Mark P. Miller, DDS, FICO
Good question...glad you asked. I lectured for Straumann for 10 years. My wife was a rep for the company for six years. One of the reasons for leaving the company was that we knew a bone level implant was better suited in the anterior than a tissue level implant in most cases. Other companies had a bone level and Straumann did not. I felt we were doing patients a disservice using a tissue level implant in the anterior when bone level implants were better for a variety of reasons. We didn't know a lot about what is now called 'platform switching' which is a proprietary name used by one of the companies. Straumann realized that there was no bone die back with bone level implants so they changed their tune and developed their own bone level implant.
The good news is both their bone and tissue level implants work wonderfully. Both can be used as single stage implants or the bone level can be buried and heal without exposure to the oral environment. There are cases when I don't want anything exposed to the oral cavity. One example we all can think of is when membranes need to be used. Then we're after primary closure and no chance of micromovement.
If you have an esthetic case in the anterior, by all means use a bone level implant. With the advent of CAD CAM abutments, we don't have to use stock round abutments anymore and can shape them more like teeth. This helps tremendously to cut down on those horrible gaps mesially and distally where food traps around implant crowns.
And don't sweat using temporary crowns. In fact, be glad to do it. You get to try out a prototype crown for a month or so to see what tissue response will be. That way there are no abutments showing following crown placement. Make a screw retained temporary crown, send the patient on their way, have them back in a month or so (some will respond 4-6 months, but let's get real), take a final impression of implant AND sculpted new tissue, and have a great result and happy patient.
Your comment about more experienced periodontists and oral surgeons favoring tissue level implants in the anterior region tells me that just maybe those 'seasoned' practitioners either haven't kept up with technology or have inventory they need to use up. Don't, as a restorative doctor, get conned into using an implant that will not give you excellent restorative and esthetic results. You tell THEM what to place, not the other way around. Whatever they place will integrate and they get paid. Whatever esthetic compromise ends up will be your fault in the patient's mind. You're the quaterback, you control the case...period.