Fabrication of a screw-retained restoration avoiding the facial access hole: a clinical report.

Dental implant restorations may be either screw-retained or cemented onto an abutment. While each method has its advantages and disadvantages, cemented restorations are commonly used in the maxillary arch, usually because of esthetic concerns. Available bone in the anterior maxilla dictates the placement of the implant, which may result in a facially positioned screw-access opening. Still, a growing volume of literature states that periimplant soft tissues respond more favorably to screw-retained crowns than cement-retained crowns. This clinical report outlines a treatment with a new method of fabricating a custom abutment-crown combination for a screw-retained restoration. The technique allows the channel for the screw to be placed at an angle other than parallel to the implant body. In this case, the practitioner may choose either a screw-retained or cement-retained implant restoration, where previously only a cemented restoration was possible.