Choosing the Right Implant Restoration

The implant is placed, it has integrated, and now the restorative decision is yours. Screw-retained or cement-retained? Stock abutment or custom? These choices shape retrievability, tissue health, and how the final restoration looks and lasts. There is rarely one right answer — but there is usually a best answer for the case in front of you. Here is how we think about it, and what we tend to recommend.

Screw-retained vs cement-retained

This is the first fork in the road, and it matters more than most others.

Screw-retained

The restoration threads directly onto the implant or abutment and is torqued down through an access channel.

• Retrievable — back it out for maintenance, repair, or hygiene without destroying anything
• No residual cement — and therefore no cement-driven peri-implant inflammation
• Needs an access hole, which constrains where the implant can be angled

Cement-retained

A crown is cemented onto an abutment, much like a conventional crown on a prepared tooth.

• More forgiving of implant angulation — no visible access channel to hide
• Often a simpler, more familiar seating procedure
• The real risk is excess subgingival cement, a leading cause of peri-implantitis if it is not meticulously removed

If you can retrieve it, you can maintain it. Where the case allows, we lean screw-retained.

A quick decision guide

If the case is…	We usually suggest
Angled implant, aesthetic zone	Cement-retained (or angled screw channel)
Posterior, hygiene-driven	Screw-retained
Full-arch or likely to need service	Screw-retained
Single anterior, ideal angulation	Either — driven by the access-hole position

Abutments: stock vs custom

A stock abutment is fast and economical, and for well-positioned implants it is often all you need. A custom abutment — milled to the specific case — earns its cost when:

1. The emergence profile needs shaping to support the soft tissue
2. Margins need to sit at a consistent, cleanable depth around the whole circumference
3. Angulation correction is required to bring the screw channel into a restorable position

What we recommend

For most cases we start from a simple principle: make it retrievable, keep cement out of the sulcus, and let the soft tissue heal against a shape that was designed on purpose. Send us the implant system and platform, a scan or impression, and your preference — and we will come back with a plan, not just a part.

Have a case you would like a second opinion on? Get in touch and we will talk it through before anything is made.