Implants replacing individual teeth are highly esteemed for their life-likeness. So, it's understandable if you have a concern about one of the two ways for attaching the visible crown to the metal implant—some dentists use screws. Wouldn't that detract from its appearance?
The answer is not necessarily. Once the screw has been set in the crown, the dentist then applies a tooth-colored filling to cover the screw head. It does differ somewhat in appearance to a solid crown that's cemented onto the implant (the other primary means for crown attachment). But it's hardly noticeable without an up-close examination. There's also a slight chance of chipping near the access hole that could diminish its appearance.
But with that said, affixing a crown to an implant via screws does have some advantages over a cemented crown. It won't cause an inflammatory reaction or subsequent bone loss as can happen with dental cement. And, if the crown requires later removal for repair or replacement, it's much easier to remove a screw-retained crown than a cemented crown.
Screw-retained crowns are also preferred when a crown is attached at the same time as the implant's installation, a procedure known as immediate loading. Ordinarily, an implant is left uncrowned to allow it time to adequately integrate with the bone. The seal created by the cement in a cemented crown can become lost during this integration period, putting the implant at risk. And, as mentioned before, the cement could interact with the gum tissues to cause inflammation.
Cemented crowns, on the other hand, are useful where appearance is a more important factor. These crowns have more of a natural tooth look, and so may be preferred for highly visible teeth within the smile zone (the area of the jaws most visible when a person smiles).
Determining which method to use then will depend on a number of factors, including the type and location of the tooth replaced, whether or not the crown is immediately loaded or even the dentist's preference. But whether cemented or screwed, your implant-based crown will still be durable and quite life-like either way.
If you would like more information on your dental implant options, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “How Crowns Attach to Implants.”