This site uses cookies. By continuing to browse the site you are agreeing to our use of cookies. Find out more here.close

Zero Bone Loss Concepts - Hard and Soft Tissue
20 September 2017 at 6:00pm BST

Posted on 04 September 2017
Content available to premium subscribers only
Tomas Linkevicius

Zero bone loss concepts

The development and maintenance of bone stability around implants.

Evidence-based clinical guide

Part I. Development of crestal bone stability. Vertical soft tissue thickness: Its’ Effects

on the Crestal Bone Stability.

Mucosal tissue thickness was shown to be the factor having impact on crestal bone

stability. Even platform switching of the implant-abutment connection does not

reduce crestal bone loss, if soft tissues at the implant placement are thin.

It is suggested that thin tissues might be thickened during implant placement, thus

reducing bone resorbtion. The proposals put forward depend on the bone height

including (1) bone reduction to passively augment soft tissue proportion, (2)

subcrestal placement to achieve greater soft tissue contact or (3) a ‘tent’ technique

that involves covering the abutment with the flap to provide soft tissue growth. If

bone height is not sufficient, vertical augmentation of the soft tissue is recommended

with different materials - autograft, a xenograft or a dermis-derived allograft.

Participants will know:

  • How to diagnose thin vertical tissues
  • Implant placement depth depending on implant/abutment connection type
  • Selection of materials for vertical augmentation
  • How to increase vertical thickness with allogenic membrane
  • Reduce the bone to… save the bone
  • “Tent” technique to increase crestal bone stability… and many more

Part II. Maintenance of crestal bone stability. Prosthetic factors: cement excess,

subgingival and supragingival prosthetic materials, impression of deeply placed


Further, it is important to preserve bone levels after prosthetic treatment. Recent

research has proved that the deeper the position of the margin, the greater amount of

residual cement is left undetected. The relation between position of cement excess in

the peri-implant sulcus, periodontal status of the patient and severity of peri-implant

disease is explained. To avoid cement excess, finished implant restoration with

occlusal opening is cemented on titanium base in laboratory and restoration is

attached to the implant by an abutment screw. Zirconium as a material is considered

the best for peri-implant soft tissues. However, it’s evident that it must be treated in

special manner and polished.

Participants will know:

  • How to select cemented or screw-retained restorations
  • The safe cementation without cement excess
  • Easy construction of cement-screw retained restorations, using Ti bases
  • Cement excess – new plague of the implants?
  • The effect of zirconium on peri-implant soft tissues
  • Adherence zone and plaque zone. What is the difference?
  • Supragingival prosthetic material – which one to select … and many more.