Angulated Screw-Retained Versus Cemented Crowns Following Type 1C Treatment in Aesthetic Zone: A 5-Year Cohort Study

Background: Immediate implant placement provides an effective solution for replacing a single maxillary anterior tooth, offering several distinct advantages. Screw-retained implant crowns are often favored for their biological benefits, particularly their elimination of excess cement, which reduces the risk of peri-implant complications. However, their application is restricted when the screw channel's access hole must be positioned in a visible area, as this would undermine the aesthetic outcome, a common challenge in immediate implant placement scenarios.

Purpose: To evaluate the 5-year clinical, radiographic, aesthetic, and patient-reported outcomes of angulated screw-retained versus cemented implant crowns following immediate implant placement in the aesthetic region.

Material and methods: This prospective cohort study included a 5-year follow-up. Eligible patients were divided into two groups according to the type of restoration: angulated screw group (AG) and the cemented group (CG). Implant survival, bleeding on probing (BOP%), probing depth (PD), marginal bone loss (MBL), buccal bone thickness (BBT), mechanical complications, pink esthetic score (PES), and patient's satisfaction assessed by visual analog scale (VAS) were evaluated at the 5-year follow-up.

Results: A total of 38 patients with 38 implants (AG = 20; CG = 18) attended the 5-year examination. After 5 years of loading, the implant survival rate was 100% in both groups with 2 cases of screw loosening in AG (13%) and 1 case of retention loss in CG (5%). No significant difference in BOP% was found between the 2 groups (mean, 18.33% ± 27.52% vs. 24.07% ± 26.34%, p = 0.331). Furthermore, the comparison of PD (3.28 ± 0.87 vs. 2.81 ± 0.75 mm, p = 0.112), MBL (0.38 ± 0.42 vs. 0.35 ± 0.32 mm, p = 0.633), BBT (1.87 ± 0.55 vs. 1.77 ± 0.61 mm, p = 0.613), PES (9.50 ± 2.30 vs. 9.61 ± 1.98, p = 0.942), and VAS (8.60 ± 0.88 vs. 8.56 ± 0.78, respectively, p = 0.96) revealed no significant differences.

Conclusion: Both treatment options can provide high implant survival, achieve acceptable clinical, radiographic, and aesthetic outcomes, and obtain a high level of patient satisfaction, with no significant differences observed after 5-year function.