I am referring to parallel walled implants as opposed to tapered implants. Screwindirect is still a tapered implant and whether you place them angled or parallel/upright it makes no difference. I am referring to the parallel nature of the fixture itself which by its physical nature will generally have less insertion torque than a tapered wedge of a fixture. Screwindirect is just a one piece system with a MUA so not the same… But along your line of thinking a tissue level fixture without a built in MUA would still be difficult to handle for full arch therapy so it would not be worth the investment considering the market craze over high torque full arch friendly hardware. The two tissue level fixtures which I have had the most success with over the years have been BSB One Stage and Strauman TL, both of which are parallel walled and routinely inserted at lower torque than what would be desired for the full arch immediate load camp…
Even though I was speaking with ZimVie about launching a tissue level in the TSV line I think it is best for tissue level fixtures to be parallel walled. I say this because parallel walled implants are inserted into a parallel walled osteotomy so there is no wedging effect. Because of this the fixture can be further inserted or backed out slightly to accommodate the surrounding soft tissue at the time of placement. This can be done without any negative effect on the stability of the fixture in the osteotomy because it is a parallel device stuck in a parallel hole. With tapered fixtures if it needs to be backed out slightly due to soft tissue height then it is done at the expense of initial stability making tapered fixtures less than ideal for tissue level design. It is for this reason that I typically drill my osteotomy +1mm when placing tissue level fixtures so I have some wiggle room to properly place the predetermined restorative margin in relation to the surrounding soft tissue… By the way ZimVie will most likely not be launching a tissue level fixture which means that I will continue with the BSB One Stage as my posterior fixture of choice while utilizing TSV for anterior and multi unit cases.