“Tissue level implant does move the implant-abutment away from the bone when placed correctly. The length of the polished collar also makes a difference, eg 0.5mm polished collar as in Nobel PCC vs 2.8mm polished collar as in Straumann standard. Implant design is only one of the many factors that may influence the peri-implant bone level. However, what is more, important are patient susceptibility and the operator that may influence the long-term health of the implant treatment. ” Cited from Jack
Tissue level implants have either a 1.8 or 2.8 mm relatively smooth metal to rough metal "collar." The collar is not exactly what we would call a collar. It is the junction at the surface between the roughened surface and the relatively smooth surface. There is no micro gap at this junction, the micro gap is where the abutment touches the implant and the way the old tissue level implant was designed, this junction, where there is a micro gap, is either 1.8 or 2.8 mm away from the Junction of the polished/smooth and rough surfaces. theoretically that roughened/ smooth junction should appear a few millimeters deep to the actual microgap . then take a look at the design of the implant from the rough smooth location there is a coronal flaring. Even when you get that micro gap the flaring is still probably occurring. Is it always a positive outcome? Well, it is not a guarantee but it helps. The only problem with it is that the design is such that it is a little bit more difficult to demonstrate the crown being created with the appropriate flair both in terms of magnitude and in terms of location.
Tissue level implants have either a 1.8 or 2.8 mm relatively smooth metal to rough metal "collar." The collar is not exactly what we would call a collar. It is the junction at the surface between the roughened surface and the relatively smooth surface. There is no micro gap at this junction, the micro gap is where the abutment touches the implant and the way the old tissue level implant was designed, this junction, where there is a micro gap, is either 1.8 or 2.8 mm away from the Junction of the polished/smooth and rough surfaces. theoretically that roughened/ smooth junction should appear a few millimeters deep to the actual microgap . then take a look at the design of the implant from the rough smooth location there is a coronal flaring. Even when you get that micro gap the flaring is still probably occurring. Is it always a positive outcome? Well, it is not a guarantee but it helps. The only problem with it is that the design is such that it is a little bit more difficult to demonstrate the crown being created with the appropriate flair both in terms of magnitude and in terms of location.
Drilling technique - bone width -Implant direction 3 point for safe bone response after dental implantation.
In a trial conducted by Wallner et al, 41 patients, 20 Tissue Levels, and 22 Bone Levels implant procedures were carried out. Intraoral radiographs of all of the 42 sites were taken immediately after implant insertion as well as during the follow-up examination. The analysis of bone height was conducted using a computerized technique. The TRAN method was used to determine the gingival biotype.
they concluded that there is no dependency of bone height on implant design or on gingival biotype. However, prior to choosing an implant design, it may nevertheless be beneficial to screen for transparent soft tissues, where the BL design offers a more natural emergence profile. For this purpose, the TRAN method is clearly the fastest and easiest.
Article Peri-implant Bone Loss of Tissue-Level and Bone-Level Implan...
I think we need to differentiate between marginal bone loss as is seen in radiographs which occurs in the short term (0-12) months and actual peri-implantitis, which is plaque induced inflammation and can only be diagnosed clinically, combining outcomes measures such as bleeding on probing, probing depth and radiographic bone loss. Whether tissue level or bone level has an impact in the prevalence or risk of peri-implantitis therefore is not something that we can see in studies reporting only radiographic bone loss. There is actually a very good randomised, split mouth trial designed to test exactly this hypothesis. Check out Vianna, et al., 2018 Evaluation of peri-implant marginal tissues around tissue-level and bone-level implants in patients with a history of chronic periodontitis. J Clin Periodontol, 45(10):1255-1265. The study shows no difference with regards to peri-implant tissue inflammation. And why should there be any? I believe both implant designs can work perfectly fine when sound design principles are used.
..and if you are interested in the long story, may I suggest one of my recent blogg-posts at https://www.mattheos.net/bone-level-or-tissue-level/
- Badges
- Science topic
- Similar topics
- Biological Science
- Anatomy
- Tissue