Abstract
Statement of problem
How the performance of dental implants is related to their occlusogingival placement,
crestal or subcrestal, is unclear.
Purpose
The purpose of this systematic review and meta-analysis was to evaluate marginal bone
loss, implant survival rate, and peri-implant soft tissue parameters between implants
placed at the crestal and subcrestal bone level.
Material and methods
Two independent reviewers searched the PubMed/MEDLINE, Embase, and Cochrane Library
databases for randomized clinical trials published up to September 2020. The meta-analysis
was based on the Mantel-Haenszel and the inverse variance methods (α=.05).
Results
The search identified 928 references, and 10 studies met the eligibility criteria.
A total of 393 participants received 709 implants, 351 at crestal bone levels and
358 at subcrestal bone levels. Meta-analysis indicated that crestal bone level implants
showed similar marginal bone loss to that seen with subcrestal bone level implants
(mm) (P=.79), independent of the subcrestal level (P=.05) and healing protocol (P=.24). The bone level implant placement did not affect the implant survival rate (P=.76), keratinized tissue (mm) (P=.91), probing depth (mm) (P=.70), or plaque index (%) (P=.92).
Conclusions
The evidence suggests that both approaches of implant placement are clinically acceptable
in terms of peri-implant tissue parameters and implant-supported restoration survival.
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References
- Effect of implant insertion and loading protocol on long-term stability and crestal bone loss: A comparative study.J Prosthet Dent. 2016; 115: 697-702
- Radiographic and clinical outcomes of rooted, platform-switched, microthreaded implants with a sandblasted, large-grid, and acid-etched surface: A 5-year prospective study.Clin Implant Dent Relat Res. 2017; 19: 1074-1081
- Comparison of clinical and radiographic status of platform-switched implants placed in patients with and without type 2 diabetes mellitus: a 24-month follow-up longitudinal study.Clin Oral Implants Res. 2017; 28: 226-230
- Mini-implants and narrow diameter implants as mandibular overdenture retainers: A systematic review and meta-analysis of clinical and radiographic outcomes.J Oral Rehabil. 2018; 45: 161-183
- Crestal bone loss around adjacent dental implants restored with splinted and nonsplinted fixed restorations: a systematic literature review.J Prosthodont. 2017; 26: 495-501
- In vitro evaluation of the implant-abutment bacterial seal: the locking taper system.Int J Oral Maxillofac Implants. 2005; 20: 732-737
- Analysis of the causes of dental implant fracture: A retrospective clinical study.Quintessence Int. 2018; 49: 279-286
- Influence of the size of the microgap on crestal bone levels in non-submerged dental implants: a radiographic study in the canine mandible.J Periodontol. 2002; 73: 1111-1117
- Ridge alterations following immediate implant placement in the dog: flap versus flapless surgery.J Clin Periodontol. 2008; 35: 640-648
- Impact of implant overloading on the peri-implant bone in inflamed and non-inflamed peri-implant mucosa.Clin Oral Implants Res. 2007; 18: 601-610
- Degree of bacterial microleakage at the implant-abutment junction in Cone Morse tapered implants under loaded and unloaded conditions.J Appl Biomater Funct Mater. 2015; 13: 367-371
- Influence of thin mucosal tissues on crestal bone stability around implants with platform switching: a 1-year pilot study.J Oral Maxillofac Surg. 2010; 68: 2272-2277
- Biologic width around one- and two-piece titanium implants.Clin Oral Implants Res. 2001; 12: 559-571
- Longevity of dental implants in type IV bone: a systematic review.Int J Oral Maxillofac Surg. 2014; 43: 1108-1116
- Impact of implant diameter on bone level changes around platform switched implants: preliminary results of 18 months follow-up a prospective randomized match-paired controlled trial.Clin Oral Implants Res. 2012; 23: 1142-1146
- The long-term efficacy of currently used dental implants: a review and proposed criteria of success.Int J Oral Maxillofac Implants. 1986; 1: 11-25
- Survival rate of titanium-zirconium narrow diameter dental implants versus commercially pure titanium narrow diameter dental implants: A systematic review.Clin Implant Dent Relat Res. 2017; 19: 1015-1022
- Potential bone to implant contact area of short versus standard implants: an in vitro micro-computed tomography analysis.Implant Dent. 2016; 25: 97-102
- A systematic review and meta-analysis on the effect of implant length on the survival of rough-surface dental implants.J Periodontol. 2009; 80: 1700-1718
- Dental implant surrounding marginal bone level evaluation: platform switching versus platform matching-one-year retrospective study.Biomed Res Int. 2017; 2017: 7191534
- Soft tissue and crestal bone changes around implants with platform-switched abutments placed nonsubmerged at subcrestal position: a 2-year clinical and radiographic evaluation.Int J Oral Maxillofac Implants. 2015; 30: 1369-1377
- Marginal bone level changes at dental implants after 5 years in function: a meta-analysis.Clin Implant Dent Relat Res. 2011; 13: 19-28
- Narrow- versus mini-implants at crestal and subcrestal bone levels. Experimental study in beagle dogs at three months.Clin Oral Investig. 2015; 19: 1363-1369
- Comparison of crestal bone loss around dental implants placed in healed sites using flapped and flapless techniques: a systematic review.J Periodontol. 2015; 86: 185-191
- Platform switching minimises crestal bone loss around dental implants: truth or myth?.J Oral Rehabil. 2014; 41: 700-708
- Clinical and radiographic evaluation of marginal bone changes around platform-switching implants placed in crestal or subcrestal positions: a randomized controlled clinical trial.Clin Implant Dent Relat Res. 2015; 17: 364-375
- Bacterial colonization of the implant-abutment interface using an in vitro dynamic loading model.J Periodontol. 2011; 82: 613-618
- Microbiota in experimental periodontitis and peri-implantitis in dogs.Clin Oral Implants Res. 2014; 25: 1094-1098
- Benefits of an implant platform modification technique to reduce crestal bone resorption.Implant Dent. 2006; 15: 313-320
- Cone beam computed tomographic evaluation of implants with platform-switched Morse taper connection with the implant-abutment interface at different levels in relation to the alveolar crest.Int J Oral Maxillofac Implants. 2014; 29: 1157-1163
- Influence of subcrestal implant placement compared with equicrestal position on the peri-implant hard and soft tissues around platform-switched implants: a systematic review and meta-analysis.Clin Oral Investig. 2018; 222: 555-570
- Influence of placement depth and abutment connection pattern on bone remodeling around 1-stage implants: a prospective randomized controlled clinical trial.Clin Oral Implants Res. 2016; 27: 47-56
- Hard and soft tissue changes after crestal and subcrestal immediate implant placement.J Periodontol. 2011; 82: 1112-1120
- Preferred reporting items for systematic reviews and meta analyses: the PRISMA statement.Int J Surg. 2010; 8: 336-341
- Comparison between flapless and open-flap implant placement: a systematic review and meta-analysis.Int J Oral Maxillofac Surg. 2020; 49: 1220-1231
- Survival of dental implants placed in HIV-positive patients: a systematic review.Int J Oral Maxillofac Surg. 2018; 47: 1336-1342
- Principles of and procedures for systematic reviews.2nd ed. BMJ Books, London2003: 23-42
- The measurement of observer agreement for categorical data.Biometrics. 1977; 33: 159-174
- The influence of submerged healing abutment or subcrestal implant placement on soft tissue thickness and crestal bone stability. A 2-year randomized clinical trial.Clin Implant Dent Relat Res. 2020; 22: 497-506
- Platform-switched implants vs platform-matched implants placed in different implant-abutment interface positions: A prospective randomized clinical and microbiological study.Clin Implant Dent Relat Res. 2020; 22: 59-68
- Effect of different implant placement depths on crestal bone levels and soft tissue behavior: A 5-year randomized clinical trial.Clin Oral Implants Res. 2020; 31: 282-293
- Influence of abutment height and implant depth position on interproximal peri-implant bone in sites with thin mucosa: A 1-year randomized clinical trial.Clin Oral Implants Res. 2019; 30: 595-602
- Does apico-coronal implant position influence peri-implant marginal bone loss? A 36-month follow-up randomized clinical trial.J Oral Maxillofac Surg. 2019; 77: 515-527
- Epicrestal and subcrestal placement of platform-switched implants: 18 month-result of a randomized, controlled, split-mouth, prospective clinical trial.Clin Oral Implants Res. 2018; 29: 353-366
- Soft tissue changes and crestal bone loss around platform-switched implants placed at crestal and subcrestal levels: 36-month results from a prospective split-mouth clinical trial.Clin Oral Implants Res. 2017; 28: 1342-1347
- Placement of implants with platform-switched Morse taper connections with the implant-abutment interface at different levels in relation to the alveolar crest: a short-term (1-year) randomized prospective controlled clinical trial.Int J Oral Maxillofac Implants. 2013; 28: 1553-1563
- Effects of platform-switching on peri-implant soft and hard tissue outcomes: a systematic review and meta-analysis.Int J Oral Maxillofac Implants. 2017; 32: 9-24
- Platform switching technique and crestal bone loss around the dental implants: A systematic review.Ann Afr Med. 2019; 18: 1-6
- Stress distribution in the transitional peri-implant bone in a single implant-supported prosthesis with platform-switching under different angulated loads.Odontology. 2017; 105: 68-75
- Zirconium oxide coating improves implant osseointegration in vivo.Dent Mater. 2008; 24: 357-361
- 10-year follow-up of immediately loaded implants with TiUnite porous anodized surface.Clin Implant Dent Relat Res. 2012; 14: 828-838
- Crestal bone loss around submerged and nonsubmerged dental implants: A systematic review.J Prosthet Dent. 2016; 115: 564-570
- Effect of implant macro-design on primary stability: A prospective clinical study.Med Oral Patol Oral Cir Bucal. 2016; 1: 214-221
- Impact of different placement depths on the crestal bone level of immediate versus delayed placed platform-switched implants.J Craniomaxillofac Surg. 2018; 46: 1139-1146
- The survival of Morse cone-connection implants with platform switch.Int J Oral Maxillofac Implants. 2016; 31: 1031-1039
- Long-term (10-year) dental implant survival: A systematic review and sensitivity meta-analysis.J Dent. 2019; 84: 9-21
- Efficacy of soft tissue augmentation around dental implants and in partially edentulous areas: a systematic review.J Clin Periodontol. 2014; 41: 77-91
- Evaluation of peri-implant marginal bone loss using modified abutment connections at various crestal level placements.Int J Periodontics Restorative Dent. 2010; 30: 609-617
Article info
Publication history
Published online: December 24, 2020
Footnotes
Supported by grant FAPESP: 2017/03744-1.
Identification
Copyright
© 2020 by the Editorial Council for the Journal of Prosthetic Dentistry.
