Implant Dentistry, this decade is highlighted as the biggest trend in dentistry. The advances in the field barely cease to amaze us. Subsequently, with persistent researches and pieces of evidence, in less than 50 years this science solves the fundamental issues suffered by most patients.

Sub crestal implants are the latest innovations that have proved to be successful in many complicated patient cases.

Dr. Vinoo Matthew, in this webinar, incorporates the theoretical relevance and clinical success of sub-crestal implants. Successful patient treatment begins first and foremost with patient education.  He introduces this webinar by elaborating on the need for normalizing Implant dentistry.

He emphasizes numerous points including:

The relevance of placing implants in practices
Successfully circumventing new horizons for providing optimal treatment.
Increasing predictability of the clinical outcomes
Viability of treatment options
Getting implants to mainstream dental treatment
Simplifying the complexity of Implant treatment.
Introduction to Sub-crestal Implants
The longevity of dental implants depends highly on the integration between implant components and oral tissues including hard and soft tissues. Literature reveals that dental implants lose an average of 1.2 mm of marginal bone loss from the first thread during healing and subsequently 0.1mm each year.

Albertson et al smith and Zarb proposed one of the criteria for implant success as vertical bone loss of 0.2mm following the placement of the dental implant is in the first year of function.

Indications for sub-crestal implants

Eliminates the damage caused by excessive heat generation during drilling or bone removal procedure.
Does not require periosteal flap elevation hence reduces excessive pressure at the crestal region.
Higher capability to withstand excessive occlusal load and periimplantitis.
Areas of atrophied bone wherein bone loss up to first thread in immediate Implants cannot be
Sub-crestal Implants
Subcrestal placement of implants that provide platform switching is the newest feasible implant dentistry science. Wider implant platform bridging with shorter implant abutment platform transition yield the best possible outcomes.

This mentioned platform switches present majorly at the implant-abutment interface.

This enables the implant to withstand, crestal pressure, lesser micro threads, and compressive forces. These forces are not directed towards the implant crest, instead are towards the fins of the implant on the withstanding trabecular bone.

The success of sub-crestal implants
Presence of parallel threads in trabecular bone.
Placement of sloping shoulder.
Providing cold weld/morse taper connection. This enables the surrounding area of the implant to completely seal the bacteria and increases biological width.
Meta-analysis
Literature has many references for the success of subcrestal implants. It reinstates the preservation of crestal bone and new bone formation

bone formed around the implant. The presence of a hermetic seal ensures the bone to climb for osseointegration.

General reasons for implant failure
The status of the peri-implant bone marginal level area.
Connection failing to preserve the crestal bone.
The intensity of compressive shear and tensile forces act more on crestal compact bone.
Presence of a weak connection between implant and abutment.
Increased treatment options provided by subcrestal implants

Immediate loading
Sinus transportation
Decreasing interocclusal height
Immediate loading image
Sinus transportation
Placement of graft around the area
A bone graft can be added to preserve space. For faster resorption of graft surgical grade calcium sulfate, beta-tricalcium phosphate is preferred. Helps to preserve bone in that area.
Graft helps prevent soft tissue from getting into the implant. Graft materials include xenograft, allograft bone substitutes.
An important histological point to note is that chondrocytes should be kept away and osteocytes should stay to facilitate the healing process.
A horizontal mattress, a Figure of 8 is placed to hold the graft in its place.
Sinus Augmentation Procedure
In cases of close proximity, around 4 mm of the implant with the sinus, the augmentation procedure is mandatory. The drill is placed up to the sinus and the sinus is transported with graft material. Sinus abutment is placed at the crest of the implant.

This is only possible with subcrestal implant.

Dr. Vinoo Matthew establishes the reliability of placement of subcrestal implants extensively in practice.

He concludes the webinar by providing tips for increasing private practice by adding solution incorporation. He implies providing more treatment options results in higher revenue generation.