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 535

Comparison of Bone-Level and Tissue-Level Implants:

A Pilot Study with a Histologic Analysis and a 4-Year Follow-up

Maria Menini, PhD, DDS1 One of the potential variables iden-

Elena Dellepiane, DDS, PhD1 tified as playing a major role in the
Talita Deiana, DDS1 preservation of peri-implant tissues
Ezio Fulcheri, MD2 is the implant collar design.1,2 Al-
Paolo Pera, MD, DDS, PhD1/Paolo Pesce, DDS, PhD1 though there is a large variety of im-
plant configurations available on the
This study clinically and histologically evaluated the performance of implants with market, implant systems can gener-
different crestal morphologies: tissue-level implants and bone-level implants. Nine ally be divided into bone-level and
patients received at least two adjacent implants in an edentulous area: one bone- tissue-level. In a tissue-level implant,
level implant (EO) and one tissue-level implant (TG) (total: 23 implants), placed
the transmucosal component fac-
beside each other using a single-stage delayed loading protocol. The implants
were rehabilitated with screw-retained fixed partial dentures. Plaque Index (PI), ing peri-implant soft tissues is part
bleeding on probing (BOP), probing depth (PD), and peri-implant bone level were of the implant body. These implants
recorded at various postsurgical follow-ups, including 2 and 6 months as well as are placed with a one-stage surgery
1 and 4 years. At 3 months postsurgery, soft tissue biopsy samples were taken and they immediately pierce the
from all implant sites and histologically analyzed. Longitudinal assessment of the soft tissue barrier (nonsubmerged
results (TG vs EO implants) was performed using a linear mixed model with random
approach). In a bone-level implant
intercept and by using Spearman correlation or chi-square after visual inspection
of the probability distribution. Student t test was used to compare means, and chi- system, the transmucosal compo-
square test was used for dichotomic variables. P < .05 was considered statistically nent is a separate device from the
significant. All implants were functional at 4 years. Peri-implant bone resorption endosseous implant body. These
was limited, with means of 1.20 ± 0.71 mm and 1.24 ± 0.82 mm for TG and EO implants can either be submerged
implants, respectively. No significant differences in clinical parameters were under soft tissue during the healing
identified between EO and TG implants. Histologic analysis revealed normal peri-
period (two-stage surgery), or they
implant soft tissue healing with poor inflammatory infiltrate. Differences in the
histologic appearance of soft tissues were more related to patients than implant can be placed following a one-stage
type. Both implants appeared to be suitable for partial rehabilitation of edentulous surgery using healing abutments.
arches without differences in the investigated clinical and histologic parameters. The bone-level implant systems
However, TG implants showed a greater risk of implant collar exposure. Int J present a microgap between the
Periodontics Restorative Dent 2022;42:535–543. doi: 10.11607/prd.4990 endosseous implant and the trans-
mucosal component. The microgap
is generally located in proximity to
the alveolar bone crest and might
present an issue of microbial coloni-
Division of Implant Prosthodontics, Department of Surgical Sciences, University of Genoa,
1
zation; still, several studies reported
Genoa, Italy. no adverse effect on peri-implant
2
Department of Surgical Sciences, University of Genoa, Genoa, Italy.
bone loss3 if a supracrestal connec-
Correspondence to: Dr Elena Dellepiane, Department of Fixed and Implant Prosthodontics, tive tissue barrier is established after
University of Genoa, Largo R. Benzi 10, 16132 Genoa, Italy. Email: elena.dellepiane@virgilio.it implant placement.4 In contrast, the
evaluation of four different implant-
Submitted March 29, 2020; accepted August 15, 2020.
©2022 by Quintessence Publishing Co Inc. abutment interfaces showed that

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536
all of the analyzed connections pre-
sented contamination after 5 years
of functional loading.5 It also ap-
peared that the connection design
might have qualitatively and quan-
titatively influenced bacterial count
levels, especially inside the implant
connections, showing better results
for the conical connection.6 Similar-
ly, different abutment types showed
significant variations in mean micro-
gap size within the first 5 hours of
loading.7 However, no significant in-
fluence of micro-leakage was found
in bacterial count at 24 hours, 48
hours, and 14 days postplacement.
It has been suggested that peri-
implant soft tissue can create a bio-
logic seal, protecting peri-implant
bone from the highly contaminated
oral environment8 and reducing the
risk of bone resorption.9 Cell adhe-
sion to the abutment surface is me-
diated by the formation of hemides-
mosomes, similar to that found at
natural teeth.10,11 Limited data from
animal studies suggest that some
characteristics of the transmuco-
sal implant components may affect
peri-implant soft-tissue adhesion
and stabilization but do not allow
definitive conclusions.12
Thus, it can be assumed that
titanium surface treatment could
influence the quality/quantity of
cell attachment as well as the heal-
ing process and host response.10,11,13
However, a recent systematic re-
view14,15 analyzing peri-implant tis-
sue behavior around titanium abut-
ment surface modifications did not
reveal any variations in terms of
Plaque Index (PI), bleeding on prob-
ing (BOP), or probing depth (PD)
between machined and modified
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titanium healing abutments in the
short term. Other studies16 agree
that abutment design may influ-
ence marginal bone loss but do not
impact soft tissues. However, the
existing evidence is moderate, as
few randomized controlled trials
were conducted and the follow-up
periods were short.16
Some studies compared the
performance of implants with dif-
ferent crestal morphologies.17–19
Thoma et al20 compared clinical and
radiographic outcomes of implants
and implant-supported reconstruc-
tions using bone-level and tissue-
level implants. Within the first year
of functional loading, high survival
rates and minimal changes in mar-
ginal bone levels were found for
both implant systems.
Although several authors have
provided evidence of successful os-
seointegration with bone- or tissue-
level implants, as well as with either
nonsubmerged or submerged inser-
tion protocols, most studies report
soft tissue parameters and interprox-
imal bone level measurements,21,22
neglecting the histologic aspect. The
results of several studies23–25 seem
to indicate that the dimensions and
composition of the biologic width
are not significantly influenced by im-
plant type (bone- or tissue-level) or
surgical protocol (one- or two-stage).
However, limited evidence suggests
that implants placed more deeply
lead to a longer biologic width.
Moreover, randomized clinical
trials comparing bone- and tissue-
level implants are scarce in the lit-
erature. Therefore, the aim of this
split-mouth study was to evaluate the
outcomes of tissue-level and tradi-
tional bone-level implants, recording
clinical parameters and histologically
analyzing soft peri-implant tissues.
Materials and Methods
Between February and October
2015, a sample of nine patients (three
women, six men) with a mean age of
61 years (range: 52 to 78 years) was
recruited for the present study. The
patients referred to the Division of
Implant Prosthodontics of the De-
partment of Surgical Sciences at the
University of Genoa and needed
fixed partial dentures supported by
at least two adjacent implants in the
same dental quadrant.
Inclusion criteria for the study
were as follows: good systemic
health without contraindications
for oral surgery; partial edentulism;
teeth in treated areas were extract-
ed at least 1 year before; no need
for bone regenerative procedures;
no unbalanced diabetes or meta-
bolic osseous diseases; no heavy
smokers (≥ 20 cigarettes/day) nor
habitual alcohol consumers.
All patients were informed
about the study protocol and pro-
vided written informed consent
prior to the start of the study. All
treatments were performed in
agreement with the World Medical
Association Helsinki Declaration.
The study was approved by the lo-
cal ethical committee of the Univer-
sity of Genoa (protocol no. 527).
Each patient received at least
two adjacent implants in an eden-
tulous quadrant, with at least one
Premium Straight implant (bone lev-
el; EO) and one adjacent Premium
 537

a b c
Fig 1  Each patient received two adjacent implants into an edentulous quadrant: (a) one Premium Transgingival implant (TG, test site) and
(b) one endosseous Premium Straight implant (EO, control site). (c) Example clinical view from a study patient. A machined surgical screw
was placed on the TG implant (left), and a standard machined healing abutment was placed on the EO implant (right).

Transgingival implant (tissue level;
TG) (Sweden & Martina) per edentu-
lous area (Figs 1a and 1b), with the
most distal implant chosen on the
basis of a draw.
Both EO and TG implants were
made of commercially pure tita-
nium (grade IV) with a ZirTi (zirco-
nium airborne particle–abraded
and acid-etched titanium) surface
(Sa = 1.3 µm) and were cylinder-
shaped with a conical progression
only in the apical portion. EO im-
plants had a machined collar (Sa =
0.6 µm) that was 0.80 mm high and
an internal hexagon connection.
TG implants differ from EO ones
only for the machined transgingival
portion, which was 2.2 mm high (re-
gardless of the endosseous implant
length). The prosthetic connection
makes use of both the conical fric-
tion concept and internal hexagon
connection. All implants had a diam-
eter of 3.8 mm, with lengths ranging
between 10 and 13 mm (depending
on bone availability). EO implants
were placed completely endosse-
ously, with their coronal platform
at the bone crest level, while for TG
implants, the interface between the
ZirTi surface and the machined collar
was placed at the bone crest level.
During surgery, cortical and
cancellous bone quality were sub-
jectively evaluated by the surgeon
and classified as 1 (dense), 2 (me-
dium), or 3 (soft).26
Implants were placed according
to a single-stage surgical protocol
and were assigned specific codes
for blinding, as described in a pre-
vious study.26 Due to the different
morphologies of the coronal portion
of the implants, blinding was not
possible during clinical procedures.
Only the statistician was blinded.
EO implants received standard ma-
chined healing abutments, while TG
implants received machined surgical
screws (Fig 1c).
The healing abutments and
screws remained in situ up to the
4-month follow-up, when implant
impressions were taken to fabricate
the fixed prostheses. Screw-retained
fixed partial dentures were delivered
2 weeks later. They were provided
with a metal framework and compos-
ite resin veneering material.
Radiographic Analysis of
Interproximal Bone Levels
Standardized periapical radiographs
were taken to investigate interproxi-
mal bone levels at baseline (immedi-
ately after implant insertion) and at
2, 4, and 6 months and 1 and 4 years
after implant placement (Fig 2). The
radiographs were taken using a
long-cone parallel technique with
an individualized film holder (Rinn
bite film holder, Dentsply Sirona).
The implant-abutment inter-
face (the microgap) was used as the
reference point for interproximal
bone-level measurements. Bone re-
sorption (BR) over the study period
was assessed from these reference
points to the most coronal bone
at the mesial and distal aspects of
each implant. The measurements
were performed with a diapha-
noscope and magnifying lens. To
calculate BR, overcoming possible
radiographic deformations, the fol-
lowing equation was used:
BR = (Li x BRrx) / Lirx
Where Li = implant length;
Lirx = implant length as measured in

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538

a b c
Fig 2  Peri-implant soft tissue biopsy samples that contained both epithelium and connective tissue were collected from each implant site
and stained with hematoxylin and eosin. (a) Section of a biopsy sample taken from the peri-implant mucosa surrounding an EO implant.
Reactive and reparative characteristics of the epithelium can be seen. (b) A magnified view of Fig 6a shows inflammatory aggregates.
(c) Section of a biopsy sample taken from the peri-implant mucosa surrounding a TG implant. Hyperkeratotic epithelium (with a thickened,
cornified layer) and acanthotic epithelium (with prominent epithelial ridges and reduced connective tissue papillae) can be seen.

the radiograph; BRrx = bone resorp-
tion as measured in the radiograph.
Soft Tissue Health Parameters
PI (according to O’Leary et al27)
was used with the help of a plaque
detector based on eritrosin (But-
ler GUM Red-Cote Liquid, Sunstar
Americas). BOP (yes/no) and PD
were recorded with the nonmetal-
lic periodontal probe at four points
for each implant. PI was recorded
at 1, 2, 3, and 6 months and at 1
and 4 years after implant place-
ment; BOP and PD were recorded
at 2, 3, and 6 months and at 1 and
4 years after implant placement. At
the 4-year follow-up, the health of
peri-implant tissues (suppuration,
spontaneous bleeding, presence/
absence of keratinized gingiva,
presence/absence of a frenulum
next to the implant, periodontal
biotype, and covered/not covered
implant collar) and patient satisfac-
tion after implant therapy were also
investigated using specific ques-
tionnaires realized for this study.
Implant sites were divided into two
categories according to periodontal
biotype (thin or thick). To evaluate
the biotype, a periodontal probe
was placed into the facial aspect of
the peri-implant mucosa. The peri-
implant biotype was categorized as
thin if the outline of the underlying
periodontal probe could be seen
through the gingiva and thick if the
probe could not be seen.28
The patient satisfaction ques-
tionnaire included six questions
related to the following: possible
presence of pain (question 1); satis-
faction regarding masticatory abil-
ity (question 2); satisfaction regard-
ing the esthetic appearance of the
rehabilitation (question 3); global
satisfaction regarding the implant
prosthodontic rehabilitation (ques-
tion 4); and satisfaction regarding
instructions and care provided by
the dental team regarding oral hy-
giene (questions 5 and 6). Each item
was rated on a scale of 1 to 5, with
1 being the worst score and 5 being
the best score. An additional space
was left for free comments. Patients
completed the questionnaire alone
but were able to call a clinician for
help if needed. The questionnaires
were marked with the clinical chart
number to preserve anonymity.
Histologic Analysis
Three months after surgery, palatal
or lingual minimally invasive peri-
implant soft tissue biopsy samples
(diameter: < 3 mm) containing both
epithelium and connective tissue
were collected from each implant
site using a surgical blade.
The samples were fixed in for-
malin 10% and analyzed at the Divi-
sion of Pathological Anatomy (De-
partment of Surgical Sciences) of the
University of Genoa. The samples
were embedded in resin because of
their small size. Then, they were fixed
and left for 3 days in alcohol and
later in a solution of 50% absolute
alcohol + 50% ether + grains of silica
gel (or 80% absolute alcohol + 20%
ether) at room temperature for at
least 24 hours. The samples were
dehydrated with absolute alcohol
and infiltrated with a Sulphur solution
for 72 hours in solution A (100 mL of
resin [Technovit 8100, Kulzer] + 0.6 g
of hardener 1). The samples were then

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embedded in a cold PTFE (polytet-
rafluroethylene) plate with 15 mL of
solution A + 0.5 mL hardener 2. The
plate was cooled for 5 to 10 minutes
with ice and put in the fridge for 24
hours. Technovit 3400 resin (Kul-
zer) was drained into the wells of the
plate to create the blocks. The blocks
were cut by a microtome, creating
sections 2 to 3 µm thick. The sec-
tions were stained with hematoxylin
and eosin and analyzed by optical
microscope. A form was completed
for each sample that indicated char-
acteristics of the epithelium (normal,
acanthotic, hyperkeratotic, atrophic,
with reactive and reparative changes),
chorion (normal, with hyalinosis, with
fibrosis, very vascularized, poorly vas-
cularized), and inflammation (absent,
small near vessels, scattered, aggre-
gated, aggregated with connection
to the basal membrane with initial in-
traepithelial involvement). The type of
phlogistic reaction was also classified
as a lympho-plasmo or a lympho-
granular predominant type.
Statistical Analysis
Quantitative characteristics and de-
scriptive analyses were reported as
mean ± SD. Longitudinal assess-
ment of the implant results (TG vs
EO) throughout the study was per-
formed using a linear mixed model
with random intercept and by using
Spearman correlation or chi-square
test after visual inspection of the
probability distribution. Student t
test was used to compare means.
Chi-square test was used for dichot-
omous variables. In all regression
models, the dependent variable
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was the outcome and the indepen-
dent variables were time indices,
the treatment group (TG or EO), and
their interaction. P < .05 was con-
sidered statistically significant, and
SPSS (version 21, IBM) was used for
computation.
Results
A total of 23 implants (11 EO, 12 TG)
were inserted in nine patients: one
woman received 3 implants in an
edentulous area, and two patients
were each rehabilitated with two
fixed partial dentures each support-
ed by 2 implants. All other patients
received 2 adjacent implants.
No patient was lost to recall
during the 4-year follow-up. Be-
tween the 1-year and 4-year follow-
ups, patients were recalled at least
once a year for professional oral hy-
giene and control, and all patients
attended the scheduled follow-up
appointments. Four years after im-
plant placement, all implants were
functional and stable, with implant
survival and prosthodontic survival
rates of 100%. All patients showed
limited crestal bone resorption at 4
years, with a mean of 1.20 ± 0.71 mm
for TG and 1.24 ± 0.82 mm for EO
implants (Table 1, Fig 3). Student
t test showed a nonsignificant dif-
ference between TG and EO for
bone resorption after 4 years
(P = .592). The linear mixed model
showed a significant difference (P =
.001) over time when treatment was
considered as grouping variable
(time*treatment interaction). No
significant differences were present
between the two implants for the
539
other clinical parameters recorded
(PI, PD, BOP), and no statistically
significant correlation was found
between bone resorption over time
and bone quality and implant stabil-
ity at implant insertion.
The histologic analysis revealed
that soft tissues were healthy, with a
normal epithelium and chorion, with-
out signs of impaired repair in a ma-
jority of samples. None of the sam-
ples showed atrophy. The histologic
appearance was more favorable for
EO implants than TG implants. In
fact, three TG samples showed a re-
active and reparative epithelium, one
TG sample had a very vascularized
chorion, and five TG samples were
characterized by aggregated inflam-
mation in the basal membrane with
initial intraepithelial involvement;
those characteristics were present in
three, none, and three EO samples,
respectively. However, the differenc-
es between the samples appeared to
be more related to the patients than
to the implant type; ie, there were
differences between the patients but
not between implants inserted in the
same patient.
Some histologic patterns were
repeated in the samples: Repara-
tive epithelium was present in six
cases, and small inflammation near
the vessels was seen in four of those
six cases.
Considering TG and EO, chi-
square test showed a nonsignificant
difference for the following variables
at 4 years: suppuration, spontane-
ous bleeding, presence/absence
of keratinized gingiva, presence/
absence of frenulum, and periodon-
tal biotype (Table 2). Four months
after surgery, two women presented
Volume 42, Number 4, 2022
540

1.24
1.20

1.00
1.20
0.84
Bone resorption (mm)

0.80
0.81
0.62
0.49
0.60
0.60
0.43
0.40
0.30

TG
0.29
0.20
EO

0.00
T0

2 mo

4 mo

6 mo

1y

4y
Time

Fig 3  Mean bone resorption (in millimeters) over time for endosseous (EO; bone-level) and transgingival (TG; tissue-level) implants.
T0 = baseline.

Table 1  Health Parameters of Peri-implant Tissues: Assessments Over Time

Treatment Implants, n Baseline 6 mo 1y 4y
Bone resorption, mm
EO 11 0.00 ± 0.00 0.60 ± 0.68 0.81 ± 0.81 1.24 ± 0.82
TG 12 0.00 ± 0.00 0.43 ± 0.77 0.84 ± 0.77 1.20 ± 0.71
EO + TG 23 0.00 ± 0.00 0.51 ± 0.72 0.82 ± 0.77 1.22 ± 0.74
Plaque Index
EO 11 – 0.45 ± 1.04 1.64 ± 1.91 0.73 ± 1.62
TG 12 – 0.62 ± 0.35 1.38 ± 1.26 1.81 ± 0.87
EO + TG 23 – 0.35 ± 0.83 1.26 ± 1.66 0.87 ± 1.69
Bleeding on probing (no. of surfaces presenting BOP per implant)
EO 11 – 0.36 ± 0.50 0.73 ± 0.90 0.45 ± 0.82
TG 12 – 0.50 ± 0.67 0.67 ± 0.78 0.50 ± 0.80
EO + TG 23 – 0.43 ± 0.59 0.70 ± 0.82 0.48 ± 0.79
Probing depth, mm
EO 11 – 1.83 ± 0.97 2.12 ± 1.11 2.37 ± 0.78
TG 12 – 1.43 ± 0.99 1.79 ± 1.02 2.49 ± 0.70
EO + TG 23 – 1.62 ± 0.98 1.95 ± 1.05 2.44 ± 0.72
EO = endosseous (bone-level) implants; TG = transgingival (tissue-level) implants; Baseline = immediately after implant placement.
Values are presented as mean ± SD.
Longitudinal assessment of the implant results throughout the study period was performed using a linear mixed model with random inter-
cept and by using Spearman correlation or chi-square tests. No significant differences were present between the two implants (EO vs TG)
for the clinical parameters recorded. The linear mixed model showed a significant difference in bone resorption over time when considering
treatment as grouping variable (time*treatment interaction) (P = .001).

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 541

Table 2  Descriptive Results for EO vs TG Implants at the 4-Year Follow-up

4-y outcomesa
No. of cases/total
Clinical parameter Implant % group no. Pb
EO 27 3/11
Presence of spontaneous
TG 8 1/12 .231
bleeding
EO+TG 17 4/23
EO 0 0/11
Presence of suppuration TG 0 0/12 –
EO+TG 0 0/23
EO 27 3/11
Thick periodontal biotype TG 25 3/12 .901
EO+TG 26 6/23
EO 2.18 mm 1.40 mm
Keratinized gingivaa,
TG 2.58 mm 1.62 mm .844
mean ± SD
EO+TG 2.39 mm 1.50 mm
EO 9 1/11
Frenulum presence TG 8 1/12 .949
EO+TG 9 2/23
EO 9 1/11
Exposed implant collar TG 25 3/12 .315
EO+TG 17 4/23
TG = transgingival (tissue-level) implants; EO = endosseous (bone-level) implants.
None of the evaluated parameters showed a statistically significant difference between EO and TG implants.
aAll data are presented as percentages (first outcome column) and numbers of cases/total sites per group (second outcome column) except

for keratinized gingiva, which is presented as means (first outcome column) and SDs (second outcome column).
bDifference between TG and EO.

an exposed TG implant collar (Fig
4). At the 4-year follow-up, one man
showed one exposed collar of each
implant type.
All patients completed the satis-
faction questionnaire and declared
to be globally satisfied after 4 years
of treatment. None of the patients
reported the presence of pain. The
satisfaction was particularly high re-
garding the masticatory ability and
the instructions and care provided
by the dental team for their oral hy-
giene. Despite the exposed implant
collars in three patients, only one
was partially disappointed by the
esthetic aspect of the rehabilitation,
and the other two patients declared
complete esthetic satisfaction.
Discussion
Both implant systems appeared
to be suitable and reliable for re-
habilitation of partially edentulous
arches without differences in the
analyzed clinical parameters. The
small BR observed during the first
year corresponded to normal bone
remodeling in the postsurgical pe-
riod. At 4 years, the bone level was
within normal limits without statisti-
cally significant differences between
the two implant types. However,
the main limit of the present study
is the small number of evaluated
implants, which caused very large
standard deviations and may pre-
vent one from drawing sound con-
clusions from this data.
Moreover, at implant insertion,
the TG implant with the 2.2-mm
machined collar had a rough sur-
face at the crest. Meanwhile, the EO

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542
Fig 4  Four months after implant place-
ment, an exposed implant collar occurred
next to a TG implant due to gingival
recession (arrow). Although no statistically
significant differences were found between
EO and TG implants in the investigated
clinical parameters (PI, BOP, PD, and BR), 3
of 12 TG implants have an exposed metal
collar.
implant with the 0.8-mm machined
collar was endosseous and had a
microgap at the crest, meaning that
the surface roughness was 0.8 mm
below the bone crest. This could
have impacted the peri-implant BR.
The present results agree with
those of other studies17–19,29 investi-
gating the marginal bone remodel-
ing and soft tissue health surround-
ing bone- and tissue-level implants:
Excellent clinical and radiographic
conditions were reported for both
implant types. However, the tradi-
tional evaluated parameters (that
are usually reported in a majority of
studies) were not sufficient for defin-
ing the success of implant therapy.
In fact, three patients showed an
exposed TG implant collar due to
gingival recession, jeopardizing the
esthetic outcome of the rehabilita-
tion. This complication represents
the main drawback of traditional
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tissue-level implants with a diver-
gent collar. A gingival recession may
be easier to manage using bone-
level implants that are more versa-
tile, whereas tissue-level systems
are simpler and suitable for virtually
any application in zones that are not
esthetically sensitive. However, their
positioning is problematic in areas
where a display of grayish metal col-
or at the restoration margin should
be avoided. Recently, tissue-level
implants with a convergent collar
have been introduced to the market
with the aim of avoiding such incon-
veniences.30 Unlike a divergent de-
sign, the convergent design of the
transmucosal components increases
the available space for the connec-
tive compartment of the supra-
crestal tissue attachment, aiming to
increase tissue thickness.30 Further
research is needed to validate the
advantages of this implant design.
An original aspect of the pres-
ent study is the method applied for
the histologic analysis, which was
conducted on very small, minimally
invasive peri-implant soft tissue
samples (< 3 mm). Due to their small
size, the samples were embedded
in resin instead of paraffin.
Although a histologic compari-
son between the peri-implant soft
tissue surrounding bone- vs tissue-
level implants is not present in the
literature, the results of the present
study are in agreement with those
by Sanz Martin et al,31 who evalu-
ated volumetric changes in hard and
soft tissues occurring from prosthe-
sis insertion to the 1-year follow-up
using one- and two-piece dental
implants. Within the first year of
loading, minimal changes occurred
regarding tissue thickness, crown
height, and facial volume for both
implant types.
The present study includes a re-
duced number of patients, preclud-
ing robust conclusions. Nonethe-
less, there was no loss to follow-up,
and the randomization approach en-
sured identical assessments of both
EO and TG implants. Moreover, the
risk of bias was further minimized, as
the implants were identical except
for their coronal portions.
Conclusions
Both implants appeared to be suit-
able and reliable for rehabilitation
of edentulous arches, without differ-
ences in the investigated clinical and
histologic parameters. However, tis-
sue-level implants showed a greater
risk of implant collar exposure, sug-
gesting that their positioning should
be avoided in esthetic areas.
Acknowledgments
The present research was partly funded by
Sweden & Martina (Due Carrare, PD, Italy).
The authors declare no conflicts of interest.
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Volume 42, Number 4, 2022