Title Cement-retained prosthesis for single implant restoration has less technical complications than screw-retained prosthesis
Clinical Question For a patient needing single implant restoration, would cement-retained prosthesis result in fewer biological and technical complications as compared to screw-retained prosthesis?
Clinical Bottom Line For partially edentulous patients requiring single implant restoration, cement-retained prosthesis has less technical complications and similar rate of biological complications compared to screw-retained prosthesis based on the evidence from three systemic reviews.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
29243683Ragauskaitė/201710 studies/443 patients in vivo/167 implant restoration in vitroSystematic review of randomized trials
Key resultsFor technical complications, studies showed more failures in porcelain fractures and screw loosening for screw-retained restoration (38%; P<0.001 and 32%; P=0.001) than cement-retained restoration (4% and 9%). For biological complications, studies showed cement-retained restoration has more severe outcome in bone resorption (>2mm) compared with screw-retained restoration (frequency of 2.8% to 0%), but less on peri-implantitis, fistulas, and mucosal hypertrophy (P<0.005)
28385429Ramamoorthi/2017104 studies/9568 prosthesesSystematic review of randomized trials
Key resultsTechnical and biological complications were grouped into major complication (restoration needed major correction to continue its function) and minor complication (restoration remained in situ but needed minor modification). Screw-retained restoration (8.5%; 95% CI:5.5%-12.9%) demonstrated double amount of minor complications than cement-retained restoration (4.2%; CI:3.2-5.4%). No significant difference was noted for major complications (P>0.05).
25615920Millen/201573 studies/5858 prosthesesSystematic review of randomized trials
Key resultsFor single implant technical complication, in general there was no significant difference but a tendency toward more complications with screw-retained restoration (P = .071). For single implant biological complication, no significant difference was found.
Evidence Search Cement-retained[All Fields] AND Screw-retained[All Fields] AND (systematic[sb] OR Meta-Analysis[ptyp])
Comments on
The Evidence
Validity: The systemic reviews covered large amount of studies with adequate pool of patients and prostheses to allow inclusion in the review. Search was detailed, comprehensive and replicable Perspective: Based on current evidence, cement-retained restoration demonstrate less technical complications and similar rate of biological complications compared to screw-retained restoration. It should be noted that biological complication of cement-retained restoration highly depends on margin position relative to gingival margin and associated excess retained cements.
Applicability This evidence serves to assist providers when deciding prosthesis design for single implant restoration and educate patients of potential complications which can occur as a result of these types of implant restoration.
Specialty (General Dentistry) (Prosthodontics) (Restorative Dentistry)
Keywords Cement-retained, screw-retained, complications
ID# 3351
Date of submission 10/26/2018
E-mail leep4@livemail.uthscsa.edu
Author Paul T. Lee, DDS
Co-author(s) N/A
Co-author(s) e-mail N/A
Faculty mentor Jon M. Dossett, DMD
Faculty mentor e-mail dossett@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available