Supracrestal implants: indications?

As to my knowledge, the answer is NO.

I fail to see reason for installing an implant supracrestally if there is no simultaneous GBR. With implants as short as 6 mm, why would one position an implant supracrestally? Implant biomechanics would be significantly compromised.

Not sure of the question are you trying to build bone vertically? Otherwise esthetics and metal showing would be an issue,not sure of what you are asking. The soft tissue thickness, biotype is a big consideration.

The one parameter you did not share with us is how high off the crest your implant placement will be. I routinely place my implants 1-2mm suprcrestal in many cases. But, with the implant design I use, I see crestal bone growth up the neck of the implant. While I can make this statement with my particular paradigm, a blanket statement that all implant systems wil behave in the same fashion is pure folly. The ability of get crestal bone growth after supracrestal implant placement, in the absence of an adjunctive GBR procedure, is directly related to implant macroarchitecture, insertion torque, surface, neck design and abutment connection. This is why I utilize the most current implant designs with particular attention to the biologic response. RJM

I would be interested to know about the implant system you use, Dr Miller. And the technique you use to get supercrestsl growth. I would be willing to change my technique and thought process to do this. Sounds absolutely perfect . And I have to agree about the bio type comment earlier. Thin bio type, not much wiggle room for errors in judgement . Thanks fir the topic and responses.,Bill

Bill; The system I use most often is from Intra-Lock International. While I use several of their implant designs, that one that I employ in the majority of my cases, particularly for extraction/immediate placement is the Fusion OS line. This architecture employs a concept called radial compression threading, which functions to keep the compression of bone within physiologic limits during the entire seating protocol. By minimizing bone microfracture, we get an earlier bone response and protection against crestal bone loss. Combined with a molecular impregnated calcium surface to upregulate osteoblasts and a low microleakage ferrule abutment connection, the vast majority of my cases show crestal bone growth after reconstruction. This led me to purposely place many of my implants supracrestally to take advantage of this outcome. RJM

Dear Dr. Miller, I am interested whether there is literature supporting this technique or, perhaps, radiographs that you could share with us. Thank you and kind regards.

Go to my website and leave me your email. I will send it to you directly. RJM

First, thank you for all your input. I never placed implants supracrestally in the anterior region. What drove me to post this question was that I just had someone from Biohorizon who claimed that with their new laser lock technology 1-2 mm positioning of implant neck supracrestal is possible with good tissue maintenance.