Which level of crestal bone should an implant be placed?
Key points
- Implants can be placed supra-, equi- and subcrestally
- After implant placement bone remodeling processes take place and a periimplant soft and hard tissue interface is established
- Implant insertion depth is dependent on implant collar design and implant surface treatment
With regards to implant height, oral endosseous implants can generally be placed supracrestally,, equicrestally, and subcrestally.
general, the rough surface of the implant will be surrounded by bone. This means a subcrestal or equicrestal insertion of implants with a structured implant surface up to the implant shoulder and a supracrestal insertion of implants with a machined implant neck. No matter which implant system is chosen, the exposure of the implant surface in the oral cavity, especially its rough component should be avoided in order to prevent from unwanted plaque accumulation and periimplant inflammation.
Typically, an immediate implant is placed deeper than it would be placed in a healed site. It is generally agreed that the implant shoulder should be placed 3 – 4 mm deep to the gingival zenith, but in the interproximal area this may be 6 – 7 mm deep. With the correct angulation and palatal placement, this should result in a healed site with adequate tissue volume to create an emergence profile.