Selecting the right level for dental implants

Restoration and Implantology
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 TBR Development Director Mr Trevisan discusses the uses of bone-level and tissue-level dental implants to “ensure optimum success”

Selection of implant type is highly important when it comes to dental implantology. Several factors need to be taken into consideration prior to treatment to ensure optimum success.

Many different implant systems with various surgical solutions are available that aim to improve biomechanical properties such as primary and secondary stability and to limit the extent of peri-implant bone loss. Among them are bone-level implants with the abutment junction at the level of the crestal bone, and tissue-level, which have the implant-abutment junction above the crestal bone at the soft tissue level [1]. Selection depends on the case.

When treatment planning, it is important to consider the type and number of implants required to replace the missing teeth, appropriate positions for implantation, prosthesis design, cantilever length, proper bioshape and length of implants, prosthetic materials and type of occlusion [2].

Aesthetics is another important area that requires increasing consideration and treatment must address this along with optimal occlusal function. Establishing an adequate amount of gingiva that is firmly attached to the underlying periosteum and bone has been cited as one of the main goals in implant maintenance. In accordance with the phenomenon of biological width, an undercut distance of the alveolar crest to the implant-abutment connection will lead to unfavourable bone remodelling.

The traditional tissue-level implant with an implant-abutment connection at a 2–3mm distance to the alveolar bone crest does not conflict with the biologic width, and when using implants with biocompatible materials such as zirconia, a pleasing aesthetic result can be achieved. Indeed, when tissue heals around zirconia, the epithelial fibres that develop are perpendicular, unlike the more vertical fibres which tend to develop around titanium – this mimics natural gingival growth. In some specific cases, though, bone-level implants may offer a preferred solution [3].

The concept of platform switching has been one of the most significant innovations in bone-level implant provision in recent years. It is based on the use of small-diameter abutments compared to the platform diameter of the implant, therefore creating a mismatch between both components at the level of the implant-abutment interphase. This allows the horizontal implant surface to move away the connective tissue inflammatory infiltrate from the bone crest and thus reduce the loading stress in the crestal portion of the bone [4].

The TBR Z1 bone-level implant from Dental Express (a trading division of Surgery Express LLP) offers platform switching and a real morse taper connection, which helps develop a gingival ring-shaped sleeve protecting the implant. TBR’s innovative tissue-level design has a unique zirconia collar, which helps maximise tissue healing due to being highly biocompatible, and reduces the risk of developing peri-implantitis. Practitioners who have been using the Z1 implant for more than a decade say they are placing it in 99% of clinical situations because it makes implantology more comfortable for the surgeon, for the technician and for the patient. It requires less chair time and it leads to more aesthetic and more predictable long-term results.

Bone- and tissue-level implants both offer different benefits and solutions. Dental professionals should ultimately choose an implant system that utilises the highest quality of materials and provides the most effective and safe solution to patients.

For more information visit, call 0800 707 6212, or discover more about the Z1 implant at 


Mr Trevisan is a biomedical engineer. He has been TBR’s Development Director since 2007

[1] Rokn, A., et al. (2017). Prevalence of peri-implantitis in patients not participating in well-designed supportive periodontal treatments: a cross-sectional study. Clinical Oral Implants Research, 28 (3), 314-319.
[2] Mosavar, A., Nili, M., Hashemi, S. R., & Kadkhodaei, M. (2015). A comparative analysis on two types of oral implants, bone-level and tissue-level, with different cantilever lengths of fixed prosthesis. Journal of Prosthodontics, 00, 1-7.
[3] Rieder, D., et al. (2016). Implant therapy outcomes, peri-implant biology aspects. Clinical Oral Implants Research, 27, 469.
[4] Molina, A., et al. (2016). The effect of one-time abutment placement on interproximal bone levels and peri-implant soft tissues: a prospective randomized clinical trial. Clinical Oral Implants Research, 1-10.