Screw Retained Benefits

RileyS

RileyS

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Can we make a list of when to use a screw retained crown? Why use one over separate crown cemented to abutment?
My doc wrote on lab slip, "would custom or a screw retained be better to fill in interprox gap?" Since there is a distance from abut to mesial adjacent tooth, would the SR help torque it down on top of the tissue better? (See the pic)

srfcz question.jpg

Other pro's:
Ease of use to doc - no cement clean up, especially for a deeper margin.
Maybe pt has hygiene issue, this way doc can remove and clean as needed?
 
rkm rdt

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How about a list on when to use a guide ?
That is more important for the very reason of this pic.

I would suggest a screw retained here because the screw is very likely to loosen and he will have to remove it.

Time to introduce the "no guide,no warranty" policy.
 
CatamountRob

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So the question is.....
Why screw?
I'm not going to answer, just checking.
 
A

adl

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Can we make a list of when to use a screw retained crown? Why use one over separate crown cemented to abutment?
My doc wrote on lab slip, "would custom or a screw retained be better to fill in interprox gap?" Since there is a distance from abut to mesial adjacent tooth, would the SR help torque it down on top of the tissue better? (See the pic)

View attachment 24726

Other pro's:
Ease of use to doc - no cement clean up, especially for a deeper margin.
Maybe pt has hygiene issue, this way doc can remove and clean as needed?
How many mm from the abut to distal of 20 ?
 
Affinity

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Most all of these I do now are screwmented with custom abutment. Dr Cements the crown, and the margins arent deep to cause any cement issues. Fully retrievable.
 
Andrew Priddy

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we are probably at a higher SR ratio than most labs.. we do a lot of UCLA's, but would probably do a screw retained over a custom abutment..
my point is, a custom abutment will allow more surface area for cementation. definitely wouldn't go over a Tibase though
 
Brett Hansen CDT

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I average about one screw-retained crown a day. Almost all of these are done with an Atlantis custom Titantium base and a monolithic crown over top(Zenostar, Zenostar MT, or e.max). Screw retained crowns have a huge advantage over cement retained for the reasons stated above. The reason I choose to go cement retained over screw retained is almost always do to the path of insertion into the implant. If the implant wasn't placed so that it is parallel with the adjacent contacts, then cement retained is usually a better option so we don't create a food trap.
 
Car 54

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Pretty much a summery of what others have said? Maybe crew retained when there is going to be a large space to fill on either to the distal or mesail where the occlusal forces will probably try to rock the abutment lose. Cementable when due to path of insertion, and the greater ability to keep the contact spaces filled.

For cementable they can chair-side make a Blu Mousse "prep" inside the crown, put a small amount of cement in the crown, fit it on the Blu Mousse prep, letting the excess ooze out, then cement the crown with that amount of cement inside, making a easier clean up, and less chance of peritonitius.
 
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In my little brain, the same contours are required for esthetics and function, regardless of how its held in place. If the screw channel allows, then I prefer screw retained.

On SteveDs post, I disagree. They give the nod to cement retained for esthetics? There should be no detectable difference.

Other than an access hole, occlusal for would/should be the same.

Flexability of fixture placement? Same issue of disagreement from me.

Draw an out line of the implant, abutment and crown, using proper form for esthetics and function...staying within the protocols for implant loading. Now you can either draw a margin at the tissue and have a custom abutment and crown, or drop the margin sub ging and add a screw channel.

Either way, should have the same end result.
 
rkm rdt

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Screw retained allows you to drop a margin past the 1-1.5 mm guidelines.
 
CatamountRob

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In my little brain, the same contours are required for esthetics and function, regardless of how its held in place. If the screw channel allows, then I prefer screw retained.

On SteveDs post, I disagree. They give the nod to cement retained for esthetics? There should be no detectable difference.

Other than an access hole, occlusal for would/should be the same.

Flexability of fixture placement? Same issue of disagreement from me.

Draw an out line of the implant, abutment and crown, using proper form for esthetics and function...staying within the protocols for implant loading. Now you can either draw a margin at the tissue and have a custom abutment and crown, or drop the margin sub ging and add a screw channel.

Either way, should have the same end result.
Proximal contacts can be an issue with screw retained. With cement retained you can often correct the POI and get better contacts. The adjacent teeth can sometimes be adjusted to eliminate this issue but I find Drs loathe to go that route.
I should add that this could also be eliminated with a surgical guide as well, but......
 
2thm8kr

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In the anterior, implant placement in the center of the ridge will place the screw channel exiting on the buccal surface or incisal edge. Even with angled screw channels for hybrids it is not always possible to do a screw retained in this region. Long connection implants like Straumann bone level are not going in the posterior if the POI is not in line with the adjacents. Guided placement doesn't always mean perfect positioning either, it all depends on skeletal structure below the gingiva. If it is deficient, will the patient go for the expense and time to augment for a better result.
 
rkm rdt

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In the anterior, implant placement in the center of the ridge will place the screw channel exiting on the buccal surface or incisal edge. Even with angled screw channels for hybrids it is not always possible to do a screw retained in this region. Long connection implants like Straumann bone level are not going in the posterior if the POI is not in line with the adjacents. Guided placement doesn't always mean perfect positioning either, it all depends on skeletal structure below the gingiva. If it is deficient, will the patient go for the expense and time to augment for a better result.
They usually will if they are informed....and the surgeon doesn't soak them for the privilege.
 
Andrew Priddy

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I do an average of 5 a day
money
cast on Thursday, fished out my Friday
IMG_0295.jpg


mostly Straumann and Nobel, but seeing a rise in Zimmer, Bio3i, and Astra EV
these are by far our best Doctors that go PFM as their preference for implant work
 
Andrew Priddy

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on a side note: we QC the ceramic work prior to final polish on the cuff.. avoids re-fire and over polishing of the cuff
 

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