To screw or cement retain ? that is the question.
Screw retention for dental implants offers many advantages including the ability to remove the prosthetics in the need for removal like screw loosening complications or hygiene /peri-implant concerns. However, not every case can be made to a screw retained prosthesis despite advances such as angulated screw channels that have helped tremendously in the anterior maxilla esthetic zone.
In some cases, true screw retention on multiple implants if the implants are not parallel and are too divergent from one another will be a challenge. The use of custom abutments can help offset angulation issues and a combination of cement retained and screw retained implants working together is sometimes the best of both worlds.
In instances where cement retention was chosen, i prefer to start off with a temporary cement such as tempbond or premier implant cement. These types of cements can make retrievability of the prosthetic easier.
One handy tool that I have used in the past is the automatic crown bridge remover from anthogyr. This is a french based company that makes high quality products. This device comes with a few handy attachment tips that can be placed underneath bridges and crowns that can dislodge the prosthesis without having to cut through it. I would suggest to highly look into this for your practice.
To cement or screw?
Given the choice between both options, I prefer to screw retain when possible my prosthetics. In the case of single unit crowns that is my go to first option. In the case of multiple units and dealing with divergent implants, the use of custom abutments and/or multi-unit level abutments can help to ease the stress of a straight to fixture connection where passivity may be a concern.
Let me know what you prefer , Screw or cement?