Dra. Cléo Salustiano In this article
SummaryHow does each type of implant crown attachment work?What changes day to day and at maintenance visits?FAQRead nextScrew-retained vs. cement-retained implant crown: what's the difference?
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Quick summary of this article+
A screw-retained crown is held to the implant by an internal screw and stands out for easy, reversible maintenance. A cement-retained crown is bonded onto an abutment and stands out for its intact surface, with no access hole. Both work well when properly indicated. The choice is technical — it depends on the implant's position, esthetics and bite — and it's made during treatment planning with your dentist, not as a catalog preference.
Screw-retained or cement-retained: what's the difference in practice? Both are ways of attaching the crown to a dental implant. A screw-retained crown is held by a screw that passes through the crown itself. A cement-retained crown is bonded onto an intermediate piece called an abutment, much like a regular crown on a natural tooth. Both work well when properly indicated. The choice depends on the tooth's position, the available space and the treatment plan.
Most patients never think about this until they hear both terms at the dental office — or until the crown needs maintenance. In clinical practice, people often find out their crown was cemented only when it comes loose, or that it was screw-retained when they notice a small filled spot on the tooth's surface.
In this article, Dr. Cléo Salustiano (CRO-SP 170844), a dentist in Mooca, São Paulo, explains how each type of attachment works, the pros and cons of each, and what drives the choice. Keep in mind that the decision is always individual and made during an in-person assessment.
This article comes from Dr. Cléo Salustiano's dental office in Mooca, São Paulo (care in English, Portuguese and Spanish). See the dental implants page to learn how the treatment is done here and book your assessment.
How does each type of implant crown attachment work?
With a screw-retained crown, the crown is fixed directly to the implant (or to an intermediate component) by a screw that runs through it. The small access hole is then sealed with tooth-colored composite. The big advantage is reversibility: at any maintenance visit, the dentist can open the access, loosen the screw and remove the whole crown without damaging it.
With a cement-retained crown, an abutment is first screwed into the implant. The crown is then cemented onto that abutment, much like a crown on a natural tooth. The main advantage is esthetics and fit: with no access hole, the surface stays intact. This helps with very visible teeth, or when the implant's angle would place the screw access in a visible spot.
The trade-off with cemented crowns lies in maintenance and the cement itself. Removing the crown later, if needed, is more complicated and may require making a new one. Also, any excess cement that seeps under the gum during placement must be removed thoroughly — leftover cement is associated with inflammation around the implant.
The trade-off with screw-retained crowns is mainly esthetic and mechanical. The access hole exists, even if it's disguised with composite. With a steeply angled implant, the access could end up on the front of the tooth, which rules this option out unless special components are used. On the plus side, no cement is involved, which makes it easier to keep the surrounding gum healthy.
In both cases, the crown can be made of porcelain or zirconia, and the final look tends to be very similar when the case is well planned. The current trend, whenever the implant's position allows, is to favor screw retention because it makes maintenance easier — but in some situations cement retention is still the more suitable answer.
The treatment plan decides: the implant's position and angle, the space between teeth, gum height, bite and esthetic needs. That's why this isn't a catalog preference. It's a technical decision made case by case, based on exams and often a digital scan.
| Feature | Screw-retained crown | Cement-retained crown |
|---|---|---|
| How it's attached | A screw passes through the crown into the implant | Cemented onto an abutment fixed to the implant |
| Removal for maintenance | Simple and reversible, without damaging the crown | More complicated; may require a new crown |
| Surface esthetics | Access hole sealed with composite | Intact surface, no hole |
| Effect on the gum | No cement; easier hygiene around the implant | Excess cement must be removed thoroughly |
| Usually preferred when | The implant's position allows it | Angled implants or high esthetic demands |
| Who decides | Individual treatment plan based on exams | Individual treatment plan based on exams |
What changes day to day and at maintenance visits?
In daily life, almost nothing changes. Both types let you chew, talk and smile normally, and the hygiene routine is the same: thorough brushing, cleaning between the crown and neighboring teeth (with floss, an interdental brush or a water flosser, as advised) and extra attention to the gumline.
The difference shows up at routine maintenance. A screw-retained crown can be easily removed and put back at check-ups. This helps the dentist inspect components, retighten the screw to the correct torque and treat the gum when needed. It's a practical advantage that adds up over years of use.
With a cemented crown, check-ups focus on the fit, the bite and the health of the surrounding gum. At placement, the dentist takes extra care to remove any excess cement below the gumline. If the crown ever needs to come off, the patient is told in advance that it may not be reusable.
Some warning signs apply to both: a crown that feels loose, bleeding gums around the implant, persistent bad breath in that area, or discomfort when chewing. These call for an appointment — don't wait for your scheduled check-up. The sooner the cause is found, the simpler the fix usually is.
Whatever the attachment, regular check-ups at the dental office are what keep everything healthy in the long run. In Mooca, Dr. Cléo follows up patients with implant crowns at maintenance visits, Monday to Sunday, 8 a.m. to 10 p.m.
Which is better: a screw-retained or a cement-retained crown?
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Neither is right for every case. Screw retention makes future maintenance easier and needs no cement. Cement retention gives a surface with no hole and works for angled implants. The choice comes from the case plan — implant position, esthetics and bite — made during an in-person assessment.
How do I know if my crown is screw-retained or cemented?
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Ask the dentist who did the treatment, or bring your records to the appointment. A common sign of a screw-retained crown is a small composite filling on the chewing surface. When there's no history available, a clinical exam and an X-ray can reliably identify the type.
Does the little hole make a screw-retained crown look worse?
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Usually not. The hole sits on the chewing surface or faces inward, sealed with tooth-colored composite, so it goes unnoticed when you talk or smile. When the implant's angle would put the access on the front of the tooth, the dentist considers alternatives.
Do cemented crowns come loose more easily than screw-retained ones?
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Not necessarily. A cemented crown can lose its cement over the years, and a screw-retained crown can have its screw loosen. Each has its own type of issue, and both can be fixed at the dental office. What matters most for longevity is planning, bite and regular maintenance.
Is crown cement bad for the gums?
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The cement itself isn't, as long as all the excess is removed at placement. Residue left below the gumline is associated with inflammation around the implant. That's why cementation is done with careful technique and checking — and the area is monitored at check-ups.
Can a cemented crown be replaced with a screw-retained one?
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In many cases, yes, especially when the implant's position allows the screw access in a discreet spot. It means removing the current crown and making a new one. The dentist uses exams to assess whether the change brings a real benefit for maintenance and gum health.
Does a screw-retained crown always need maintenance?
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Regular check-ups apply to any implant crown. With a screw-retained crown, the dentist can check the screw torque and remove the crown for inspection when needed. How often you need check-ups is individual — based on your hygiene, bite and history — and discussed at your appointment.
Does screw vs. cement retention change how I chew?
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No. When well planned and adjusted, both restore comfortable, secure chewing. Fine-tuning the bite at placement — and at check-ups — is what helps the crown work in harmony with your other teeth, whatever the attachment type.
Does the crown material change depending on the attachment?
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Not necessarily. Porcelain and zirconia can be used for both screw-retained and cemented crowns. Material and attachment are two decisions within the same plan: one looks at esthetics and strength; the other at implant position and future maintenance.
Are full-arch implant dentures also screw-retained?
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Fixed full-arch dentures on implants (known in Brazil as "protocolo") are usually screw-retained, precisely because they need to be removed periodically for maintenance and professional cleaning. It's the same principle as a single screw-retained crown, applied to a larger structure supported by several implants.
Can a screw-retained crown come loose?
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The screw can loosen over time, especially with a strong bite or teeth grinding (bruxism). The advantage is that the dentist can remove the crown, retighten or replace the screw and put the same crown back, usually without making a new one.
Which attachment works for a front tooth?
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It depends on the implant's angle and the esthetics. When the screw access would come out on the visible surface, cementing or using components that change the screw angle may be preferred. The plan weighs esthetics, hygiene and maintenance.
Where can I get an implant crown in Mooca?
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Dr. Cléo Salustiano (CRO-SP 170844) places implant crowns in Mooca, São Paulo, with individual planning, Monday to Sunday, 8 a.m. to 10 p.m. She sees patients in Portuguese, English and Spanish. Book via WhatsApp at (11) 97409-7834 or on Doctoralia.
