J Dent Rehabil Appl Sci.  2020 Dec;36(4):222-231. 10.14368/jdras.2020.36.4.222.

Concept and application of implant connection systems: Part II. Placement and restoration of external connection implant and tissue level implant

  • 1Department of Prosthodontics and Research Institute of Oral Science, College of Dentistry, Gangneung-Wonju National University, Gangneung, Republic of Korea


To use the external connection implant (EXT) appropriately, the inter-implant distance should be carefully considered during placement, and the bones raised above the implants should be trimmed during the second surgery. The hex abutment is more useful than the non-hex abutment. EXT is particularly useful when the inter-arch space is limited. The tissue level (TL, internal butt connection) implant has a biomechanical advantage of coronal wall thickness and a biological advantage of an inherent transmucosal smooth surface. During TL implant restoration, an abutment can be selected using the abutment and fixture margins with considerations for the inter-arch space. Since no single type of implant can satisfy all the cases, it is necessary to select the appropriate type, considering the occlusal force and the bone condition.


external connection; tissue level; abutment; placement
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