through the cingulum area.

46
 An implant for an anterior cemented restoration is placed
under the incisal edge. An angulated abutment is then used,
which eliminates the ridge lap and replicates a more natural
emergence profile.

47
 In posterior screw-retained restorations, the access hole will
exit through the central fossa of the prosthetic tooth. The
cementable crown obviously has no entrance cavity. Allowing
the forces of occlusion to be distributed along the axial
inclination, congruent with the long axis of the tooth, is easier.

48
Delivery:
 For screw retained restorations, only a radiographic
examination is required to verify the prices fit of the
prosthesis.
 However for cemented restorations, there is need for careful
removal of cement remnants in addition with radiographic
examination. The removal of cement residues is critical for
peri-implant health.

49
y:
 The main advantage of screw retained prosthesis is
retrievability. The crown is not only recoverable, but no
damage occurs upon removal of the crown.
 In screw retained prosthesis, the access hole is covered with
composite. To retrieve the screw retained prosthesis, the dentist
must remove occlusal obturation, underlying cotton pellet and
coping screw.

50
 Once the prosthesis is reinserted, the screws may need to be
changed and torqued.
 The main disadvantage of cemented prostheses is the difficulty
of their retrievability.
 Although retrieval is needed less often because of the
dramatically increased survival rates for dental implants, the
need for future removal of FPDs should not be overlooked. For
this provisional luting cements are being used.

51
Summary

52
53
Conclusion:
 It is to be stated that the decision to screw or cement retain
abutments remain an individual choice for dentists.
 Clinicians should be aware of the limitations and is advantages
of each type of prosthesis so as to select the one that is most
appropriate for a given clinical situation.

54
Bibliography and references:
 Carl E. Misch; Contemporary implant dentistry; 3rd Edition.
 Charles A. Babbush; Dental implants art & science; 2nd
Edition.
 Michalakis K.X, Hirayama .H; Cement retained versus
screw retained implant restorations- A critical review; Int J
Oral Maxillofacial implants 2003; 18; 719-728.

55
 W.Chee, Screw versus cemented implant supported
Restoration, British dental journal volume 201 no. 8 Oct 21
2006 501
 Hebel KS, Gajjar RC. Cementretained versus screw-retained
implant restorations: achieving optimal occlusion and esthetics
in implant dentistry.JPD 1997;77(1):20-35
 Sanath shetty,Principles of screw‑retained and cement‑retained
fixed implant prosthesis: A critical review;Journal of
Interdisciplinary dentistry,2014

56
 Giblin J; A Rationale for the successful retention of implant
supported restorations- to screw or cement; Australian dental
practice; 2009; 136-146.
 Roberta,Cement retained versus screw retained dental
prostheses:A literature review;Dental press
Implantology,April,2013

57

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Screw vs cement retained

 Cement retained prosthesis

• Two piece abutment

Screw retained versus cement retained prosthesis

Screw retained versus cement retained prosthesis

• References and Bibiliography

Screw retained versus cement retained prosthesis

Screw retained versus cement retained prosthesis

 Screw-retained prostheses have a well-documented history of

Screw retained versus cement retained prosthesis

Screw retained versus cement retained prosthesis

 No cement in soft tissue periimplant area

 Retention even for small dimensions

Carl E. Misch; Contemporary implant dentistry; 3 rd Edition.

 Screw loosening under final cemented prosthesis

 Device not sealed(bacterial growth)

Screw retained versus cement retained prosthesis

•Non passive fit of prosthesis

Screw retained versus cement retained prosthesis

Screw retained versus cement retained prosthesis

Screw retained versus cement retained prosthesis

Screw retained versus cement retained prosthesis

Screw retained versus cement retained prosthesis

Screw retained versus cement retained prosthesis

• A single unit abutment (one piece abutment)

• Two piece abutment.

Screw retained versus cement retained prosthesis

 The one piece abutment for cement is often the abutment of

choice for multiple splinted implants, provided no transfer

done with the laboratory.

Screw retained versus cement retained prosthesis

Screw retained versus cement retained prosthesis

 Not for single tooth restoration.

 Not for angled abutments.

 Weaker for fracture.

Carl E. Misch; Contemporary implant dentistry; 3 rd Edition.

Screw retained versus cement retained prosthesis

• Anti rotational under shear forces.

Screw retained versus cement retained prosthesis

• Abutment loosening under restoration.

• Torque and counter torque devices needed for preload.

• Proper seating with radiograph must be checked.

• Thinner walls limits freedom of preparation.

Carl E. Misch; Contemporary implant dentistry; 3 rd Edition.

Screw retained versus cement retained prosthesis

• Ease of fabrication and cost

Screw retained versus cement retained prosthesis

Screw retained versus cement retained prosthesis

simple as it requires the fabrication of customized abutments, a

procedure that is technique-sensitive and demanding.

Screw retained versus cement retained prosthesis

bone, bone loss, and development of micro flora at the gap

fastening screw and implant fracture

Screw retained versus cement retained prosthesis

many clinical and laboratory procedures that must be very

precise. Each stage in the fabrication procedure can

incorporate a small error, which will contribute to a positional