Reconsidering tissue-level implants for the aesthetic zone

Dental Tribune International

Tue. 20. October 2026

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LONDON, England: Although tissue-level implants can achieve satisfactory aesthetic outcomes, their use in anterior restorations continues to be debated owing to concerns about limited control over the emergence profile and possible implant collar exposure. In a new clinical article, researchers make the case for their use, examining the potential biological and mechanical advantages of their design.

The authors first highlight the vertical platform shift inherent in tissue-level implant design. The transmucosal collar positions the implant–abutment connection coronal to the crestal bone, a feature associated with reduced marginal bone loss. This feature also allows the soft-tissue attachment established during healing to remain undisturbed during subsequent prosthetic procedures.

In implant designs with a divergent—outward-flaring—collar, the authors explain that the wider collar may reduce pressure from the soft tissue during guided bone regeneration, helping to prevent displacement of the grafting material. The authors also suggest that this collar design may support the facial soft-tissue contour and even reduce the need for soft-tissue grafting.

The paper also highlights several other potential advantages. The collar may improve the crown–implant ratio, supporting load distribution, and provide mechanical protection at the implant–abutment connection. In implants with divergent collars, the predetermined emergence angle may help avoid wide restorative emergence angles, which have been associated with peri-implantitis.

The article also addresses the clinical use of tissue-level implants in the aesthetic zone, covering pre-surgical planning and implant placement. The authors discuss apico-coronal positioning and the orientation of the screw access holes and describe a modification to the drilling protocol for sites with a deficient facial bone wall.

Overall, the paper brings together published evidence and the authors’ clinical experience to explain why tissue-level implants could be considered in aesthetically demanding areas and what their design means for placement. The broader question is in which clinical circumstances the biological and mechanical advantages outlined might favour their selection over bone-level implants.

The article, titled “Tissue-level implants in the aesthetic zone: Why and how?”, was published on 9 October 2026 in the British Dental Journal.