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).

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!

Why Teeth with Root Canals Often Need Crowns

When we do a root canal on a back tooth, we nearly always recommend a crown. Many of our patients will naturally ask us why? Frequently, the last thing a patient wants to do after they have recently had a root canal is to then sit in the chair for a crown! We certainly wouldn’t want to either. So why?

A picture is worth a thousand words, and we think this photo of one of our patients tells a descriptive story:

broken or cracked or split tooth high quality photo

This premolar on one of our patients literally split in two! After the root canal, we had recommended a crown, but he declined. The patient lost the tooth and needed an implant. Photo and subsequent dentistry by Dr. Nicholas Calcaterra.

As described in the photo above, this tooth cracked into two pieces with a fracture going deep beneath the gum tissue. If he had a crown, this would not have occured. He lost the tooth and needed a dental implant.

Brittleness + Great Forces = Tooth Failure

When a tooth has had a root canal, it becomes brittle. It loses the ability to flex slightly under loads. In addition, there is less natural tooth structure remaining, typically because of a past history of dental decay. When you put that all together, you have a very weak tooth.

The jaw muscles, specifically the masseter, are generally considered to be the strongest muscles in the human body. In one test, the masseter was able to generate a force of 975 pounds!

When you apply a force of several hundred pounds to a weak and brittle tooth, the following will likely happen:

Fractured tooth high quality photo and picture

Fractured lower left molar. In this case, the tooth could be saved, but not without heroic efforts. Photo and subsequent dentistry by Dr. Nicholas Calcaterra

This lower molar fractured after root canal treatment. In this case, the tooth was able to be saved by doing a special procedure called crown lengthening and then placing a crown.

How Crowns Protect Teeth

dental crown photo showing a reflection in the mirror

This crown will slide over the tooth, protecting it.

A dental crown, often called a “cap”, is a custom fabricated combination of either porcelain or metal that covers the entire surface of the tooth above the gumline. When you chew, the powerful forces that hit the crown are then directed down the long axis of the tooth.

In addition, the chewing forces cannot exert a splitting force onto the tooth, because the entire tooth is covered. As a result, catastrophic fractures like the ones seen above are avoided.

The photo to the right shows a crown for one of our patients. It will fit completely over the tooth. Not only will it prevent fractures but it will make the tooth look much more natural and esthetic.

Below are before and after photos of we preserved two badly broken down teeth with crowns:

Before and After photos of all ceramic and porcelain dental crowns

The above teeth had large silver fillings and both fractured. We were able to protect them with beautiful all ceramic crowns! Photos and dentistry by Dr. Nicholas Calcaterra

We hope that the narrative and the photos show you that teeth can break. And when they do break, the results can be catastrophic! So if/when you need a root canals on a back tooth, you should strongly consider getting a crown if your dentist recommends it.