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A Screwmentable Approach for Predictable Posterior Implant Restoration by Dr. Christopher R. Resnik

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Categories: Implant Dentistry;
A Screwmentable Approach for Predictable Posterior Implant Restoration

by Dr. Christopher R. Resnik

Implant restorations in the posterior region must balance function, biologic health, and long-term serviceability. While both screw-retained and cement-retained restorations are widely used, each presents limitations that can complicate delivery and maintenance. Screw-retained restorations allow retrievability but may present challenges in delivery due to the line of draw, especially when seating multiple implant restorations. Cement-retained restorations achieve excellent aesthetics and have easier seating, but carry well-documented risks associated with residual cement. Screwmentable restorations—combining a custom abutment with an extraorally cemented crown and screw-access channel—offer a hybrid solution designed to address these concerns.1-4


Case overview
A patient presented for restoration of three adjacent posterior implants at sites 29, 30, and 31. The restorative objective was to deliver durable, functional restorations that support peri-implant tissue health while allowing long-term retrievability. Restorative options include screw-retained, cement-retained, or screwmentable restorations. Since there were multiple implants at varying implant angulation, a screwmentable approach was selected. In collaboration with Glidewell Dental Lab, the screwmentable restorative approach leverages the lab’s digitally driven design and manufacturing workflows. This approach allows easier seating of the independent implant restorations, while minimizing the biologic risks associated with intraoral cementation.


Restorative planning and design
Using a fully digital workflow, custom abutments were designed by Glidewell Lab to establish proper emergence profiles and support peri-implant soft tissue (Fig. 1). All three abutments were fabricated with supragingival margins, improving visibility at delivery and reducing the risk of undetected cement.3 The custom abutments were designed to be parallel, simplifying crown fabrication and improving the predictability of insertion and seating.
A Screwmentable Approach for Predictable Posterior Implant Restoration
Fig. 1: Digitally designed, parallel gold anodized custom abutments with supragingival margins.

As part of Glidewell Lab’s restorative workflow, the custom abutments were gold anodized, a complementary service intended to enhance soft-tissue aesthetics and improve visibility at the restorative margin. Gold-tone anodization can help reduce the visual impact of the abutment through peri-implant tissues, particularly when margins are supragingival or tissue levels change over time (Fig. 2).
A Screwmentable Approach for Predictable Posterior Implant Restoration
Fig. 2: Seated custom abutments in sites 29, 30, and 31.

Each definitive crown was fabricated individually. With the screwmentable option, crowns can be cemented to respective abutments in the laboratory under controlled conditions or, based on clinician preference, can be provided separate from the abutment for the clinician to cement (Fig. 3). Extraoral cementation has been shown to significantly reduce residual cement, a known contributor to peri-implant inflammation and disease.2,3 This digitally coordinated workflow allowed margin integrity and fit to be verified prior to clinical delivery.

A Screwmentable Approach for Predictable Posterior Implant Restoration
 
A Screwmentable Approach for Predictable Posterior Implant Restoration
  
Fig. 3: Extraoral cementation of individual crowns to gold anodized custom abutments. Glidewell Lab performs this as a standard service, or the clinician can request that the abutment and crown be provided separately if the clinician prefers to cement chairside.


Delivery and clinical outcome
At delivery, the custom abutments were inserted into the implants utilizing a seating jig. Verification X-rays were taken to confirm seating. The abutments were then torqued to 35 ncm, based on manufacturer recommendations (Fig. 4). A true benefit of the screwmentable options is that each crown is tried in like conventional crown and bridge. This allows for easier seating and adjustments to the contact areas, especially when inserting adjacent implant restorations. After precise adjustment of interproximal contacts and occlusion, each crown demonstrated a passive fit, stable occlusion, and appropriate contours for hygiene access. The crowns were then cemented extraorally to the respective custom abutments.
A Screwmentable Approach for Predictable Posterior Implant Restoration
Fig. 4: Clinical delivery of screwmentable restorations prior to sealing screw-access openings.

The implant restorations were then re-inserted and re-torqued to 35 ncm. After waiting 10 minutes to allow for the settling effect, the screws were re-torqued. Screw-access openings were sealed with Teflon tape and composite fillings were placed. Postoperative evaluation demonstrated healthy peri-implant tissues and patient comfort. From a clinical standpoint, the screwmentable workflow streamlined delivery while maintaining restorative control.


Discussion
Screwmentable restorations offer meaningful advantages for general dentists restoring posterior implants. The use of custom, gold anodized abutments with supragingival margins enhances cement control, margin visibility, and soft-tissue aesthetics while simplifying long-term maintenance. Parallel abutment design improves restorative efficiency, particularly when restoring multiple adjacent implants, as well as improving the retention and resistance of the restoration.

By combining lab-based cementation with screw-retained retrievability, screwmentable restorations provide flexibility without sacrificing biologic safety. When paired with a digitally advanced laboratory partner such as Glidewell Lab, clinicians can leverage precise design, controlled manufacturing, and predictable clinical outcomes.


Conclusion
For posterior implant cases involving multiple adjacent sites, screwmentable restorations represent a predictable and versatile restorative option. The combination of digitally designed, parallel, supragingival gold anodized abutments with individually restored units allows clinicians to optimize contacts, occlusion, and peri-implant health while preserving retrievability. This hybrid approach supports long-term success and aligns well with modern, digitally driven restorative workflows familiar to today’s general dentist.

References
1. Hebel KS, Gajjar RC. Cement-retained versus screw-retained implant restorations: achieving optimal occlusion and esthetics in implant dentistry. J Prosthet Dent. 1997;77(1):28–35.
2. Wilson TG Jr. The positive relationship between excess cement and peri-implant disease: a prospective clinical endoscopic study. J Periodontol. 2009;80(9):1388–1392.
3. Linkevicius T, Vindasiute E, Puisys A, et al. The influence of margin location on the amount of undetected cement excess after delivery of cement-retained implant restorations. Clin Oral Implants Res. 2011;22(12):1379–1384.
4. Michalakis KX, Hirayama H, Garefis PD. Cement-retained versus screw-retained implant restorations: a critical review. Int J Oral Maxillofac Implants. 2003;18(5):719–728.

This content is sponsored by Glidewell Laboratories.
For more information, visit glidewelldental.com.
Author Bio
Dr. Christopher R. Resnik Christopher R. Resnik, DMD, MDS, DICOI, is a prosthodontist in private practice in Winter Park, Florida. He completed his dental degree, prosthodontic residency, and master’s degree in oral implantology at the University of Pittsburgh School of Dental Medicine. He is a faculty member of the Resnik Implant Institute and holds associate faculty positions at the University of Pittsburgh Graduate Prosthodontic Program, University of Louisville Graduate Prosthodontic Program, and Temple University Graduate Periodontics Program.


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