Cemented or screw‑retained single crowns — what the new randomized‑trial meta‑analysis means for your chair

A 2026 meta‑analysis of randomized trials found no clear difference in marginal bone loss between cemented and screw‑retained single implant crowns overall, but heterogeneity and biological risks from excess cement argue for a pragmatic, case‑by‑case choice.

Choosing retention for a single implant crown is a daily decision in every clinic. A new systematic review and meta‑analysis of randomized clinical trials pooled eight RCTs (154 cemented, 166 screw‑retained crowns) and found a pooled mean difference in marginal bone loss of −0.17 mm (95% CI −0.36 to 0.03) favouring screw retention but not reaching statistical significance (P = 0.08). The authors highlight substantial between‑study heterogeneity (I2 = 86%). ([lifescience.net](

Put bluntly: the average difference — under two‑tenths of a millimetre — is small. In practical terms that magnitude is well within the range of early bone remodelling and the measurement noise of routine periapical radiographs, so you should not expect dramatically different radiographic bone levels simply because you chose cement or screw retention. The meta‑analysis conclusion is therefore: both retention methods can be compatible with stable marginal bone when done carefully. ([lifescience.net](

That said, the pooled result hides consistent themes in the individual trials. Some recent controlled studies found more bone loss and more biological events with cemented crowns, usually linked to residual excess cement. A 24‑month comparative study of 38 cemented versus 38 screw‑retained posterior single crowns reported mean MBL 1.12 mm (cemented) versus 0.68 mm (screw), and found excess cement in about one third of cemented cases — excess cement strongly correlated with bone loss (r = 0.71, p<0.001). This is the clearest, most directly actionable finding for everyday practice: cement left subgingivally is a real and avoidable risk. ([pmc.ncbi.nlm.nih.gov](

Another recent systematic review focused on zirconia crowns found that screw‑retained restorations had less early bone loss and a lower complication rate in some analyses, although long‑term bone levels were similar between methods. Taken together, the literature points to two consistent trade‑offs: cementation lowers the risk of an unsightly access hole and can simplify occlusion and emergence profile; screw retention gives you easy retrievability and reduces the biological risk from cement. ([pmc.ncbi.nlm.nih.gov](

What this means on Monday morning. If you are restoring a posterior implant in a patient with limited access for hygiene, thin gingival biotype, or a history of periodontal problems, favour screw retention — retrievability helps you remove biologic complications early, and it avoids the single biggest preventable cause of inflammation: excess cement. If the case is aesthetic (high smile line), and you plan margin control that keeps the cement supragingival, cementation remains acceptable — but only if you use a strict cementation protocol and document it. ([pmc.ncbi.nlm.nih.gov](

Practical, low‑cost steps to reduce cement risk in a modest clinic: place the crown margin at or slightly above the mucosal margin whenever anatomy allows; use a minimal amount of cement and vent the crown before seating; cement crown extra‑orally onto an abutment or use a preformed cementation jig so you can remove excess easily before delivery; consider provisional (easily retrievable) cement for single crowns where retrievability may be needed; always take a periapical radiograph after cementation and check clinically for cement with explorer and floss. When in doubt, prefer a screw‑retained solution or a screw‑access on a customized abutment — the equipment and time cost is low compared with treating peri‑implantitis later. ([pmc.ncbi.nlm.nih.gov](

Limitations and honest caveats. The 2026 meta‑analysis pooled only randomized trials but follow‑ups and prosthetic designs varied, explaining the high heterogeneity. Some comparative studies are small and use different implant/abutment systems, so local factors (implant platform, connection, abutment height) still matter. The bottom line: this evidence does not mandate one universal rule — it supports an individualized choice, with an emphasis on strict cement control when cementation is used. ([lifescience.net](