Best Height to Install Dental Implants?

It depends on the implant system used, that question can best be answered by the implant company rep. Secondly the clinical application determines the type of placement. Probably the best place to start is by treatment planning a case and finding a surgeon to work with. The most important part is restoring the implant first. Work as a team with your surgeon and get comfortable with restoring first. There are submucosal and transmucosal placements. Start slow with a partner you are comfortable with. Believe it or not your restorative skills will be your most important asset . It's not just about placing the implant, it's the restorative portion which drives the case. Good Luck.

nowadays the length of the implant is not an issue anymore. You can place an implant as short as 6 or 8 mm . Dont worry about the difference between the crown length and the implant. Its not a problem if you dont have a 1:1 ratio. As for the protocol try always to have high torque insertion by using conical implants and by undersizing the implant drlling. hope it helped

Being a ceramist I am esthetically orintated and strive to make my work look and work like natural teeth. I like to see the platform of the implant at least 4mm below the proposed height of the gingival zenith. This is the minimum dimension needed to allow for sub-gingival contouring to displace and support the soft tissue which gives rise to the papillae and results in a much more desirable emergence contour.

As CRS states, the manufacturer's suggested height is the first consideration, but this recommendation will be tempered by the location, the proposed function, the patient's bone maintenance, resorption history, etc.. For example, division 3 (flared) anteriors, esp. lowers will suffer greater labial plate resorption following an immediate implant placement, so you may want to add a millimeter or more depth there. Each implant design has an ideal placement height to the bone and the soft tissue level, but the Buccal and Lingual ridge heights are often differing. Take some good courses on your chosen implant system and consult with an experienced operator after first having examined your site for the ridge shape and soft tissue contours. Ther is usually an acceptable range of 2-3 mm from the ideal height which should be varied according to conditions. John

Excellent comments by earlier posters. I would like to expand on that mentioned by CRS. Implants with a "smooth collar" (e.g. Nobel Replace Select) the collar is typically placed supra-crestal. Implants with a rough surface to the implant platform (e.g. Straumann bone level), you want to bury all the rough surface to provide maximum implant bone contact, so you place at a crestal level. Implants with a rough surface extending onto the platform (e.g. Ankylos), it is recommended to place sub-crestal. That is general rule. However, as CRS stated, it also depends on the application. In immediate placement, the level of the platform is slightly more apical relative to the crest, than it would be in non-immediate placement, to accomidate for the remodelling of the extraction socket alveolar crest. Last but not least, CRS makes a good point, hone your restorative skills. The implant supported restoration is the part of the "implant" that the patient will see, will function with, and ultimately influence them to decide if they are happy, or not about the treatment.

To put your question in a differing approach, it is best to wax up the ideal final restoration and then to work from that down to the implant while consulting with the implant placing surgeon, the lab, and maybe a periodontist in aesthetically challenging areas. Take your wax up to the lab and ask how much room they'll need for occlusion as well as subgingival. Set up your ideal final result before deciding anything else and get the best info available before any surgery. John

When placing an implant that is capable of a fluid-impervious abutment connection (Astra, Ankylos, et. al.), I feel confident in placing them slightly subcrestal. My experience with implants that have a flat, tri-lobe connection, where there can be micro-leakage at the platform level, is that over time there will be cratering of bone surrounding the implant if it is placed subcrestal. Where the crestal bone is uneven (e.g. higher on the lingual than the buccal), I am enjoying success with the Astra Profile implant. Best Wishes, Jim (I have no financial connection with any implant company)

When I first started placing implants a long time ago I used to bury them one mm below the surface and saw the bone die back to the first thread. Now we know about biological width! I don't like to bury anterior implants below the bone but follow the natural contour since the adjacent bone peaks at the interdental papilla. Also I've had luck with getting 1-2mm of vertical bone over an implant with some grafting. I like to use the lingual plate height as my guide it's pretty reliable marker and I sometimes.I place a buccal onlay graft. I remember back in the day when the implant manuals would tell you to smooth down the bone level height to make it easier to start the pilot. I would never do that now with the sharper thin pilot drills!! Back then there were only a few systems and fortunately those implants are still functioning 20 years later!

Different implant designs need different crystal relationships. Bicon's are designed to an ideal 2-3 mm sub crestal position. One cannot just state an across the board,ideal crestal relationship for all the different designs. Bicon's also have the most parallel Morse taper which seals out moisture as well as bacteria and we often see bone growing over the implant/abutment junction. I have no vested interest in Bicon, but want to make it clear that what guidelines are ideal for one design may not be ideal for another design. Most manufacturer's courses clearly detail their unique ideal placement protocols. John