The Use of Tissue Level Design Implants in Immediate Protocols

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. 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. 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.