A look at improving the patient experience.
Much like any area of dentistry, when it comes to providing dental implant surgery for patients, there are a number of options available. For professionals, it’s not just about evaluating the case in hand and weighing up the possible solutions but also selecting an implant system that complements the way you work.
You also need to consider how your implant system of choice will affect the patient journey, especially in regards to time spent in the chair, the healing period and the resulting aesthetics.
In light of this, one common discourse that arises among professionals is whether tissue level implants or bone level implants offer the best outcomes. Though there are advantages to both, tissue level implants provide clinicians with some considerable benefits in appropriate situations.
Optimal aesthetics
In the modern world, aesthetics matter. Gone are the days of dentistry merely providing a functional solution, and today, patients want to receive results that are functional and natural-looking. Tissue level implants, when used in posterior sites, can offer an aesthetic advantage. Due to their built-in emergence profile, tissue level implants tend to result in more natural-looking soft tissues following placement, usually meaning that once the restoration is placed the outcome is indistinguishable from the natural dentition.
The reason behind this begins with tooth loss in this area. According to the International Team for Implantology, alveolar ridge width tends to diminish once the natural dentition is removed or lost, and this means that the implant being placed should have a narrower diameter than the root of the original tooth. As the diameter of the crown being placed on the implant should match that of the original tooth, it is beneficial to use an implant with a wider platform and a narrower body – making tissue level implants ideal.
A reduced chance of peri-implantitis
One enduring issue associated with dental implant surgery is the threat of peri-implantitis. Though research on the subject continues, there has been significant evidence to support the idea that tissue level implants are less prone to this complication.
For instance, one study that examined the risks of peri-implantitis among both bone level and tissue level implants found that there was a correlation between the angle of the emergence profile and associated risk of the disease. In this sample, it was found that this significantly raised the risk of peri-implantitis in bone level implants, but didn’t in those placed at tissue level.
Additionally, a different study examining the peri-implant behaviour of tissue level implants found that use of these implants resulted in less peri-implant bone loss when compared to bone level alternatives.
There is some argument to suggest that the placement of the abutment-restoration connection (microgap) plays a role in the longevity of a dental implant. This microgap may become colonised with bacteria, which over time could lead to oral disease that compromises the implant. Research has found that tissue level implants tend to have a smaller microgap, potentially as they are likely to experience a smaller level of biomechanical stress when compared to bone level implants.
Though there is no concrete evidence linking this to peri-implantitis rates, having a smaller microgap is always beneficial.
Swifter healing
As tissue level implants are placed during a single surgery, this can be advantageous to healing.
Once surgically inserted, tissue level implants are given the opportunity to osseointegrate and form a soft tissue attachment to the polished part of the implant simultaneously. Unlike bone level implants where this soft tissue will need to be disturbed in later stages of the treatment journey for abutment connection and restoration, tissue level implants are more accessible, meaning this tissue won’t be disturbed and can continue to heal.
Not all implant systems are equal
Where tissue level implants are chosen, you then need to consider how different implant systems can benefit you and your patients. The design of an implant will affect which indications it can be used for, as well as other important aspects of the treatment journey, such as healing times and risk of peri-implant disease.
The Straumann TLX Dental Implant System is an excellent choice for clinicians looking to introduce tissue level implants into their repertoire. Suitable for immediate placement protocols and able to achieve optimal primary stability, these implants are available in a variety of diameters, including a slim 3.75mm option that can be utilised in a range of indications.
Furthermore, the design encourages immediate soft tissue attachment preservation and reduces the chance of any nesting bacteria, helping to support long-lasting, exceptional results.
A fantastic option in the right case
Ultimately, both bone level and tissue level implants can provide exceptional outcomes. However, tissue level implants do bring a number of excellent benefits when used in appropriate cases, meaning they should be part of every dental implantologists arsenal.
For more information visit www.straumann.com
References available on request.