Clinical Oral Investigations

, Volume 23, Issue 3, pp 1067–1075 | Cite as

Screw-retained monolithic zirconia vs. cemented porcelain-fused-to-metal implant crowns: a prospective randomized clinical trial in split-mouth design

  • Paul WeiglEmail author
  • Kristina Saarepera
  • Kristina Hinrikus
  • Yanyun Wu
  • Georgia Trimpou
  • Jonas Lorenz
Original Article



The objective of the present study was to compare the clinical performance of screw-retained, monolithic, zirconia, and cemented porcelain-fused-to-metal (PFM) implant crowns.

Materials and methods

In a prospective, randomized, clinical, split-mouth trial, 22 patients’ bilateral premolar or molar single-gap were restored with either screw-retained (test group) or cemented supraconstruction (control group). Clinical parameters, soft-tissue health, crestal bone-level changes, technical complications, and patient’s subjective feelings were recorded during a follow-up period of 12 months.


No implant was lost during the follow-up period. Of the crowns, 4.5% (test) and 9.1% (control) showed bleeding on probing (P = 1.000), and plaque was visible in 13.6% (test) and 27.3% (control) of the crowns (P = 0.240). Changes in bone crest level seemed to have no correlation with the restoration method (P = 0.77/0.79). Technical failures were observed in three restorations of the test and four of the control group. Evaluation of patients’ satisfaction revealed high acceptance regarding fit, esthetics, and chewing effectiveness in both groups.


Over a 12-month follow-up, screw-retained and cemented crowns could show comparable clinical and radiological results regarding soft tissue health, marginal bone level, and patient satisfaction. Duration of treatment alone was significantly shorter in screw-retained crowns.

Clinical relevance

Prosthetic retention methods are related with the occurrence of complications, such as peri-implantitis. However, scientific valuable data that proof superiority of a specific retention technique are rare. In single-gap implants, screw retention and cementation seemed to achieved comparable results.


Single-tooth implants Dental restoration Treatment outcome Cementation Screw-retaining Peri-implantitis 



The study was performed without funding from external resources.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the present study involving human participants were in accordance with the ethical standards of the Ethical Committee of Tartu University, Estonia (Protocol No. 234/T-5) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Scholander S (1999) A retrospective evaluation of 259 single-tooth replacements by the use of Brånemark implants. Int J Prosthodont 12:483–491Google Scholar
  2. 2.
    Romanos GE, Nentwig GH (2000) Single molar replacement with a progressive thread design implant system: a retrospective clinical report. Int J Oral Maxillofac Implants 15:831–836Google Scholar
  3. 3.
    Gibbard LL, Zarb G (2002) A 5-year prospective study of implant-supported single-tooth replacements. J Can Dent Assoc 68:110–116Google Scholar
  4. 4.
    Donati M, Ekestubbe A, Lindhe J, Wennström JL (2015) Implant-supported single-tooth restorations. A 12-year prospective study. Clin Oral Implants Res 27:1207–1211CrossRefGoogle Scholar
  5. 5.
    Gotfredsen K, Wiskott A (2012) Consensus report - reconstructions on implants. The third EAO consensus conference 2012. Clin Oral Implants Res 23:238–241CrossRefGoogle Scholar
  6. 6.
    Vigolo P, Mutinelli S, Givani A, Stellini E (2012) Cemented versus screw-retained implant-supported single-tooth crowns: a 10-year randomised controlled trial. Eur J Oral Implantol 5:355–364Google Scholar
  7. 7.
    Sherif S, Susarla HK, Kapos T, Munoz D, Chang BM, Wright RF (2014) A systematic review of screw- versus cement-retained implant-supported fixed restorations. J Prosthodont 23:1–9CrossRefGoogle Scholar
  8. 8.
    Sherif S, Susarla SM, Hwang JW, Weber HP, Wright RF (2011) Clinician- and patient-reported long-term evaluation of screw- and cement-retained implant restorations: a 5-year prospective study. Clin Oral Investig 15:993–999CrossRefGoogle Scholar
  9. 9.
    Lemos CA, de Souza Batista VE, Almeida DA, Santiago Júnior JF, Verri FR, Pellizzer EP (2016) Evaluation of cement-retained versus screw-retained implant-supported restorations for marginal bone loss: a systematic review and meta-analysis. J Prosthet Dent 115:419–427CrossRefGoogle Scholar
  10. 10.
    Anchieta RB, Machado LS, Hirata R, Bonfante EA, Coelho PG (2016) Platform-switching for cemented versus screwed fixed dental prostheses: reliability and failure modes: an in vitro study. Clin Implant Dent Relat Res 18:830–839CrossRefGoogle Scholar
  11. 11.
    Wilson TG, Valderrama P, Burbano M, Blansett J, Levine R, Kessler H, Rodrigues DC (2015) Foreign bodies associated with peri-implantitis human biopsies. J Periodontol 86:9–15CrossRefGoogle Scholar
  12. 12.
    Sailer I, Mühlemann S, Zwahlen M, Hämmerle CH, Schneider D (2012) Cemented and screw-retained implant reconstructions: a systematic review of the survival and complication rates. Clin Oral Implants Res 23:163–201CrossRefGoogle Scholar
  13. 13.
    Hofstede TM, Ercoli C, Hagan ME (1999) Alternative complete-arch cement-retained implant-supported fixed partial denture. J Prosthet Dent 82:94–99CrossRefGoogle Scholar
  14. 14.
    Zhang Y, Lee JJ, Srikanth R, Lawn BR (2013) Edge chipping and flexural resistance of monolithic ceramics. Dent Mater 29:1201–1208CrossRefGoogle Scholar
  15. 15.
    Pandis N (2012) Sample calculation for split-mouth designs. Am J Orthod Dentofac Orthop 141(6):818–819CrossRefGoogle Scholar
  16. 16.
    Kim Y, Oh TJ, Misch CE, Wang HL (2005) Occlusal considerations in implant therapy: clinical guidelines with biomechanical rationale. Clin Oral Implants Res 16:26–35CrossRefGoogle Scholar
  17. 17.
    Gross MD (2008) Occlusion in implant dentistry. A review of the literature of prosthetic determinants and current concepts. Aust Dent J 53:S60–S68CrossRefGoogle Scholar
  18. 18.
    Rilo B, da Silva JL, Mora MJ, Santana U (2008) Guidelines for occlusion strategy in implant-borne prostheses. A review. Int Dent J 58:139–145CrossRefGoogle Scholar
  19. 19.
    Yuan JC, Sukotjo C (2013) Occlusion for implant-supported fixed dental prostheses in partially edentulous patients: a literature review and current concepts. J Periodontal Implant Sci 43:51–57CrossRefGoogle Scholar
  20. 20.
    Koyano K, Esaki D (2015) Occlusion on oral implants: current clinical guidelines. J Oral Rehabil 42:153–161CrossRefGoogle Scholar
  21. 21.
    Torrado E, Ercoli C, Al Mardini M, Graser GN, Tallents RH, Cordaro L (2004) A comparison of the porcelain fracture resistance of screw-retained and cement-retained implant-supported metal-ceramic crowns. J Prosthet Dent 91:532–537CrossRefGoogle Scholar
  22. 22.
    Zarone F, Sorrentino R, Traini T, Di Iorio D, Caputi S (2007) Fracture resistance of implant-supported screw-versus cement-retained porcelain fused to metal single crowns: SEM fractographic analysis. Dent Mater 23:296–301CrossRefGoogle Scholar
  23. 23.
    Karl M, Graef F, Taylor TD, Heckmann SM (2007) In vitro effect of load cycling on metal-ceramic cement- and screw-retained implant restorations. J Prosthet Dent 97:137–140CrossRefGoogle Scholar
  24. 24.
    Nissan J, Narobai D, Gross O, Ghelfan O, Chaushu G (2011) Long-term outcome of cemented versus screw-retained implant-supported partial restorations. Int J Oral Maxillofac Implants 26:1102–1107Google Scholar
  25. 25.
    de Brandão ML, Vettore MV, Vidigal Júnior GM (2013) Peri-implant bone loss in cement- and screw-retained prostheses: systematic review and meta-analysis. J Clin Periodontol 40:287–295CrossRefGoogle Scholar
  26. 26.
    Weber HP, Kim DM, Ng MW, Hwang JW, Fiorellini JP (2006) Peri-implant soft-tissue health surrounding cement- and screw-retained implant restorations: a multi-center, 3-year prospective study. Clin Oral Implants Res 17:375–379CrossRefGoogle Scholar
  27. 27.
    Vindasiute E, Puisys A, Maslova N, Linkeviciene L, Peciuliene V, Linkevicius T (2015) Clinical factors influencing removal of the cement excess in implant-supported restorations. Clin Implant Dent Relat Res 17:771–778CrossRefGoogle Scholar
  28. 28.
    Wadhwani C, Goodwin S, Chung KH (2016) Cementing an implant crown: a novel measurement system using computational fluid dynamics approach. Clin Implant Dent Relat Res 18:97–106CrossRefGoogle Scholar
  29. 29.
    Wilson TG Jr (2009) The positive relationship between excess cement and peri-implant disease: a prospective clinical endoscopic study. J Periodontol 80:1388–1392CrossRefGoogle Scholar
  30. 30.
    Shapoff CA, Lahey BJ (2012) Crestal bone loss and the consequences of retained excess cement around dental implants. Compend Contin Educ Dent 33:94–96 98–101; quiz 102, 112Google Scholar
  31. 31.
    Bianchi AE, Bosetti M, Dolci G, Sberna MT, Sanfilippo S, Cannas M (2004) In vitro and in vivo follow-up of titanium transmucosal implants with a zirconia collar. J Appl Biomater Biomech 2:143–150Google Scholar
  32. 32.
    Hisbergues M, Vendeville S, Vendeville P (2009) Zirconia: established facts and perspectives for a biomaterial in dental implantology. J Biomed Mater Res B Appl Biomater 88:519–529CrossRefGoogle Scholar
  33. 33.
    Nakamura K, Kanno T, Milleding P, Ortengren U (2010) Zirconia as a dental implant abutment material: a systematic review. Int J Prosthodont 23:299–309Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Prosthodontics, School of DentistryJohann-Wolfgang Goethe UniversityFrankfurt/MainGermany

Personalised recommendations