CAD/CAM Article
Cement-Retained vs Screw-Retained Restorations on Implants: Differences, Bone-Level Considerations, and the impact of evolving CEREC and Cercon 4D Workflows
Dr. Vishal Sharma
CDOCS Faculty
In implant dentistry, cement-retained and screw-retained restorations are the two CEREC-facilitated routes to restore an integrated implant. Each approach carries distinct advantages and risks for function, esthetics, retrievability, and peri-implant health. With chairside CAD/CAM workflows, and the rise of Esthetic Zirconia such as Cercon 4D paired with TiBases, clinicians can tailor restorations to implant angulation, emergence profile, and patient needs.
This article distills practical differences between the restorative options, surveys current bone-level evidence, and highlights how modern digital workflows influence decision-making and predictability, especially for CEREC-designed screw-retained crowns. It also notes when cement-retained restorations remain preferable.
Key differences: Cement-retained vs screw-retained restorations
Cement-retained restorations
Advantages:
Simpler insertion path with a seamless occlusal surface in posterior restorations; can yield superior anterior esthetics without a visible screw access hole.
Disadvantages and risks:
Subgingival excess cement can trigger peri-implant inflammation and bone loss; retrieval for maintenance can be more involved; marginal fit between abutment and crown requires precise design. As an extra CEREC milling block is required, consequently the cost of a CERECcement-retained abutment with crown is higher.
Figure 1. From Left to Right: TiBase, Custom CEREC milled Abutment, Custom CEREC Milled Crown.
Figure 2. Implant placed with acceptable parallelism to adjacent proximal contacts allows for the usage of a Screw-retained restoration milled from single Zirconia implant block.
Screw-retained restorations
Advantages:
Easy retrievability for maintenance, adjustment, or repair; eliminates residual subgingival cement risk, reducing cement-related peri-implant disease.
Disadvantages and risks:
Screw-access channels can impact esthetics or occlusion if not planned well; high potential for screw loosening or fracture if occlusion and parafunction are not managed, channel placement may complicate occlusion if not carefully designed.
Figure 3. Left: A screw retained restoration designed in CEREC. Right: The milled provisional with the screw access channel emanating through the incisal edge–the final restoration is indicated to be a cement-retained restoration due to this screw access path.
Figure 4. The implant placement lacks acceptable parallelism to the proximal surfaces of the adjacent teeth, and is therefore likely better suited for a cement-retained abutment and separate crown restoration.
Literature landscape: bone loss around implants with cement- vs screw-retained restorations
What reviews show
Marginal bone loss around implants tends to be similar for cement- and screw-retained restorations when technique, design, and maintenance are sound. Variability often stems from cement management, screw-retention mechanics, and emergence/occlusal design. This is a paradigm shift, as it was previously believed and seen that cement retained restorations had a higher risk of bone loss.
Practical interpretation
Bone-level outcomes hinge more on design, fabrication, and maintenance than on retention mode alone. With careful cement management, cement-retained crowns can achieve bone level health comparable to screw-retained designs; with well-planned screw channels and diligent maintenance, screw-retained crowns show long term, stable bone.
Takeaway for clinicians
Both approaches can yield favorable bone levels when combined with precise digital workflows, robust prosthetic design, and consistent ongoing hygiene maintenance. It is important to acknowledge and mitigate cement-related risks in cement-retained cases, and anticipate mechanical considerations (torque, anti-loosening) in screw-retained designs.
CEREC and screw-retained restorations: advancements in digital workflows. Predictability and path of insertion.
CEREC enables verification of the path of insertion immediately after digital impressions and during design, ensuring the screw channel aligns with a practical access point without compromising esthetics or occlusion. The latest advancements in the software have increased the accuracy and predictability of these procedures, decreasing the frequency of this author’s insertion adjustments.
Workflow improvements
Open implant libraries, enhanced scanner accuracy, and refined planning tools allow screw-retained crowns to be designed around implant angulation, emergence profile, proximal draw and occlusion before fabrication. Screw-access channels can be integrated into the virtual model, improving fit and predictability of the final restoration.
Indications for screw-retained CEREC crowns
When retrievability is prioritized for maintenance or future refinements; when implant angulation favors a screw-retained path; when esthetic or functional demands allow for precise control of emergence, insertion axis and occlusion without relying on cement.
Cement-retained restorations in the CEREC era
When to consider cement-retained crowns
Angulation or parallelism that would force an unfavorable screw-channel trajectory; esthetics where cement-retained crowns look more seamless; scenarios where meticulous cement management provides a durable, long term, esthetic solution.
Wanting to avoid angulated screw channel access (ASA) due to its increased risk of future prosthetic complications (such as screw loosening).
Practical considerations
Use strict protocols during cementation-such as Teflon usage and de-ox style products–to minimize subgingival residual cement and ensure thorough removal; equigingival margins can better facilitate this. Utilize a highly polished Zirconia abutment restoration for better tissue biocompatibility.
Cercon 4D esthetic Zirconia with a TiBase has allowed for expanding options for screw-retained crowns for the following reasons:
High-strength, esthetically capable Zirconia with enhanced translucency and stability for long-term function, superior tissue biocompatibility vs other restorative materials.
Figure 5. A Cercon 4D CEREC Implant
Block with a precision insert for compatibility with a TiBase
TiBase and screw-retained configurations
TiBase bases enable screw-retained restorations with zirconia crowns, supporting reliable retrievability and durable esthetics when implant placement angles are compatible.
Biocompatibility and tissue response
Polished zirconia surfaces are widely regarded as biocompatible, promoting favorable soft-tissue health when maintained properly.
Clinical implications and practical guidance
Decision framework
Assess implant angulation, maintenance access needs, and the planned emergence profile.
Weigh biologic risks of cement versus cementless approaches in the patient’s history–a major factor here being ability to control gingival inflammation.
Leverage CEREC’s digital planning to confirm path of insertion and optimize margins before fabrication.
For non-parallel implants or where a screw channel would hamper occlusion or esthetics, cement-retained designs may be indicated; otherwise, modern CEREC workflows with a TiBase-ceramic crown combination can yield highly predictable screw-retained restorations.
Maintenance and long-term success
Across retention modes, emphasize meticulous oral hygiene and regular maintenance.
Cement-retained crowns: enforce rigorous cement management and margin cleanliness. Screw-retained crowns: ensure proper torque and anti-loosening strategies and verify that
the screw channel does not create occlusal interference.
Conclusion
Both cement-retained and screw-retained implant restorations offer reliable options with bone-level outcomes often similar when designed, fabricated, and diligently maintained with an adequate hygiene protocol. The choice should be guided by implant angulation, esthetics, retrievability needs, and the clinician’s comfort with the digital workflow. As CEREC and material options and tools advance, the ability to tailor the path of insertion, margins, and emergence continues to expand the predictability of both approaches.
References
- Alresheedi, B. A., Alazmi, S. O., Almutairi, F. J., & Zawawi, K. H. (2021). Ten-year Survival Rate of Cement- and Screw-retained Restorations on Bone-level Dental Implants in Grafted and Non-grafted Sites: A Retrospective Study. The International Journal of Oral & Maxillofacial Implants, 36(1), 161–169. https://doi.org/10.3290/j.ohpd.b2082139
- Hamed, M. T., Mously, H. A., Alamoudi, S. K., Hashem, A. B. H., & Naguib, G. H. (2020). A systematic review of screw versus cement-retained fixed implant-supported reconstructions. Clinical, Cosmetic and Investigational Dentistry, 12, 703-710. https://doi.org/10.2147/CCIDE.S231070
- Scherrer, S. S., Moráguez, O. D., Gavric, J., Worni, A., & Mojon, P. (2025). Multicenter RCT 5-year survival of screw-retained Cerec chairside-made hybrid abutment posterior ceramic crowns. Dental Materials, 41(9), 1151-1166. https://doi.org/10.1016/j.dental.2025.06.024
- Davaatseren, B., Kwon, J. S., Eom, S., Lee, J. H., & Kim, B. (2025). Influence of Abutment Geometry on Zirconia Crown Retention: An In Vitro Study. Materials, 18(11), 2469. https://doi.org/10.3390/ma18112469
- Aldhuwayhi, S. (2023). Zirconia in dental implantology: A review of the literature with recent updates. Materials, 12(5), 543. https://doi.org/10.3390/ma12050543 Ibrahim, E. A., Khamis, M. M., Ezzelarab, S., & Abdelhamid, A. M. (2023). Retention of zirconia crowns to titanium bases with straight versus angled screw access channels: an in vitro study. BMC Oral Health, 23, Article 77. https://doi.org/10.1186/s12903-023-03177-7
- Figures 1-5 Reprinted from CDOCS Workshop CL350 (2025)
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