Soft Tissue-level Implant Design for Long-term Success

No subgingival microgap, no micromovements

Odoo • Image and Text
When it comes to implant-supported restorations, two-piece implant systems have proven themselves in clinical practice due to their prosthetic flexibility. For restorations in the esthetic zone, the visually highly exposed anterior region, practitioners continue to predominantly use dental implants with a bone-level design, as the emergence profile can be favorably shaped with these implant systems by using gingiva formers as mesostructures. 
Patent™ has a true tissue-level design that positions its
prosthetic connection at the supragingival level.
However, bone-level dental implants have a crucial drawback: their restorative interface, i.e. the transition from implant to prosthetic abutment, is positioned at bone level and incorporates a microgap that is susceptible to the penetration of pathogenic bacteria. This is particularly problematic in view of the fact that dental implants – unlike natural teeth – are not biological systems and therefore do not achieve a complete connection with the overlying soft tissue. As a result, bacterial pathogens in the oral cavity can – depending on the implant material used and the associated soft tissue integration more or less successfully – penetrate past the implant into the deeper bone and accumulate inside the sensitive microgap (for example in the form of plaque). The resulting inflammatory reactions can cause resorption of the peri-implant bone and, in the worst case, the development of peri-implantitis – the pathological inflammation of the implant site. Since this sensitive area of a bone-level implant is positioned subgingivally and is therefore difficult to access, it is almost impossible to carry out effective preventive measures or practice suitable implant hygiene. If a bone-level implant is about to develop inflammation-related peri-implantitis, the only option is antibiotic therapy and, in advanced stages, the time-consuming uncovery and cleaning of the implant. If peri-implantitis has progressed too far and the associated loss of peri-implant bone is too advanced, the implant must be removed.

In view of such restoration-related biological complications, which are primarily associated with bone-level implants, dental implants with a tissue-level design enjoy increasing popularity. Tissue-level implants can help minimize the risks of biological complications by bringing the prosthetic implant-abutment interface away from the crestal bone and positioning it supragingivally above the soft-tissue level. As a result, the prosthetic interface of tissue-level implants is easily accessible and easy to clean. This is one of the reasons why the Patent™ Dental Implant System incorporates such an implant design. Scientific studies have shown that the Patent™ Implant, thanks to its tissue-level design, which in principle mimics a natural tooth, i.e. is "biomimetic", sustainably minimizes the risks of biological complications such as peri-implantitis and maintains the stability of the marginal bone levels and the health of the peri-implant soft tissues over the long term.

Superior implant design and prosthetic connection

The Patent™ Implant has a threaded portion with a highly rough surface (approx. 6 µm) in its endosseous part, which is placed in the bone, and a threadless portion with the same topography above it. In its transmucosal portion, the implant incorporates a tulip-shaped 2.5 mm high collar. This portion of the implant is machined and does not undergo any surface treatment after milling to allow optimum soft-tissue adhesion. If the Patent™ Implant is placed correctly and not inserted too deeply, the crown margin is positioned at equigingival level and the prosthetic interface between the implant and the cemented glass fiber abutment is at supragingival level. Since the prosthetic interface of the Patent™ Implant is not positioned deep in the tissue at bone level, but above the gingival margin, the peri-implant soft tissues can begin to adhere firmly to the transgingival implant part beneath in the form of a cuff, largely free of irritation and undisturbed by bacterial pathogens, shortly after insertion. The "soft-tissue seal" created as a result of this process protects the deeper bone from bacterial pathogens during healing and maintains the stability and health of the peri-implant soft and hard tissues over the long term. Thanks to their incredibly beneficial soft-tissue reaction and the associated long-term healthy soft-tissue conditions, Patent™ Implants are not only indicated for restorations in the posterior region, but also particularly for restorations in the esthetic zone. In this light, Becker et al. and Brüll et al. observed an increase in keratinized gingiva around inserted Patent™ Implants in their 2- and 3-year clinical studies after the respective study periods. In the long-term follow-up study by Becker et al. the authors observed healthy soft-tissue conditions with mucosal recession of <1 mm in inserted Patent™ Implants after a functional period of more than 9 years.

Furthermore, since the prosthetic connection of the Patent™ Dental Implant System is not a screw-retained but a cemented construction, the risk of micromovements in this area, which could negatively affect the integrity of the hard and soft tissues, is virtually eliminated. In the literature, bone-level dental implants with screw-retained internal connections are associated with micromovements between the screw and the implant. On the one hand, these promote crestal bone resorption and, on the other hand, produce abrasion particles that are deposited in the peri-implant tissue and cause inflammatory reactions. In contrast, a high-tech glass fiber post is inserted into the 3C platform of the inserted Patent™ tissue-level implant and cemented tightly above the gingival margin. Thanks to this novel cemented prosthetic connection, the risk of compromising micromovements around the restorative interface of the Patent™ Implant is virtually non-existent. Furthermore, in the event of a prosthetic complication, the glass fiber abutment can be removed and replaced at the supragingival level, preserving the integrity of the underlying hard and soft tissues.

Latest Generation Zirconia for Patent™ Implants
"Ceramic steel” for unparalleled long-term function

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