Astra Tech Implants: Anyone Else Experience Flowering in the Top of the Implants?

I know the story. You have a problem and the company say; never heard that before.... I have about 800 referrels per Year and I can tell You that I see 4-8 cases with Astra 4,5 or 3,5 fractured ever Year. Patients come to change Dr and implant type... I see this on cases where the bone is gone the first 3mm or more; I do not place Astra since I Think the 4,5 is a wrong design. To wide at the crest leaves less Bone + not a tight seal+ way to thin walls! I wish You good luck choosing a other implant brand. // Erik

I stopped using Astra a few years ago. Never had a fracture but had multiple Direct Abutments come loose after some years of function. Was told that we probably did not torque the abutment correctly but as others noted, we have had 1000's of Straumann and other implants that never had abutments come loose. The company never stood behind us for compensation for proper replacement which was very disappointing.

Fractures with Astra implants was predictable based on it's 79 or 81 degree lead-in bevel with pure titanium. The long bevel (vs a short 45 deg. Bevel of the Screw-Vent/Legacy internal hex implants) creates thin walls and tightening an abutment into the deep conical connection creates a wedging effect that splits the implant after the metal fatigues. A 45 degree lead-in bevel provided adequate tactile sense to guide the abutment to full seating without the need for radiographs, and provided the same lateral stability without compromising strength. This connection has a 26 year history and once we stopped using pure Ti. in 1990 and started offering 4.7mm and 5.7mm implants instead of just 3.7mm, fractures became a thing of the past. Today we can make 3.2mm implants without fear of fracture.

Jerry, great answer/comment.

Aha, Niznick is back. As always, his comments are enlightening and educational. However, anyone reading this should be aware that Niznick sold Implant Direct to Sybron and still, I believe, heads the Implant Direct Sybron business. So his comments, as a competitor to Astra, should be read "tongue in cheek". He is certainly a biased observer. It would be interesting to hear other Astra user comments here, from those who are not biased and don't own a competing implant system.

FYI, Astra has since been sold to Dentsply, so some of the discussion here is moot. Surely Dentsply will be making changes to the acquired Astra product line. I think they relaunching it later this year.

The problem here was not design, but rather the refusal of European manufacturers to go from commercially pure titanium (CP-4) to a titanium alloy (Grade 5 or 23 ELI) as the American companies did. Virtually all of the maufacturers in excess of twenty years of sales have experienced fractures of implants or components, with Niznick being no exception. We saw flowering of his smaller implant diameters as well, which was a design flaw. When he changed the thickness of the upper part of these implant sizes, the problem went away. What amazes me even more, is how he extolled the virtues of his Tapered ScrewVent for so many years as being the best in class. Then he redesigned this implant and called it Legacy 1. Then there was Legacy 2. Then, Legacy 3?? Why so many redesigns in a short period of time? Could this underlie a performance problem with each new iteration? I am now experiencing a rash of LATE failures with my Tapered ScrewVent cases, with severe cupping and peri-implantitis. Let's hear from other clinicians who are now experiencing the same problems. RJM

I have been using Astra implants but only the cylinders. This discussion seems like the "flowering" problems are primarily associated with the "Y" shaped design. It would be very appreciated if anyone could let me know if these problems are also common on the cylinder shaped Astra implants. Thank You for sharing this finding. Greg Steiner Steiner Laboratories

Gerry; I have posed this question on a number of blogs and you have never answered the question. First, there is no price differential between your Legacy 1,2, and 3 implants. So let's get to the heart of the matter. Why do you keep changing the architecture on your original vaunted platform? Is there a biologic reason or is it just another one of your marketing gimmicks? Keep throwing stuff at the market and confuse enough people to detract from the failures we are seeing. Remember how you used to excoriate all of the other companies over their failures and complications? Well, your platforms deserve the same scrutiny. I think the failure and peri-implantitis rate of the tapered screwvent deserves it's own special blog. With regard to my relationship with implant systems, I have served as a beta tester for over a dozen comapnies over 28 years, Intra-Lock included. I have no financial position nor do I own stock in any company in the industry, unlike yourself. So let's stick to the science. RJM

Just so there are no lies being told...... the Legacy Line is as follows: Legacy 1 Implant is a total of $125 and includes the following items within it's all-in one packaging: -Implant Extender; also used as a 2mm healing collar when used with cover screw -Cover screw -Fixation screw -Carrier/Transfer Legacy 2 Implant is a total of $150 and includes the following items within it's all-in one packaging: Fixture mount can be used as temp abutment -Implant Extender; also used as a 2mm healing collar when used with cover screw -Cover screw -Fixation screw -Fixture Mount/Transfer (FMT)-temp abut Legacy 3 Implant is a total of $175 and includes the following items within it's all-in one packaging: Carrier/Transfer can be used as FINAL abutment -Implant Extender; also used as a 2mm healing collar when used with cover screw -Cover screw -Fixation screw -Carrier/Transfer-Preparable Final Abutment Sincerely, An Observer.

Dear Just Fair; The direct link to your Implant Direct website is a thinly disguised marketing ploy. Come on Gerry, you still refuse to answer the real question that has been posed to you countless times. Give us one cogent reason for all of your redesigns of Legacy. Why is it that clinicians who abandoned this architecture would gladly pay more for an implant that has few of the complications and failures that this line has? Every time you answer this most important question with another "implant price" advertisement, I will call you out. A couple of years ago, you challenged me to a debate on implant science. I'm still waiting for the invitation at a major conference. What say you? RJM

Thank you Dr. Niznick for your insight. I never had an implant direct implant fail due to fracture, and I placed about 50. I stopped placing them because I needed to keep 100K worth of inventory and implant direct had no extended credit program, which is how I ended up with HiOssen (Osstem). Back to Astra Tech... I never saw a 3.5/4.0 (aqua) or a 5.0S fail due to fracture or screw breakage. Maybe I was lucky. Unfortunately the 4.5 appealed to me prosthetically as it allowed an extremely nice emergence profile for premolars. I would have liked to know that it was prone to flowering due to the thinness of the wall. Astra Tech's last official statement was that the flowering must be caused by a casting flaw, putting undue stress along the conical connection. I hope they come up with a patient management solution soon. Unlike 3i and Nobel...

Niznick:...you have not answered my question about your financial interest in one of Implant Direct’s less significant competitors. Miller: It's obvious you did not read my first April 17th post. But if that should change, I'll make sure you are the first to know. Niznick:...In 2010, there were 3 studies published on implant Direct’s implants with 98%, 99% and 100% success. Miller: Sure, and 3i also had the same "success" rates that were published and then had to withdraw one of their major implant lines from the market because of the real world failure rates. Niznick:...When the NobelActive came out with deeper threads, I developed the ReActive with flat based threads like the SeissPlus I developed in 2000 and sold to Zimmer. Miller: So all you are doing is keeping up with the Jones'? When NobelActive first came out, you blasted them for this new implant design because you felt there was no science to back up their claims. Now you are imitating Nobel. Science or Marketing?? Niznick:...Be assured, non of them have the funky “Blossom” treads of the Intra-lock implant Miller: It's obvious you are no longer a fan of science or biology. There are several papers recently published in JOMI and Clinical Oral Implants Research which specifically refer to the advantage of low torque insertion, the design feature of the BLOSSOM symmetrical helical tap. I assume that after reading these, the next implant design you will clone will be that of your "less significant competitor" Intra-Lock International. RJM

Flowering! How poetic! What a pleasant description for shearing the platform off, of an endosseus fixture. I have had this happen three times; twice with Nobel 3.5's and once with a long 5.0. I was able to retrieve the narrow body fixtures, but not the 5.0. I ended up cutting that implant down( slowly ) and grafting autogenous bone over the top. Over a year later, it is still covered and the bail out implant is functioning. Not my proudest moment! I feel pretty comfortable torquing a Biohorizons over 75 ncm's, but I have learned my lesson with Nobel. I believe this is a significant engineering flaw, that is going to come back and bite Nobel . So, you were the guys paying attention during biomaterials class. Yawn!! Bv

I place approx. 500 implant/year. So Astra wanted to become our supplier and they offered me 20 implants. I placed them under supervision of an ASTRA employee, just to make sure, that I did everything as I should. On 6 of the 20 I found with flaring in the neck region. So I decided not to use this system.

Not to be misunderstood: With flaring I meant bone resorption around the implant neck.

Hi all, I have a patient who had an Astratech implant-supporting single PBM over 12 months ago. She recalled around 3 months ago, an episode of pain on biting that felt to her like it was "infected" , no obvious recollection of bleeding, swelling, or other discharge. Pain went away after a while, and last week noticed sudden looseness of the crown, very loose (buccal-lingual, and rotational). Implant is 4.5mm dia. Radiograph shows the mesial and distal craters of bone loss to the first groove (the bone level implant has threads in the upper coronal portion and current crestal bone level is above the first groove). I removed the crown, 1 piece (abutment and crown), only took a few turns to remove the whole unit. Additionally, there is tenderness on palpation on the buccal ridge. A faint white vertical line is evident on the buccal aspect (inner surface of the implant), not separated but definitely there on visual examination under magnification 2.5x. I'm suspecting a crack has been initiated. What is your experience with Astratech 4.5mm did. implant in terms of fracture at the initial period? Would appreciate very much to hear from your experience.