Screw-Versus Cement-Retained Restorations for Provisionalization of Implants

Type of Case: The fabrication of provisional prostheses is a treatment modality that is used to support and develop soft-tissue contours and improved health of a dental implant site before final restoration. The use of a provisional restoration may improve the esthetics and allow evaluation of the crown anatomy and soft-tissue interface. Developing the crown and soft tissue in the provisional phase allows the practitioner, patient, and laboratory technician to evaluate the potential for achieving the desired outcome. This paper contrasts the two predominant methods for fabricating provisional restorations and assesses their use in implant dentistry. Clinical Approach # 1 (AN, MN, and SP): There is very limited evidence on selecting different types of connection for implant provisional restorations. Although basic restorative principles apply, the selection between screw-over cement- retained provisional restorations is still based on empirical criteria. The use of cement-retained provisional restorations provides superior esthetics, even when implant position is not favorable. Conversely, the use of screw-retained provisionals eliminates the deleterious effects of cement. This approach aims to provide the indications for the different types of connection and to critically analyze their advantages and disadvantages. Clinical Approach # 2 (SJO and P-RL): Provisional restoration of implants in the esthetic zone improves the retention of hard and soft tissues and results in overall improved esthetic. Additionally, the fabrication of a provisional at the time of implant placement is a patient-centered treatment and shortens duration of treatment. This approach identifies important objectives for fabrication techniques. Various methods for fabricating cemented provisional prostheses are discussed, including numerous commercially available prefabricated abutments. The advantages and disadvantages are presented for each technique. Inherent technique difficulties and recommendations to avoid cement retention and timely fabrication are presented. Clinical scenarios are used to illustrate the inherent advantage of cemented restorations over screw-retained approaches.