Tissue-level implants in the aesthetic zone: why and how?

Tissue-level (TL) implants, originally developed to eliminate the need for a second surgical procedure, are increasingly being used in the aesthetic zone due to their unique design advantages. The vertical platform shift positions the implant-abutment junction coronally, minimising marginal bone loss and optimising the crown-to-implant ratio. The machined, divergent collar may support space maintenance during guided bone regeneration and the buccal soft tissue contour. Additionally, favourable pre-determined emergence angles may be helpful in reducing mechanical and biological complications while enhancing implant-abutment stability. Achieving predictable outcomes requires meticulous prosthetically driven 3D planning, integrated digital workflows, precise surgical execution, and careful handling during the prosthetic phase. This manuscript presents the rationale for using TL implants in the aesthetic zone and offers practical guidance to achieve successful outcomes in clinical practice.