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  Posted by: Dental Design      21st November 2023

Bone level or tissue level? Implant technology is evolving fast

When it comes to dental implants, according to, one of the most highly searched questions is ‘What dental implants are the best?’ As a dental professional you’ll know that there’s no easy way to answer. But with patients confronted with frequent horror stories in the press – sound, reassuring advice is vital.

Dental implants are a relatively new option for people with serious tooth problems. Pioneered about 60 years ago, implants have grown in popularity since the 1970s as an alternative to the sometimes less comfortable dentures to replace missing teeth. They are often more stable than removable prostheses too.

As you are aware, there are two main types of implant: bone level, also called endosteal, and tissue level, or subperiosteal, implants. Tissue level implants enable osseointegration of the rough[i] surface of the implant body and soft tissue attachment to the polished implant abutment during the same healing period after implant placement. This is obviously an advantage for the patient who only needs to undergo one surgical procedure. In addition, subsequent prosthetic steps deal only with the part above the soft tissue attachment; therefore, soft tissue attachment is not disturbed by repeated abutment removal and reconnection, which is inevitable when using bone-level implants.[ii]

Another advantage to tissue level implants is that they have a lower susceptibility to peri-implant disease.[iii] As the global number of individuals that undergo restorative therapy through dental implants increases, peri-implantitis is considered a major and growing problem in dentistry.

While it is known that the size of the micro-gap and amount of mechanical stress on implants are important indicators in their success, it has also been shown that patients with a history of periodontitis, or underlying health conditions such as diabetes or osteoporosis, have an increased risk for peri-implantitis with bone-level implants[iv]. However, a recent study has shown that tissue level implants offer patients with diabetes or osteoporosis a distinct advantage for implant survival. The group showed that tissue level implants neutralise the effect of possible underlying diseases that lead to higher failure rates.[v]

When it comes to bone level or tissue level implants, neither option is superior to the other. It really does depend on an individual patient’s requirements and suitability.

The Association of Dental Implantology highlights young people (whose mouths and jawbones are still growing), smokers, drinkers and those suffering with gum disease as patients who may not be suitable for either type of implant.[vi] However as already mentioned,v and as technology continues to advance, even patients with once contraindicated conditions such as diabetes can now be considered for successful dental implant treatment.

 The Straumann® TLX Implant offers the next stage of evolution for tissue level implants. Its design addresses the significant principles of hard and soft tissue healing. Its shape helps to reduce the risk of inflammation and bone resorption as the implant-abutment interface is moved away from the bone. It is suitable for all dentists’ preferred treatment protocols – ranging from immediate to conventional placement and loading. The Straumann® TLX Implant System complements the bone-level BLX Implant System and both use one common drill set and TorcFit connection for maximum compatibility.

In the UK, implant dentistry has been on the rise for several years. Its popularity derives from both its functional and cosmetic benefits. However, it’s not just about creating a Hollywood-worthy smile. Implants can improve the bite and chewing function, stabilise surrounding teeth and jaw tissue and help prevent bone loss for partially or completely edentulous patients.

Understanding the various different types of dental implant and keeping informed of the latest technologies, ensures dental professionals can recommend the best treatment for their patients.

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[i] Martins Matos GR, Surface Roughness of Dental Implant and Osseointegration. 16 August 2020 DOI 10.1007/s12663-020-01437-5[ii] Ranjan Gupta; Neha Gupta; Kurt K. Weber, DDS. Dental Implants. 8 August 2022. [Accessed August 2023][iii] Derks J, Schaller D, Håkansson J, Wennström JL, Tomasi C, Berglundh T. Effectiveness of Implant Therapy Analyzed in a Swedish Population: Prevalence of Peri-implantitis. J Dent Res. 2016;95:43–9. [Accessed August 2023]

[iv] Eur J Dent. 2020 Oct; 14(4): 672–682. Published online 2020 Sep 3. doi: 10.1055/s-0040-1715779

[v] Marchio, V., et al., Tissue level implants in healthy versus medically compromised patients: a cohort comparative study. Minerva Stomatologica, 2020. 69(5): p. 295-301. DOI: 10.23736/S0026-4970.20.04359-9 [Accessed August 2023]

[vi] Association of Dental Implantology. Considering dental implants. [Accessed August 2023]

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