Screw-Retained versus Cement-Retained Implant-Supported Prostheses: A Systematic Review of Clinical Outcomes
Abstract
Background: Implant-supported prostheses may be retained using screwretained or cement-retained mechanisms, each presenting distinct biological, mechanical, and prosthetic considerations that may influence long-term clinical outcomes. Aim: This systematic review aimed to compare the clinical performance of screw-retained and cement-retained implant-supported prostheses with respect to implant survival, marginal bone loss, biological complications, technical complications, esthetic outcomes, patient satisfaction, retrievability, and costeffectiveness. Materials and methods: This systematic review followed PRISMA 2020 guidelines and was prospectively registered in the PROSPERO database (CRD420251003584). A comprehensive electronic search was conducted in PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials BETWEEN June 2024 to January 2025. Randomized controlled trials and observational clinical studies comparing screw-retained and cement-retained implant-supported prostheses with a minimum follow-up of 12 months were included. Risk of bias was assessed using the Cochrane RoB 2.0 tool for randomized trials and the ROBINS-I tool for non-randomized studies. Due to heterogeneity among studies, results were synthesized narratively. Results: Twenty-eight studies involving 2,457 patients and 3,219 implantsupported prostheses met the inclusion criteria. Implant survival rates exceeded 95% for both retention systems. Marginal bone loss and esthetic outcomes were comparable between groups. Biological complications were slightly more common in cement-retained prostheses, whereas screw-retained prostheses showed a higher incidence of screw loosening. Patient satisfaction was high for both retention types. Retrievability was consistently better with screw-retained prostheses. Conclusion: Although demonstrating overall favorable clinical outcomes, there were excess cement related biological issues encountered with cement retained and screw loosening issues encountered with screw retained prostheses. The choice of retention system should be guided by prosthetic design considerations, esthetic requirements, and anticipated maintenance needs.