These implants have had an SLA® surface since 1997 and a SynOcta® abutment connection since 1999. They basically correspond to the Straumann® Tissue Level Implant System available today. Since 2005 the implants have been optionally provided with an SLActive® surface, which is scientifically proven to accelerate osseointegration even in compromised patients. Since 2009 all implants have been made of the extra strong titanium-zirconium alloy Roxolid®.

Basic research for the first Tissue Level generation was done by a group led by the Swiss dentist Prof. Dr. André Schroeder (University of Bern, Switzerland). Along with Per-Ingvar Brånemark, Schroeder was one of the fathers of modern oral osseointegration². One of Schroeder’s scholars at the time, Prof. Dr. Daniel Buser, was a co-developer and the first clinical user of the ITI Bonefit® system, which led to the modern Tissue Level concept.

Clinical concept

From the very beginning two-part ITI Bonefit® and today’s Straumann® Tissue Level implants were designed for a one-stage surgical protocol. This involves transgingival healing, which eliminates the need for a second-stage surgery to expose the implant shoulder. In comparison with bone level implants, impression-taking and the handling of healing caps, abutments and prosthetic superstructures are significantly more straightforward, making daily clinical practice significantly easier. The protocol also saves time and reduces the complexity of the overall treatment.

Learn more about the potentials of the Straumann® TLX Implant System:

• What international experts say about the new Straumann® TLX Implant System
• A biologically sound implant design: The Tissue Level Story
• Immediate protocols welcome: Sound biology meets digital efficiency
• Straumann® TLX Implant System: How to become an expert

Another important aspect of the original Straumann® Tissue Level Implant System is its biomimetic design. The Standard type implant has a machined transgingival part continuous with the endosteal screw. The vertical dimension of this section gives a height of 2.8 mm (Standard implants), which is in the range of the mean biologic width of natural teeth^{3, 4}. Thanks to this design the inevitable microgap between the implant shoulder and the abutment or restoration can be positioned at the gingival margin – away from the bone. Moreover, the smooth surface of the transgingival collar facilitates hygienic maintenance, which helps to reduce the risk of peri-implant infection and disease (see next section)⁵.

According to Professor Buser, after bony remodeling during the osseointegration process the micro-rough (SLA®/SLActive®) part of the implant should be completely covered with healthy bone. This applies to placement both into native or augmented bone and is an important prerequisite for long-term peri-implant tissue stability.

Scientific documentation

With more than 35 years of clinical application, Straumann® implants placed according to the Tissue Level concept are among the best documented in the market. Over a period of 10 years, clinical studies have demonstrated high success rates of up to 98.8 %⁶. This has been shown in studies both by university- and practice-based groups, with up to 4,591 implants in the follow-up^6-10. The implants have also proven successful in various indications, e.g. full-arch rehabilitations in the maxilla¹¹.

Moreover, in a huge independent study Straumann® implants with an SLA® surface had the lowest odds ratio* for early implant loss, in comparison with two-part bone level implants of other well-documented brands (Figure 3)¹². They also had a significantly lower odds ratio for developing peri-implantitis after 9 years, in comparison with bone level implants⁵. This may be especially relevant in patients with a history of periodontitis.

All of these results underline the high predictability of implant therapy with the Tissue Level concept developed by Straumann®.

          
* biometric risk measure, applied for the strength of association between two events (factors)