{"id":391,"date":"2026-04-08T07:52:35","date_gmt":"2026-04-08T07:52:35","guid":{"rendered":"https:\/\/forum-impl.iti.org\/en\/?post_type=article&p=391"},"modified":"2026-07-06T13:41:59","modified_gmt":"2026-07-06T13:41:59","slug":"the-use-of-tissue-level-design-implants-in-immediate-protocols-8301","status":"publish","type":"article","link":"https:\/\/forum-impl.iti.org\/en\/article\/the-use-of-tissue-level-design-implants-in-immediate-protocols-8301\/","title":{"rendered":"The Use of Tissue Level Design Implants in Immediate Protocols"},"content":{"rendered":"\t\t
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Abstract<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t
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The tissue level (TL) implant is considered a challenging implant for the esthetic zone as the perceived potential esthetic risk of exposure of the machined collar or metal shine-through commonly drives clinicians to select bone level (BL) design implants, especially for immediate implant placement (IIP) protocols. Despite using BL design implants, studies investigating the outcomes of IIP have reported a high frequency of facial mucosal recession. In our experience, TL design implants provide comparable outcomes and seem to have been unfairly implicated for esthetic failures.\u00a0<\/p>

This article provides a narrative review of the evolution of TL implants and outlines the benefits of this design for IIP. Additionally, clinical cases are utilized to highlight the effectiveness of TL implants for IIP in the esthetic zone.\u00a0<\/p>

Based on the current evidence, there is a paucity of studies assessing the stability of clinical outcomes for IIP with TL implants in the esthetic zone. The standard indications and contra-indications apply regardless of implant type, and the optimal restoratively driven three-dimensional position of the implant should not be compromised.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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Introduction<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t
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The tissue level (TL) implant has been at the forefront of innovation for more than four decades and is one of the oldest and most well-evidenced implants used in modern dentistry. At a time when Br\u00e5nemark implants followed a fully submerged healing protocol, the one-piece TL (ITI) implants were novel, pushing the boundaries to pioneer transmucosal healing (Br\u00e5nemark et al. 1969; Buser et al. 1990; Buser et al. 1997; Andersen et al. 2002).<\/p>

As time progressed, surgical protocols were refined to allow for earlier placement and predictable loading protocols. Over the last two decades, the demands and benefits of immediate implant placement (IIP) have continued to increase from a patient and clinician perspective (den Hartog et al. 2008; Slagter et al. 2014; Huynh-Ba et al. 2018; Morton et al., 2018; Morton et al., 2023). IIP is defined as the placement of a dental implant into a fresh socket on the same day as tooth extraction (Gallucci et al. 2018).<\/p>

Many readers might find it surprising that several early studies on IIP in the esthetic zone utilized TL implants as this was what was largely available at the time (Lang et al. 1994; Bragger et al. 1996; Andersen et al. 2002; Bianchi & Sanfilippo 2004). In the 1990s, these implants were parallel-sided with passive thread designs and, with developing IIP protocols, were considered technically demanding to place and lacked sufficient primary stability for IIP. From 2000 onwards, bone level (BL) design implants gained preference and have been predominantly used in research studies, with the introduction of implant geometries that offer relatively predictable high primary stability at implant insertion (Cochran et al. 2016; Dard et al. 2016). Until recently, implant geometries that aid immediate protocols have been largely absent from manufacturer portfolios for TL implants, and therefore, modern studies have rarely reported outcomes of TL implants (Wittneben et al. 2023). However, the authors believe TL implants can be successfully and predictably utilized for IIP in the anterior esthetic zone and achieve stable long-term esthetic outcomes.\u00a0<\/p>

It is to be reiterated that replacing a single tooth in the anterior maxilla (#15 to #25) with an IIP protocol is a complex procedure. The rules for placing TL immediate implants in the anterior maxillary esthetic zone are similar to those for BL design implants. IIP may be considered the treatment of choice when ideal conditions are present (Wittneben et al. 2023), such as:<\/p>