SCREW-MENTABLE ??

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So yes. This is a thing.
But why you ask ?

   First of all I want to mention that there isn’t any scientific data on this topic that I could find.
It seems this type of restoration came as a result of seasoned clinicians and technicians problem solving and engineering a creative solution.

Thank you Dr Anthony Mennito AKA @smileprofessor for the photo

I’m sure you know well, there are pro’s and cons of both cementable and screw retained implant prosthetics. As a lab we have no preference either.

However, sometimes we have to be creative together to provide the best outcome for the patient.  A Screwmentable option can be just the solution we need.

For example. It is less than ideal to have your access hole so near to a functional or esthetic part of the restoration.

This may be unavoidable depending on implant placement. Plus in an esthetic zone you would prefer a screw retained restoration.

So lets compare.

Screw retained restorations seem to be more common mainly because of cement associated peri-implantitis.
Some other pluses, are that they are accommodating in a situation where there is a shortage of vertical space and are easier to remove if the need arises. Another plus is they are less expensive to produce.

If you have to make adjustments to your proximal contacts, it can be cumbersome to keep screwing it on and off and then pray you didn’t take too much away once you’ve torqued it down.

Also, in the situation with splinted units or a bridge, draw and angulation can be a challenge for seating as well.

A custom abutment(s) and cemented prosthesis are certainly still a practice widely used. Customizing an abutment can make up for poor implant angulation especially when designing a multi unit or splinted restoration.

Having 2 parts will make for an easier path of insertion. Downside is, if you have to remove the restoration for some reason, you risk heating the implant while cutting off the crown.

Something to think about in a patient you for see transitioning into a multiple implant restorative situation.

” Always have future engineering in mind “

“What if I need angle correction with out the angulated channel and special driver. Then I need abutment and crown separately. But don’t want to worry about residual cement affecting the health of the implant ?I would like to plan for easy retrievability.”

With a Screwmentable option you simply integrate the two restorative concepts. 
There is no change in work flow for the doctor or the lab.
You can have the abutment margin slightly sub gingival since you are cementing the crown to the abutment extra orally. Very useful in an esthetic zone.

Always know that you can reach out to our implant specialists to discuss a case together. 

There probably isn’t much ‘Young ” Johnny here hasn’t seen or figured out.

Written by Roberta Bertram CDA

Reviewed by John Zahel RDT

                                                                                                                           
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