Implants with a polished neck (Tissue Level): what they are for and the advantages of Straumann

Key points

• On a "bone level" implant, the junction with the crown is hidden inside the bone; on a "tissue level" implant it sits higher, at the level of the soft tissue, because the top of the implant has a smooth, polished neck.
• The polished neck exists so that the gum, not the bone, sits against it: bone does not like smooth metal or a junction between parts, whereas the gum does.
• Advantages: the implant-to-crown junction is moved out of the bone, leaving fewer triggers for bone loss at the neck; restoration is simpler — one fewer component; care is easier.
• A limitation: in the smile zone, with a thin gum, the polished margin can show through — bone level is more often chosen there.
• At Tursunov Clinic, Straumann Tissue Level costs 500,000 ₸, and a Korean polished-neck system costs 200,000 ₸; the surgeon makes the choice based on the CBCT scan.

Two levels: where the implant ends

Any implant has a part that sits in the bone and a part the crown attaches to. The difference between systems is where the boundary between them falls.

Bone level. The implant is rough along its whole length and ends at the level of the bone. The abutment and crown attach at that same depth, so the junction between the two parts sits inside the bone. The gum forms around the abutment.

Tissue level. The top 1.8–2.8 mm of the implant is a smooth, polished neck that rises out of the bone and passes through the gum. The junction with the crown ends up above the bone, at the level of the soft tissue. The bone only contacts the rough part; the gum contacts the polished part.

This polished neck is exactly what the clinic's doctors most often explain at a consultation: patients hear the word 'Straumann' without knowing that one brand covers two fundamentally different options.

What the polished neck is for

Bone and gum respond differently to a metal surface. Bone grows onto a rough surface; it does not "accept" a smooth one and pulls back from it. The gum, on the other hand, sits tightly against smooth polished titanium and less well against a rough surface, where plaque collects.

There is another factor: the micro-gap. There is always a junction between the implant and the abutment, and bacteria live in it. If that junction sits in the bone, the body gradually pulls the bone back from it over time — one of the reasons some implants lose 1–1.5 mm of bone at the neck after restoration. If the junction is moved higher, to the level of the gum, there is simply no bone next to it.

That is the logic behind tissue level: the polished neck passes through the gum and "holds" it, while the junction between parts moves out of the bone. The design is built from the start to keep the bone at the neck stable.

Advantages of Straumann Tissue Level

Straumann has been making the Tissue Level implant for over 30 years; it is one of the most studied designs in implantology, with long follow-up series. What this option gives the patient:

Stable bone at the neck. The junction is moved out of the bone; published long-term follow-up on Straumann Tissue Level shows minimal bone loss at the neck, occurring mostly in the first year.

Fewer parts, fewer risks. There is no separate stage of shaping the gum with an abutment: the gum forms around the implant's own polished neck during healing itself. A separate healing abutment is often not needed.

Simpler restoration. The platform comes out at the level of the gum, so the prosthodontist works with it directly, the crown is easy to try in and fix, and the crown margin does not sit deep under the gum — which matters for both screw- and cement-retained crowns.

Easier care. A smooth neck holds plaque poorly, and the crown margin is accessible for cleaning. For patients who have had gum problems, that is an advantage.

A single operation in most cases. Tissue Level is designed for placement without a second surgical stage: the polished neck comes straight through the gum, and an impression can be taken from it within a few weeks.

None of this makes tissue level "better" than bone level overall — it is a different tool for a different task.

When tissue level is chosen, and when it is not

More often chosen for:

molars, where the aesthetics of the gum margin are not critical and strength and simple care matter more;

patients with a history of gum disease — a polished neck is easier to monitor;

cases where the number of surgical stages needs to be reduced;

single crowns and bridges in the side segments.

Bone level is more often chosen for:

front teeth with a thin gum: the polished implant margin can show through grey, and the crown margin needs to be hidden deeper;

cases where the gum is very thin or scarce and augmentation is planned;

full dentures on multi-unit abutments (All-on-4/5) — there the level is evened out by the abutments, and bone level is more convenient.

The decision is made by the surgeon after a CBCT scan, looking at bone height, gum thickness, tooth position and bite. At Tursunov Clinic that is Arnur Tursunov or Almas Khamiyev.

What it costs at Tursunov Clinic

According to the clinic's price list:

Straumann Tissue Level (Switzerland) — 500,000 ₸

Straumann BLT — bone level — 410,000 ₸

Straumann BLX — bone level — 450,000 ₸

A polished-neck implant, Korean system — 200,000 ₸

A zirconia crown on a Straumann implant — 270,000 ₸

A metal-ceramic crown on a Straumann implant — 250,000 ₸

The implant price does not include the crown or, if needed, a bone graft; a step-by-step estimate is given in writing after the consultation and CBCT scan (11,000 ₸; the consultation is free). Instalments with Kaspi Red 0-0-24 or Halyk 0-0-12.

What to ask at the consultation

Which implant level do you recommend for my case, and why?

Will the implant margin be visible when I smile?

Is a second surgical stage and a healing abutment needed?

How many years of follow-up does this design have?

What is included in the price: just the implant, or the implant with the abutment and crown?

Related services and guides

• Dental implants in Astana
• Single-tooth implant in Astana
• All-on-5 in Astana

Frequently asked questions

Is tissue level only made by Straumann?

No, polished-neck implants are also made by other manufacturers, including Korean ones. Straumann Tissue Level is the most studied of them; the clinic offers both options.

Is the polished neck visible in the mouth?

Not in the side segments — it is covered by gum and the crown. In the smile zone with a thin gum it can show through, which is why bone level is more often used there.

Does tissue level last longer?

How long it lasts depends on hygiene, bite and overall health, not just the design. The advantage of tissue level is bone stability at the neck, but no one can guarantee a lifespan.

Can All-on-4 be done with tissue level?

Full dentures on multi-unit abutments usually use bone level. The decision rests with the surgeon and prosthodontist.