Dental crown implants are made up of a number of different parts. The crown will be your new prosthetic tooth, and is usually made of ceramic—designed to be a replica of the natural tooth it's replacing. The implant is a titanium alloy screw placed in your jaw, with your bone healing around the screw to hold it in place. The crown is connected to the implant with a small abutment, and is either screwed or cemented into position. But what's the difference?

Implant Placement

The titanium screw is usually vertically implanted into your jaw, but it may be placed at a slight angle to take advantage of where your jawbone has the most density. Whatever its position will be, it must be angled so that when the crown is attached, the prosthetic tooth will be in the correct alignment in relation to your natural teeth. But how does your dentist determine which connection is best for the implant's abutment—cement or a screw?

An Access Hole

Dental crowns that will be attached to an abutment with a screw have a very obvious design feature. There's a relatively large, perfectly circular hole in the center of the crown's biting surface. This is an access hole; it allows your dentist to reach the abutment through the crown in order to tighten the screw. Does this mean implant crowns secured with a screw already come with a sort of cavity?

Disguising the Access Hole

This hole in the crown is essential, but of course, your dentist won't leave you with a completed restoration that has a gaping hole in its center. Once the implant's screw has been adjusted, the crown's hole is filled—much like a cavity. The dental composite resin used to fill the hole will be color-matched to the crown. The filled hole then blends into the biting surface of the crown, although it may still be faintly visible.

The Implant Crown's Position

Screw-retained dental crowns are usually reserved for the back of your mouth, also known as posterior teeth—where it will be impossible for anyone to notice the filled access hole (if it's noticeable at all). Your anterior teeth (at the front of your mouth, and so are visible when you smile) will generally be replaced with a dental implant crown secured with cement. 

The most appropriate connection for your dental implant is largely up to your dentist, but from a patient's point of view, you're not going to notice any difference, regardless of whether your implant's crown is held in place with a screw or cement.

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