Anklyos Implants: Looking for Guidance Before Switching to this System

I am oral surgeon in south Korea. I have used Ankylos system for 5 years. The company recommend subcrestal placement in Ankylos protocol, But You do not always install the implant subcrestally. I think, the installation depth depends on the gingival biotype. If you can see the thick gingival biotype (usually more than 3mm), you need not install the implant subcrestally and just install equicrestally. and If there is limited inter-arch space, I recommend other system that has castable abutment. Sometimes, I have used 3.5mm diameter in posterior edentulos area which includes molar tooth but you should consider the bruxism or other oral habits. I am now preparing the article about narrow diameter implant which was install in posterior edentulous area.

Hi there, Ankylos is a nightmare if you want to treat BIG cases (6-8 implants)and full arch bridge.Why? BECAUSE THERE IS NO WAY ON EARTH YOU CAN GET THE ABUTMENTS IN MOUTH IN THE WAY THE LABORATORY MILLED THEM!!! THe lab usually will have to cast you an individual metal key(which also deforms and doesn`t make the situation easier). Ankylos is best for 1, 2 3 single implants. THis is due to the lack of internal hex connection. It only has a cone, allowing 360 deg. abutmentrotation. Now they introduced some locking struts to eliminate the problem. Don`t count on it! The system was developed with too much scientific and less practical thinking (what do you expect from university professors?) Stick to a system that has an Internal hex (BIOTEC, Imtec Endure, IMPLANT Direct) or torx connection. Avoid Octagonal or worse dodecagonal (12 walls-straumann). Too much torque (more than 50 kills the interface. Ask me how I know. Stick toa system, manufacturing implants from Grade 4 titanium. Strong enaough even in small diameters. Best of luck: Dr Dimitrov

I agree with the above statement! Nightmare! I have been using PerioSeal...simple design, great esthetics! The great part is the simplicity of the system, less parts...means less inventory and overhead because majority of the restorative components are imterchangable between all implant sizes, and the bonus is the cost! I can place and restore one tooth for $344. Plus the tissue and bone around all my implants look very very healthy. Their locking mechanism their prosthetic components is genius and simple...NO torquing! Used IMplant direct in the past and horrible customer service.

Hi there, Ankylos is a wonderful system, simple, reliable and fair in pricing. bone level or sub crestal implants are more esthetics. Cone morse is Ankylos is a kind of cold welding, no bacteria, no bone loss or saucer bone loss around cervical. Straumann has developed quite the same solution just because Ankylos great success. For the problems cited above there is a new abutment with special slot guiding system who avoid problems. You can go go without any problem.

Ankylos is a great system, if you know what you are doing. I frequently place multiple implant and have no problem with the abutment. There is a reason there is no internal connector on the implant/abutment, that is to eliminate the microgap that most other system have; expecially ones with internal hex. With Ankylos there is a friction fit between the implant and the abutment. Something that no other implant listed in this post has. It is always good to a lab that is familiar with the system. When using custom abutment, the lab must fabricate a jig reguardless if it is a single tooth or multiple implants. Yes a 3.5 is strong enough for a premolar as well as a molar. The system is not complicated if you understand the concepts behind engineering. Best of luck Sloanwhitedds

Just wait for Ankylos Cx, that will come out sometime within the next year - it allows for the indexing of the abutment within the implant and eliminates the placement "JIG". Otherwise this is one of the best system on the market. You can get amazing emergence profiles for anterior teeth with great esthetic results.

I suspect you're looking at the Ankylos implant due to the stronger morse taper and the lack of a microgap. It also has a narrower diameter abutment neck. narrowere than the implant diameter, also known as platform switching, medializing the microgap etc. Several other implants now have these features without the limitations of a lack of indexing. Check out Astra, the new bone level Strauman or the new Nobelactive. You can also platform switch with the 3i implant you are currently using, although it does not have a morse taper. I have always been leery of implant systems where you cannot index the abutment to the implant (Bicon, Ankylos) due to a lack of flexibility. However these are all good systems if one knows the limitations.

Internal connection, friction-fit, cold weld all started with Zimmer. Friction fit connection was a patent from Dr. Niznick. Tapered Screw-Vents have been the same for a decade with no changes. Why no changes? Simply it works. No speedy, then groovy, then replace select, then active. Why are these companies always quick to jump the gun with so many different implants that accomplish the same result. Look at the product portfolio, history, science and then determine what best fits your needs. I recommend TSV from Zimmeer.

I have been using Ankylos for over four years in my practice. Not only is the 3.5mm strong enough for a premolar, it is strong enough for a molar. With regard to restoring the larger cases...you can avoid any of the mentioned problems simply by using the Standard abutment system. It is then simply restored as conventional fixed prosthodontics and no transfer guide is necessary from the lab. While other systems have been referenced, keep in mind that Ankylos has over 20 years of clinical history..that certainly means something to me in private practice. I have not found any limitations with the system at all.

Good points Dr D.

Other excellent systems to consider are "MIS-7" and the MIS Biocom, the Tatum "D" Implant and Tatum Tapered. The "Bicon" 5x8 and 5x11 are excellent in the posterior quadrants. These are all excellent implants and have their pros and cons as per prostho. The Tatum "D" and "Bicon" are plateau implants, once integrated they are rock solid. The MIS-7 and Tatum Taper are easy to place and restore. Do your homework and use what pleases you.

I have used the ankylos system for about 3yrs. now and I have to say I am amazed at the esthetics produced. I am a periodontist and expectations are high for very esthetic results, which can be acheived with this system. It is a paradigm shift though- I used to use Nobel and there is a big difference in the philosophy of this implant ie. subcrestal placement (can be placed crestal if needed and esthetics are not a concern), morse taper and lack of internal "index" or hex to lock in place (it does "lock" into place though and this is what prevents the microgap ie. bacteria). These changes are for a reason- we are starting to understand why certain designs don't work as well and what to do to improve them. This is the new generation of implant design- it's not just getting the implant to integrate anymore. However, yes, you do have to do some homework to understand why you use this implant and what the advantages are, as well as why there are different abutments for different purposes. I have found the reps.are very well trained and can help you tremendously with prosthetic and surgical solutions. Hope this helps.

I think that Ankylos has some good attributes (morse taper and medialized abutment.) BUT, why would you want an implant without an index? It would be very difficult to transfer the abutment from the model to the mouth without some kind of jig. I think that Ankylos is coming out with an indexed implant for that reason. I would either wait for the indexed Ankylos or look into a # of others with similar characteristics for preserving bone but have an index. (ex. astra, straumann, blueskybio.com)

I like you use have used a few systems and did for a time try Ankyloss. Surgically is is fiddely to use and very old fashioned, but restoratively the system is a nightmare, ask the technicians. I agree that it has some advantages in the morse taper fit but the disadvantages in miss fits due to the difficulty in using it, having no index and not being able to do proper try-ins far out weigh the advantage. Stick with what you have got or use the new Nobel Active, you will be much happier

I have not worked with the Ankyloss system but in looking at it it seems to be a natural choice for someone who also uses the iTero digital imprssion system. Has anyone scanned in the Abutments on ankyloss with an iTero?

I suppose everything may be regional as to what system Dr.'s are using. In the two study clubs I participate in, which consist of over 50 Dr.'s not one specialist is using Ankylos. Consequently I do not have any experience with the system. The area I practice in is dominated by Nobel and Zimmer. Morse taper, friction-fit, over 20 years of clinical studies. No flash, no fuss, just clinical results....Zimmer TSV is your workhorse!!!

I have gone from using 3i and straumann predominately and swiched to ankylos as my main system 14 months ago. be waned there is a steep learning curve, because the implant does not 'feel' the same when placing. If you are very used to a more conventional thread, (3i, nobel etc) the square ended thread of the ankyos will feel alien. The best way to describe it is the difference between a wood screw and a bolt. you will have to re-calibrate your brain and follow the protocols VERY carefully at first, mabey get a mentor who uses the system for the first few. Restoriavely there are chalanges but again you change the protocol to compensate, as the earlier poster said. It also offers some unique solutions for edentulism (SYNCONE) which simplify the portocol. Having said that, it ain't a cure all, I dont use it for sinus lifts and some other apps, so you always need another system in the locker (i use implant direct)

Ankylos has more than 20 years of development and use, and there has not been any need for significant change in the design. It says a lot about other systems which kept on coming out with so called new designs, which when looked into carefully, are actually going back in time. The simplicity in the universal use of abutments in different diameters, the low torque needed etc are added advantages. In multiple units, you only need to fabricate an index or jig for every two abutments. There is no need to make an entire arch for indexing that will create inaccuracy and difficulty to seat those with notable angulation difference. When you use a different system, learn the advantages and the way to maximize them instead of simply applying similar proceudures recommended for other systems, then condemn because they don't work. From more than 20 years of using different systems from Branemark to Zimmer, I find Ankylos is a very simple and reliable system, versatile enough if you understand the limitations. Besides operator familiarization, using a lab tech who knows the system is a must for trouble-free outcomes. The recent modified index is not really necessary. It increases the cost of manufacturing more than others.

As for monica babbits excitement for the ankylos system, I have been using nobel and zimmer and limited cases of astra for 10 years and each have surgical and prosthetic pros and cons, I see no pros for using the ankylos system, I am currently having to remove implants, and figure out prosthetic options for patients that she placed ankylos implants. There are no benefits to this implant use what experienced surgeons use and not what the trend implant of the week is. Ask yourself what will this case look like in 5-10 years not in 3 mo.

I have attended the lectures from some of the above posts and even went to Germany to train on Ankylos. The concept is powerful, but the major drawback is the lack of index. Sure a jig can work, but what about the person who has to remake it 8 years later. Dr. Goldenberg is right, standard abutments solve this, but you don't always get to use standard abutments. The fact is, remaking a multiple unit Ankylos case could not be worse if there are any alterations to the abutments. Imagine the patient wearing a prosthesis. What will you do when you have to take the abutments out to make a new impression? You have to make the jig intra-orally. That is a huge production drain and is not good for the patient because the process can take hours. You have to repeat taking the abutments in and out every appointment if the patient is going to keep using the proshtesis they have while you make a new one. I hope you get the point. So single unit cases work great. But we cannot guarantee someone will not need more implants in other sites later. Indeed many end up in full arch cases. So think about the patient. They love you, but have to move. They end up in someone elses office needed work, and see what you've done. The posts stating you cannot have a good morse taper with and index must be tempered against Ankylos own position to make an index. Which is correct? Ankylos is a great single tooth implant system. But Astra Tech, Bicon, now Straumann Bone Level, and Nobel Active can allow the same benefits. Also remember that the connection is only one of many factors that contribute to crestal bone loss. All of the above mentioned systems can show the same radiographic results with bone over the implant because it happens. But it doesn't always happen. Length of implant, diameter, occlusal forces, etc. all contribute to whether crestal bone will be preserved. For me, and I have used all systems, Ankylos is a no go until there is an index, and I don't believe you will loose the benefits of conical connection when the index arrives.

The bottom line is the only limitation of the ankylos implant is Doctor/labs ignorance of how the system works. Most index systems require an x-ray to confirm the abutment is completely seated. This is not the case with ankylos. Once the abutment is torqued in there is no question it is seated (no xray required). Dont be fooled if there is an index there is a microgap. Sloanwhitedds

Dr. White should possibly look at the research being done in Germany by Ankylos sponsored researchers. Ask Dr. Weigl if he sees the microgap with Astra, Bicon, NobelDirect, or Straumann Bone Level. I did. Take a cross section of the implant, there will be a gap at the indexed interface, but the rest of the conical wall is sealed just like Ankylos. It only has to be "sealed" at the top to be beneficial. Let's be fair however, the degree of seal depends on the angle of the internal wall and the tolerances developed by the manufacturer. Some say Bicon is needs more divergence (it seals too well), and Straumann Syn_octa should diverge less (not enough seal). Astra Tech is very similar in its angle to Ankylos. The practice of taking X-rays to determine seating is also not necessary with the platform shifting abutments so this is not comparing apples to apples. Compare platform switch implants only because there are indisputible advantages to the connection. By the way 3i is not of this mold because there is not morse or conical connection. I agree with the post mentioning using Ankylos is a whole different thought process. It is one you should pursue and you should understand why Ankylos has tremendous potential. It is why Astra Tech has been such a great implant, and it is why Nobel and Straumann have shifted to the concept. But it does not mean all of these companies did so because they believed Ankylos was better. They may have just seen that one aspect of Ankylos offered potential they thought patients and practitioners would want. This process of understanding is exactly why Ankylos will add the index, and it clearly will not result in a microgap through the whole abutment process, only at the indexed portion. Look at the Straumann solid abutment for example, you don't have an index internally, and you have solid conical contact. Dr. Weigl's study only shows the Syn-Octa, which has a gap because it is a multi unit abutment. Every system will have its limitations, the problem with those who are promoting Ankylos with no issues is that they are not being real and may not understand what other systems offer. Ankylos will not result in bone over the implant in every case and it is a total looser on multi unit cases (when compared to other systems). It will give you a chance at more bone and the connection is amazing. But without an index, it is incomplete and the connection is just one part(though important) of the implant complex.

Sorry, I meant Nobel Active in the above post. I guess I am ignorant afterall (thanks Dr. White).

I agree with Dr. Kimsey's question. If the problem is indexing for splinting multiple units why not just scan the case with iTero with a bevel edge finish?

The iTero or other units like it would be a good solution for crown and bridge but not necessarily for fixed or removeable full arch dentures. The technology for these cad/cam systems is amazing but still not availabe to solve every application. Back to the splinting issue, it really is simple the first time around. The lab makes a jig that helps you insert the abutments, it works great. The problem comes in with full arch cases where you didn't do the case or you didn't save the index jig. There are still other challenges with Ankylos like no screw retained temporary for shaping tissue or the ability to make a custom abutment. These parts are available in other countries, but not FDA approved yet. The protocol requires the proper healing caps to shape the tissue to final contour and this can work great, but sometimes it is not enough and it would be nice to be able to sculpt tissue with a temporary before impressions are made. So despite Dr. White's assertion that the only problems are due to ignorant practitioners and labs, perhaps there is more to the story.

As for Dr. John Willardsen's comment, I still stand by the Ankylos implant and the RESEARCH behind it. As far as the professional comments go, the implants that needed to be removed have to do with the patient not the implant system- the patient refused bone grafting and was given lengthy consultations regarding the disadvantages of this. The Anylos implant works. FYI- I use Ankylos and not a copycat version of it.

As for Willardson's comments he sounds like the sort of guy who needs to slag off other dentists to create work for himself. Sad. Take a look at his website - says it all really..He's in love with himself.

I have been using Ankylos for over 5 years. It took me a year to get over the narrow 2.5mm conical connection being strong enough for any lasting strength, but finally the clinical and scientific evidence convinced me this implant is a proven implant that can and does mimic a natural tooth's biologic width. No bone loss, no down growth of epithelium and a thick band of connective tissue. What is the hang up with a jig, I have placed a few hundred of these implants and I can place an abutment down in 12 seconds with a jig. I call this a rapid seating device not only a great safety feature if we ever drop a screw or an abutment in someones mouth. I am sure we have never done that? If you rather do conventional crown and bridge ---they have 20 different abutment choices for intra-oral crown and bridge impressions, which I prefer in immediate loading cases, and in general. I hope this helps with the great features Ankylos provides.

I do not know what everyone is excited about with the jig and the comment on 6-8 implants?? The new Ankylos C/X implants have the ability to be indexed internally or not. Do your homework before you bash such a superior product. Why are all of the implants now trying to copy Ankylos? Because it has set the benchmark for tissue response and lack of boneloss. This is simply the easiest system to restore PERIOD! If you want to use the index you do, and if not, you do not. How easy do they have to make it for us? Ankylos is the best results I have ever seen in my practice PERIOD!

I do no understand the comparison with Nobel Active. Active is made for type 4 bone, and has actually 2 micro gaps? The bone loss on this puppy will be no different than any other Nobel and it will go down to the first thread. The attempts of platform switching are only one component in understanding the benefits of the Ankylos system. Microgaps, bacteria proof and clinical data are key. This is what made my decision much easier to switch. BTW, I was using Strauman Bone level and it cannot compare to the bone or tissue results I get with Ankylos. There is micro movement with the bone level and therefore bone loss as always. Hope this all helps.

dr. dimitrov said it all. José Rosa

I believe, if used as suggested (subcrestal placement)there is little doubt in my mind about the outcome.The conical connection which guarantees the lack of micromovement/microleakage is a must for every dentist concerned with the future of his works,Someone complained about this system being designed not by an engineer.I prefer my implants to be designed by an implantology professor and my car by a mechanical engineer.

Ankylos is a good system with good evidence and quite an old system.. They are not comming out with an internal hex along with the morse taper connection so the lab part will be much simpler than before.no need of keys or indexing now... The marginal bone loss is much less compared to the other butt joint systems like Xive and there is also platform switching so it helps in preserving bone till the crest. I feel the narrow diameter i.e. the A series is not adequate for molars and aesthetics is much a problem as the crown will not have a good emmergence profile. Also there is no possiblity to have a custom abutment so that again is a negative part. Ideally the protocol what I follow is to place the implant 2 mm below the adjacent tooth CEJ and if the gingival biotype is thin then I place my incision line palatally to bulk up the area with soft tissue. Placing implant crestally or subcrestally doesnt really matter if you place the implant in the correct 3 dimentional position. Ideally I prefer to use Ankylos in anterior Esthetic areas mabe for a single tooth case.

Sorry there is an error in my above statement.. It should read --- They are "NOW" comming out with an internal hex along with the morse taper connection so the lab part will be much simpler than before.no need of keys or indexing now…

Ankylos since 2004 Great system. Since '04 I sleep well... Morse taper has advantage over butt connection implants. I've never felt a need for an internal hex. In my cases I suppose there won't be need for a C/X interface. Without an index there is versatility in planning prosthetics and there's no problem with using a jig. I know in 10 years my patients will be thankful they've got ANKYLOS... All You have to do is to think a bit different then U were tougt on courses and choice of implant brand will be obvious Regards

I didn't bother to read all of these posts, but Ankylos does provide impression caps to index their standard abutments. My doc has placed as many as 6 in an arch, freehand, close enough to parallel to not require custom abutments. Just place the abuts, caps on top and pickup impression. In the last 3 years, we've only needed one or two custom abutments- 15 degree angle or tapered straight work for most things.

I almost forgot: look at the screw-retained Balance abutments from Ankylos. Yes, you would need a jig if you don't impress from the final abutment placement, or if you removed and replaced an abutment. Oh, well... gotta go assist on trephining-out a bunch of broken Core-Vents...

Great conversation and insight from many users however, I can't understand why more are not trying/using the Astra system since it is an indexed conical connection, bone level implant with built in platform switch. I also learned all their implants have a fluoride modified surface increasing early integration potential. It can be tricky restoring for the first time just like any system but they only have 2 connection sizes--seriously, very easy and great, great results and well documented.

Astra now has three sizes.

You may want to consider the MIS-7 or the AB dental internal hex implant. These work very well and the price is right.

Astra is not a concial attachment it is indexed. Not even close to Ankylos's concial attachment which is not confined by the internal hex--which every other system is. Astra does not have angled abutments for abutment level impressions and it does not have a true platform switch like Ankylos. Why say that they have all the components that Ankylos has---but they do not have anything close. Use the real implant system which is Ankylos.

Suggestion for DrDimitrov Maybe orientation acrylic jig made by the same laboratory that milled abutments would be helpful? 360 degrees positioning capability is an advantage and disadvantage.Same problem with BICON system.Look up at the BICON website, section VIDEOS - CASE STUDIES - full arch 8 and 10 implant restoration.

What are the viws on Adin Implant system from Isreal

Ankylos implants are very different from what most of us are using.This system is superior to any implant system in the anterior region.The subcrestal placement allows for a true biologic width to be established.The gingival former results in superior esthetics with the cerconium abutment.This abutment is less expensive than other cerconium abutments and is preformed.This system has only been in U.S. for a short time.I think other companies are going to copy it.

I am using Zimmer Implants for the past 4 years. It is the best one in the world. I always suggest for Zimmer Dental Implants only.

Just take your impressions AFTER you place the abutments. We have a 9-implant case now. No problem.

mod ein the going and for you,everbary for implants for conexion extern very good........and player magnigfic

Dear gentlemen! I am using Ankylos the past 2 years. Today i met the nightmare many have spoken of! How to get the prosthodontics fixed on a complete edentulous maxilla with 8 implants! jigs and keys and everything was tried ! Unfortunatelly the patient went home with a provi total prosthesis based on 3 ball attachements. and i am spending the night together with my lab technician to find a solution. No idex means almost perfectly alligned implants. Which in many cases is not "the case". I trust and believe the Ankylos syatem but it's a deadend now! I would apreciate if anyone of you could send me any info regarding the solution of this problematic or even any photos of jigs made for such extended works. thank you

you can use the new Regular abutments,placing them directly in the mouth.they come in different degrees,0° 7.5° 15° 22.5° etc. so you can place them on the implants,rotate them until you find the correct parallelism,connect them with the implants,and then take an impression as the 8 elements were natural teeth..and then restore them as they were natural teeth..

The best choise in my opinion is Bicon, more than 25 years, bacterial sealed connection, no boneloss and very simple to use.

i think that ankylos system has a wonderful design and indeed a very good aesthetic results, in spite of the problemn encountered with prosthetic procedures. i think that the reason is the transfers components for the closed tray impression.the problem is that the transfers cant be repositioned in the preciesly exact posiotions they are on implants, that is due to their big lower cercumference. the use of the open tray techniqe is recommended, otherwise i recommend to reshape the lower cercumference of the transfers. in case of the metal framework not fitting on the abutments inspit of using a key, try to cut the metal framework in two or three places (for full arch), after firmly screwing abutments in place using the key provided by the lab, to allow the metalic framework to seat adabtivily on the abutment shoulder, then reunit the cuts areas with resin or composite material and take a new impression of the framework and use it to relocate the slightly malpositioned analoges, then welding the framework again.