Peri-Implantitis and Survival Outcomes of Tissue Level Versus Bone Level Dental Implants: A Systematic Review and Meta-Analysis

Abstract

Objectives: The aim of this systematic review and meta-analyses was to evaluate the outcomes of using tissue level in comparison to bone level implants in terms of clinical and radiographic changes, peri-implantitis, and implant failure rates.Materials and Methods: Electronic databases were searched to identify randomized studies that compared tissue level to bone level implant. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. Data were analyzed using a statistical software program.Results: A total of 798 studies were identified, of which, five studies with 501 dental implants in 241 participants were included. Overall meta-analysis showed that the use of tissue level implants had lower rates of peri-implantitis (relative risk [RR] 0.59; 95% confidence interval [CI] 0.14-2.48; p = 0.47) and implant failure (RR 0.59; 95% CI 0.07-4.69; p = 0.62) but the differences were not statistically significant.Conclusions: Tissue level and bone level have comparable survival rates and risk of peri-implantitis within 1-5 years of observation. Additionally, no significant differences in probing pocket depths and marginal bone level changes were observed.Clinical Relevance: Tissue level implants demonstrated lower rates of peri-implantitis and implant failure, as well as smaller changes in probing pocket depths at 12 and 24 months, compared to bone level implants. Although these differences were not statistically significant, they suggest potential clinical advantages of tissue level implants in maintaining peri-implant health and stability over time.