Tissue Level Implants

I have been observing a conversation/thread on the IADS forum (International Association of Dental Specialists) in which some rather significant figures in the field of implant dentistry have weighed in. The overwhelming conclusion is that we in the profession have made a mistake by abandoning the tissue level implant in favor of the “less technique sensitive” bone level fixtures. I keep coming across old cases from when I was utilizing tissue level fixtures and I am officially converting back to this wonderful implant design. The attached PANO has 3 tissue level Blue Sky Bio One Stage fixtures that I placed and had restored by the referring dentist in 2014. Notice the excess cement, which was the problem with this design when used in conjunction with the solid abutment, on the mesial of #19 and the absence of bone loss associated with this. To think that we as a profession, myself included, would be so foolish as to abandon this device simply because manufactures promoted and convinced us that bone level fixtures were superior when in fact they are just easier to place and easier to sell. The tissue level fixture will always have its esthetic compromises but the fact remains that it is and always has been a wonderful, possibly even superior, product for the replacement of single posterior teeth.

This same patient just left my office having #12 replaced and I think I will stick with the tissue level fixture. Regardless of how much we medialize/platform switch/conical… you name it there will always be a microgap and hence the potential for problems. This simple design from the early days of implant dentistry simply removes the microgap and replaces it with a crown margin 1.8-2.8mm coronal resulting in long lasting stability. Probably the most significant contribution, IMHO, of the tissue level fixture is the fact that in spite of its built in transmucosal component making it nearly impossible to submerge it still enjoys tremendous success thus providing proof that all fixtures can receive a healing abutment at the time of placement. Every tissue level fixture placed has the equivalent of a 2-3mm healing abutment attached to it regardless of the initial stability and they still survive which is why I have always been in favor of placing transmucosal healing abutments rather than submerging fixtures…it just works and we can think the good folks at Straumann for demonstrating this long before we thought it was even possible.