Screw-Retained versus Cemented Implant Crowns

In our office, we restore tons of dental implants. So naturally, we keep abreast of the latest techniques in creating teeth that look, feel, and function like real ones.

And because we like to post so much implant information and photos on this site, we get lots of patients who ask us great questions. Recently, we’ve had a lot of inquiries on cemented versus screw-retained crowns. So we decided to do a post on it!

Screw Retained Implant Crown Photos

Below is a photo of one of many cases we’ve completed recently:

High quality photos of screw retained implant crowns

Photos of screw retained implant crowns. She went from bare implants to two new teeth in 45 minutes. Dentistry and photos Dr. Nicholas Calcaterra.

In the above case, you can see the screw heads peeking through the crowns in the second photo. We then placed a small filling over each screw head. She received two teeth in less than hour. By using this design, we did not need to use cement. But why did we choose screw-retained crowns?

Reasons for Screw-Retained Implant Crowns

dental implant no cement next to it

Excess cement around this implant can lead to failure.

In the past, many dental implant crowns were cemented on. This can lead to two potential issues:

  1. Retrievability: when a crown is cemented on, it cannot be removed without destroying it. So if there is ever an issue down the road, there is no easy way to address it without cutting off the crown.
  2. Implant Failures: research is showing that excess cement remaining on an implant after cementation can lead to implant failure. It can be difficult to find and locate all the excess cement that might remain.

When a crown is held on by a screw, it can be removed within 5 minutes if there is ever a problem. And since there is no cement used, there is no potential for failure due to excess cement.

So why not Use Screw-Retained Crowns all the Time?

That’s a great question! In many cases, the screw hole can affect the esthetics. This usually is not an issue for back teeth like molars. But when it comes to a front tooth crown, we have to take every single detail into account.

front tooth dental implant has to be cemented

In restoring this front tooth dental implant, we had to use cement. Photo and dentistry Dr. Nicholas Calcaterra.

In the above case, the screw hole would have affected the esthetics. And given that it is a front tooth – we want and need perfection. So in these types of cases we typically use cemented-on crowns.

Are you interested in implants? Do you have an implant but not a crown yet? Call us at (203) 799 – 2929 if you would like to know your options.

Reference on the the dangers of excess cement: The positive relationship between excess cement and perio-implant disease: A prospective clinical endoscopic study. Wilson TG Jr., Journal of Periodontology, 2009  80(9) : 1388 – 92).

We use American Dental Labs

formaldehyde is not found in Chinese dental crowns

Formaldehyde has not been found in crowns from China but other toxic chemicals have.

Most of you reading this probably can remember – or perhaps are dealing with – the Lumber Liquidators scandal involving Chinese products containing formaldehyde.

You may be asking what this has to do with dentistry and dental crowns. We’ll get to that.

Formaldehyde is a known carcinogen that is used to embalm tissue in addition to being employed in many industrial applications. In the Lumber Liquidators case, elevated levels were found in many of their flooring products, which were attributed primarily to lax oversight along with insufficient standards from their Chinese suppliers.

I’ll Take the Dental Crown Without Lead Please.

Unfortunately, dental crowns fabricated in China but tainted with toxic chemicals have been found in the United States.

dental crowns from China can contain lead

Does this crown contain lead?

In this 2008 ABC News story, a woman in Ohio received a new dental bridge with a very poor fit. After talking to the dentist – who worked at Aspen Dental – she had it tested and found it had high levels of lead. The lead levels were five times higher than what is allowed in children’s toys (source: CPSC). But remember, toys are not permanently cemented in anyone’s mouth and are not in 24 hour contact with saliva!

When she talked to that Aspen Dental office, she was told the bridge came from China.

This is not an isolated phenomenon restricted to the United States. This report out of Australia talks about crowns from Asian countries tainted with different heavy metals. And this report from the UK talks about Chinese crowns and the lack of oversight of the materials used.

Why Dental Products from China?

Money is saved by doing dental crowns in China but quality is compromised

Some dental offices – mostly Corporate Chains – use Chinese labs to save money.

Unfortunately, many dental offices, particularly corporate chains, will use Chinese labs because of one thing: $$$.

We get inquiries, fliers, and emails at least once a week from Chinese labs. The numbers are compelling – a Chinese crown can cost approximately five times less than what we pay to our Connecticut labs. But in nearly all cases, the quality is very poor, and there is no accountability if lead, cadmium or other toxic and dangerous materials are permanently embedded in the restoration.

As the saying goes, you get what you pay for.

Our Commitment to You

we use Connecticut labs for our dental crowns

We use Connecticut labs almost exclusively!

In our office, we ONLY use labs that fabricate the restorations in the United States, with most of them based in Connecticut. This allows us to make these commitments to you, our patients:

  • All dental restorations placed in our office will have been fabricated under the strict regulations of the FDA (Food and Drug Administration).
  • We are able to provide you with the exact “ingredients” used in our crowns.
  • You will never have to worry about toxic or improper chemicals being used in our restorations.

And lastly, since we use Connecticut based labs 99% of the time (we occasionally use a lab based in Missouri for special cases), we are helping to support the Connecticut economy and provide jobs to Connecticut based lab technicians. It’s a win-win-win situation for everyone… our patients, our Connecticut dental labs, and us!



Fifty Shades of Teeth

Have you ever looked at someone’s smile and immediately thought to yourself “Ouch, that tooth sticks out like a sore thumb!”

Front tooth crown with a bad color and shade match

This tooth was very noticeable. Photo by Dr. Nicholas Calcaterra – dentistry by someone else!

This patient was very uncomfortable with her smile. And she had every right to be uncomfortable (if you want to see how we fixed her smile you can go here).

When we analyze the shades of front teeth, we use what is called the 3-D shade guide. The guide is used by cosmetic dentists and has close to 30 shades. Then, when you factor in other variables such as translucency and light reflection, you get close to fifty shades of teeth!

So how do we achieve dramatic results?

A Match Made in Heaven

Let’s answer the question by looking at some dramatic results with before and after photos:

high quality before and after front teeth photo showing shade matching

We bent over backwards to match the shade. Without the pre-op photo, you would not be able to tell which teeth have crowns! Photo and dentistry Dr. Nicholas Calcaterra.

The above patient lives in Orange and is a student at Amity Regional High School. He suffered trauma to his two front teeth with both requiring root canals. One of his teeth was repaired by another office using bonding. The repair – somewhat sloppy – is very noticeable because the shade and contour do not match.

Because of the history of trauma, we did cosmetic all ceramic crowns on both teeth. We worked extremely hard, going through multiple steps (as outlined below), and were able to achieve a remarkable success. We believe the photos speak for themselves.

Shade Matching – A Team Approach

Many of you are probably asking – how do you achieve this?

Process to match a front tooth crown by color and best dental shade.

He began with a very dark crown due to trauma, as seen in the upper left. In the upper right, we hold one of many different shade tabs as part of our analysis. Note that he did NOT want the “tilt” or “midline slant” corrected – only the shade – because he felt that was his signature look! Dentistry and photos Dr. Nicholas Calcaterra.

We take a very rigorous and systematic approach. Some of the steps include:

  • We analyze your smile and the teeth/tooth bothering you. We first understand what your concerns are. We then recommend the most appropriate solution.
  • Based on your specific needs, we then select one of many Connecticut based labs that we use. We don’t ship our labwork overseas.
  • We take multiple photos and sometimes have you meet with a lab technician for a custom shade match.
  • We then let you try it in for a test drive – if you don’t like it – we tweak the shade until you are 100% satisfied.

Throughout the process, it is a team approach: our team, the lab, and you.

If you are unhappy with the shade of your crowns and would like to meet with us, call us at (203) 799 – 2929 or visit this page. We’d love to have you experience fifty shades of teeth.

Hockey Pucks Don’t Scare Us

It was just a routine day at the office for us. But not for our patient John. A senior at Amity High School in Woodbridge, John took a hockey puck to his front tooth! At first glance, it looked like a case of “man vs. hockey puck with the puck winning!” When John showed up at our office in Orange nearly 1 hour later, we collectively said “Not so fast Mr. Puck!”

Hockey Puck damage to front tooth before and after photos of dental work

Our patient John was cheerful but obviously distressed when he came in. We ultimately got him back to normal!

The photo above shows before and after shots of John. How did we do it? Did we mention that it was the Senior Prom in 36 hours?

Due to the extent of the fracture and the pain, we had to do an immediate root canal. Upon completion of that procedure, we did bonding to give John something to smile for the Prom. It worked.

For a fracture of this size, bonding is not the best long term solution. Cases like these require crowns. So, we prepared the tooth for an all ceramic crown. We did custom shading of the porcelain so it would match his other tooth completely. We were also able to close the gap slightly between his two front teeth. See a closeup below:

Before and after photo front teeth and hockey puck dentist with crown

Before and after photos. We did an all porcelain crown. Even at this closeup, there is no way you can tell it is a crown! Photos and dentistry by Dr. Nicholas Calcaterra.

John is now a student at UConn in Storrs and is very happy with his new tooth! And he is careful of hockey pucks. See you at your next cleaning John!