Subcrestal placement of implant: prosthetic complications?

I like to use the lingual crest as a guide placing the top of the implant aligned with it. Then I onlay graft some Bio OSS and close primarily. Usually I get some bony overgrowth on the buccal. Usually not a problem if it is just a few milliliters. If you bury an implant subcrestally I see die back to the first thread due to biological width. Good luck!

The simple answer to this question is to plasty your ridge to a flatter profile before inserting the implant. Placement of the implant subcrestally can complicate the restorative phase in that it may be difficult/impossible to get the abutment/impression coping fully seated on the fixture, which will necessitate bone removal (aka unplanned undiscussed second "surgery" = angry patient) Placement of the implant subcrestally by 1mm to account for "bone loss due to biologic width to the first thread" is simply the result of using a poorly designed system. As a clinician accepting this bone loss as routine to me sounds absurd. You need to use a different system. Another interesting point is if you have an implant with some buccal dehiscence and you place Bio-Oss around the threads, do you ever get "osseointegration" in that area? Not really important, but interesting from a theoretical point of view. CRS are you using a membrane? Do you have any experience with re-entry using Bio-Oss around the top of the fixture as far as what it looks like after a few months?

I prefer using ankylos implants in the post.mand. I place the implant crestal on the buccal and recontour the ling. bone to allow about 1 mm subcrestal position. The shape of the abutment allows for nice tissue healing and no impingement of the ling bone.

CRS, you work off a panorex? Why not CBCT in this region? That would be my choice. You can then plan the case rather than deal with things as you go along. Having taken a scan showing a sloping ridge, I would usually use the Astra Profile implant which works beatifully in these cases...no graft, no membrane, no bone levelling (although I do this occassionally), just simple placement.

contour your ridge before you place the implant..simple!

I will remove sharp edges of the lingual cortex first as well diseased bone from buccal cortex, now place the implant 1mm subcrestal or equicrestal or supracrestal buccaly depends up on the available height and if supracresta then graft, if third molar is missing then best to involve same side in to the flap after placement of implant.

To add in to it plast of lingual cortex after implant placement as in such situation if you achieve rest of the parameters such as stability, position, removal of diseased bone etc. alteration of soft tissue is also required to reduce the pocket.

Ankylos is a good option with the indication for subcrestal placement. Astra Tech offers a Profile implant for sloped ridges. The actual implant is sloped to match the contour of the bone. I've used this several times with good results but it does require components for impression that are different than standard sized Astra and can be tricky to keep track of the slope at installation the first 1-2 cases. Both implants are owned by Dentsply--our rep let us try both options via trial surgery. Since I was already an Astra user, I use Profile for these cases.