Factors Affecting the Decision to Use Cemented or Screw-Retained Fixed Implant-Supported Prostheses: A Critical Review

Purpose: This review aimed to compile and enumerate all the factors described in the literature that may affect the decision to use either cemented or screw-retained restorations and to determine the relative weights of each factor by type of retention and prosthesis. Materials and Methods: The literature was reviewed, and the factors were classified as either determining (present in a clinical situation in which one of the retention mechanisms was clearly more suitable than the other) or conditioning (present in clinical situations in which one type of restoration was not clearly more advantageous than the other). Results: Three determining factors (esthetic outcome, retention, and biologic risk) and five conditioning factors (passive fit, fracture strength, occlusal area, complications, and retrievability) were identified. Conclusion: Although there is not a clearly better alternative for all clinical situations, determining factors in certain scenarios can render one of the two approaches more recommendable. For esthetic reasons, when the implant angle cannot be corrected to conceal the access hole, cementation is more suitable; however, screw retention is the better option when the occlusal space is under 6 mm or margins cannot be located supra- or equigingivally. In the absence of determining factors, the decision should be based on conditioning factors, which carry different weights depending on the type of prosthesis.