BIOLOGICAL WIDTH

Dr Rosenberg is driven by biology – and it’s the biology behind the Tissue Level Implant that keeps him coming back to Straumann. “The design of the Tissue Level implant respects the concept of the biological width where it is recommended that there should be at least 2-3mm between the restorative interface and the crest of bone,” says Dr Rosenberg. “If the biological width is violated, then over time we would expect to see bone loss around an implant as the body starts to reconstruct the biological width itself.”

PLACEMENT

“The Tissue Level is available with two gingival collar heights 2.8mm Standard and 1.8mm Standard Plus” explains Dr Rosenberg. From a surgical perspective considerations need to be made when placing a Tissue Level implant. The surgeon needs to control where the restorative platform is placed to achieve an ideal restorative outcome. Straumann’s recommendations and protocols must be followed to ensure a predictable and stable outcome; not only in the short term but in the long term as well.  When placed correctly, and respecting the biological width I have noted stable bone levels over the last 18 years.

MAINTENANCE

The Tissue Level implant is designed so that when placed, the restorative platform should be equi-gingival or 1-2 mm sub-gingival. This enables the patient and dental professional to access the restorative interface and is easier to maintain with good oral hygiene practice. 

ANTERIOR REGION 

When Dr Rosenberg first started using the Straumann Implant system nearly two decades ago, Tissue Level implants were the only implant in the range. To avoid the risk of collar exposure the implants were placed deeper. This goes against the concept of its design. Placement of Tissue Level implants in the anterior region is more challenging. Patients with high smile lines and or gingival recession could become an aesthetic concern due to the smooth collar. Straumann subsequently added Bone Level Implants to its portfolio which enables added flexibility to where the implant to abutment interface will be. This allows the restoring dentist to have more control. “Therefore, I would say that currently I am using Tissue Level implants in the posterior sextants only,” says Dr Rosenberg. 

Restorative Platform

The Straumann Tissue Level implant is an ideal implant for the posterior region. Straumann offers five iterations of their Tissue Level implants with diverse body and neck sizes and designs. In addition, Straumann offers five types of connections comprising prosthetic platforms of different widths, from 3.3mm to 6.5mm. “When it comes to replacing molars the Tissue Level implant is ideal. I favour the Wide Neck Standard Plus implant,” says Dr Rosenberg. “The Straumann Tissue Level Wide Neck (WN) implant is 4.8mm in diameter with a 6.5mm restorative platform. This allows placement of the implant slightly sub-gingival and still have an acceptable emergence profile.” Every university has its system and treatment philosophy. Dr Rosenberg’s mentors at the University of North Carolina at Chapel Hill favoured the Straumann Implant System, and he inherited their enthusiasm. “The first implant system that I placed 17 years ago was a Straumann Tissue Level implant,” says Dr Rosenberg. He’s been using them ever since.