Implant Direct: Pros and Cons?

dr. s i have used and still use implant direct and honestly don t see any difference with other implants. you just save a lot of money for your self or i would hope for your patient.the surgeon hands ,the bone ,the planning ,the thickness of the tissue,these are the real factors .the type implant is really a minor factor.we all use different implants and we all succeed pretty well.the economics are there .in these day and age do you honestly beleive that the implant companies want anything else than your money,they want to take as much as possible. do you think it s not outrageous to pay 80.00 for a transfer 30.00 for a screw 300.00 for an implant 200.00 for an abutment ect...these companies are not any different crooks they are run by people that there only thought is to make as much money as possible (sounds familiar with wall street). they have no concern on affordability ,patient power purchase. dont be stupid understand the economics of dentistry ,when an implant companie provides you the transfer and the abutment with the implant that is an excellent promotion. everybody wants money(so do i) but we should not destroy are patient base ,i mean it has to stay reasonable . greed is the evel that brought us here and i don t beleive implant direct is that greedy.don t be naive and try it.i have no interest in the companie . my interest is for the other companie to reduce there prices so there is less on us and the patient.at implant direc you get the implant ,the transfer and the abutment for 150.00

I use the Replant with the Nobel drills and have had no major problems. Some times in the 5.0 & 6.0 size implants the prep is tight and may have to be slightly over prepared in type I bone or heavy cortical bone. I have had this problem with Nobel implants as well. I am not crazy about the delivery system. The implant is hard to remove from the delivery vial and the fixture mount transfer is too wide for narrow spaces. The fixture can be removed and the regular Nobel delivery tools can be used. Somewhat awkward, but it works. I use these for all implant treatment and have had equal success to the Nobel implants. I have some side by side and I can not tell the difference. The Implant Direct implants appear to be harder i.e. seem to withstand a greater torque when placed with a hand tool, at least in 3.5 diameter. As far as abutments and healing collars I interchange them all the time.

I have bought nearly 20K of their products over the past two years. I use mostly the Zimmer clone (Legacy) and the Screwplant. For $175 I can get a screwplant implant that is HA coated, comes with a healing cuff, impression post and abutment. After healing I use my cerec machine and make the crown (cost about $30). I can provide treatment to my patients while investing less heavily in supplies. They also have a very nice selection of countoured abutments and castable abutments when needed. My experience is that these implants compare very nicely with BioHorizons, Zimmer and others that I have used in the past. Quality and effectiveness have not suffered in my experience. Addtionally, I love being able to order at the office or at home at any hour of the day and night online and not have to deal with a customer rep. Give them a try. Your only regret will be that you had not done it sooner.

I have just started using implant direct in lieu of more expensive implant companies, mostly for all on 4 cases with the replant implant. They offer the same restorative components for 1/3 as much and the implants are 1/2 of other companies. I achieved adequate primary stability even in extraction sites and found placement to be easy. The restorative components I used (angled screw receiving abutments and temporary copings) were a little confusing (lots of detachable parts) but by the end of the second case I was used to them. Overall I give them a B pending osseointegration. It's nice to save 50% in cost for each case. It allows me the opportunity to be more flexible with treatment plans. One warning: Implant direct does not guarantee their implants, so if one fails you have to purchase another to replace it. With Straumann and Nobel this is not the case, they will replace a failed implant FOC.

I was a Zimmer user for years, the surface and srew shape of most Implant Direct implants is exacly the same as was used by ScrewVents since the 90's. The delivery indeed can be a little better, but you learn to work with it.. My treatment plans are more extensive and way more fun to do since I can offer a lot more for the same price.

Dr. Gerald Niznick and I have at least three things in common:- we are both Canadian, share the same birth day, and are both always searching for a more practical approach to get the job done well. I think we have to take off our hats to Dr. Niznick for his bold approach to market implants directly to the dental public at a more reasonable price. It is shocking to see implant manufacturers getting away with the prices they are charging...totally outrageous. Titanium is not a precious metal, it is readily available and is very inexpensive. Next time you are at a dental convention, look at the size of the booths the "big name" manufacturers take.....just realize that you are personally paying for all of it! The manufacturing process is done almost entirely by machines, that spin these things out like popcorn.The packaging and sterilizing are not that expensive, but cost as much as the implant itself. It is true that a good part of the income generated goes to a company's research, but a larger part goes to profit. If the prices of implants and their associated parts would come down drastically, more people would be able to afford them..... the dentists would be busier, and the manufacturers would still be making lots of money. I know Dr. Niznick personally, and am not a customer, because I can buy the same products he manufactures and sells, at a fraction of the cost......but good luck to Gerry, and keep him in business...he is a revolutionary and what he supplies you has his personal reputation built into it.Trust him, you will not go wrong. Gerald Rudick Montreal

You forgot to mention that you have the same first name as Dr. Niznick. But seriously, a key question has not been answered: All the big companies have major sales forces and reps, and can therefore provide much better service and training. This is why they charge more. Issue, I guess, is what is better service and training worth? Is Implant Direct mainly suited to just the very experienced?

I think we will agree that if you diagnose, treatment plan, and surgically place appropriately ANY system will be successful. What does it boil down to? Clinical success, prosthetic options, well positioned portfolio of regenerative products. I agree most implants are slightly different, however, in the end they are accomplishing the same results. What is the difference betweeen Implant Direct vs. Noble/Zimmer/etc... THE REP!!! Low pricing is great but my Dr.'s are not willing to sacrifice the service I provide to there referrals including education, chairside interaction and reliability. Inside sales support vs. being there and being able to answer questions when the finger is being pointed at you brings validity to your product. I deliver cases to the lab for my accounts, send lab technicians to the office to help with treatment planning and identify were and how we can improve his practice. I'm always explaining to the Dr.'s or staffs, "This is what I did for you today" Consequently, Dr.'s in my area never ask me about pricing because they understand that I'm working for them to increase case acceptance and referall satisfaction!! Because of this they are willing to pay the extra for the support I give them in return! If GMC sold you a brand new Cadillac Escalde today for $500.00 but it broke down next week and someone wasn't there to help fix it, would you still buy it? What is important to you?

You have to remember, that Dr. Niznick established Implant Direct for the "EXPERIENCED IMPLANTOLOGIST". Not the Doc that needs hand holding. I do not use Implant Direct, but I like to concept and to me Reps are ok, but I do not need my hand held. I can read and understand a concept.

I have used Implant direct for two years and have had excellent success with them. It does take more effort to use the fixture transfer system included. After placing a few, I learned to work with/around it. The cost savings is great for the doctor and the patient. I have the success rate I did with Paragon/Sulzer/Centerpulse/Zimmer, Lifecore, and Biohorizon. I agee that I don't need a rep calling on my office or holding my hand. Using proper protocol will allow these and other clone implants to work.

I have a small dental laboratory in Georgia. I agree that it helps to have a good rep. I rarely need one, but a good rep can save you when you do need help. It is tough when a company hires a rep with out dental knowledge. A good lab can help you as well. Not all labs know what they are doing. If an implant company has a good rep, it makes life easier when a GP, OS, or Lab needs help even if you do not.

Many talk of the need to cut costs for their patients and themselves, but what price do you put on security and reliability? When you order and place an implant from Implant Direct, that's it, no guarantee. If it fails you and your patient pay for another one, which will cost you the same if not more than buying one from a "Big" implant company such as Zimmer. Think of it this way, by purchasing from a company like Zimmer you are assuring that the patient's implant is covered for life, no matter whether you are still around or not, their implant will be replaced at no charge for the product for LIFE. Do you guarantee YOUR work for LIFE? If not, what price would you put on that? To me, that is a lifetime guarantee that is definitely worth it and cannot be matched by especially by Implant Direct. Service, reliability, security, exceptional quality & a lifetime quarantee is definitely worth the small increase in price you pay for the product. Thanks for listening to my two cents.

Practice development and referall education. To me that is not "Hand Holding" but account development. All of my surgeons have been placing implants for years so mt interactio with clinical or personal experiences is minimal. However, they use me as an extension of there office to follow up with the referalls, plan educational programs, order prosthetics, etc. All of these have proven to grow there practices. I understand that each specialist has his own perspective on how they want to develop there implant cases. In my case it is important to them. Maybe I'm lucky, I know I'm fortunate, to have Dr.'s who value the time and effort I put into there practice. I don't consider this "Hand Holding" at all. If these Dr's were incompetent, I wouldn't want them representing my products at all!!

Thank goodness the free market system is taking hold in implantology. In reality, we are dealing with nothing more than dental hardware (nuts,bolts,screws,bars and plastic)albeit sterile and medically approved.Parts that would cost pennies in a hardware store have been going for hundreds of dollars.This great profitability has attracted many players and now the price competition has begun.The cost of implants is coming down and those companies that don't compete on price will lose market share as the market matures. They will either drop their prices or go away.Thank you Dr. Niznick for opening Pandora's box!

This depends upon to comfort level of the Doc. I usually call tech support at eg. "MIS", "Bicon" or "Tatum Surgical" and receive proper answers. I also agree that using a laboratory that knows what they are doing is very important. I do not need a rep dropping in to see how I am doing! However, if that is what you want, then OK! R. Hughes, DDS, FAAID, FAAIP,Dipl.ABOI

If Niznick is driving dental implant prices down, then why isn't the cost of dental implant treatment declining for patients? This is clearly not happening and the reason is because Niznick's implants are primarily used by experienced implantologists who would never dream of lowering their fees in a million years. These are experts and all expertise command high prices. In fact, they are probably raising their fees despite the lower costs of the actual implants. At the same time, the newer implantologists and GP's, who represent the growth of implant dentistry and the future of patient care, will not use Niznick's implants, since there is no service or training. Therefore, paradoxically Implant Direct, despite the low prices, will not help the implant industry grow. In order for the implant industry to grow and for more patients to choose dental implants over alternative treatments, we need more GP's getting involved in implants. They need extensive training and support. Low prices can't pay for this support and education. Ultimately, with greater education and training, more dentists will place/restore implants and with the increasing volume implant manufacturers will be able to drop costs and patients too will hopefully see a lower cost for implant treatment.

We should all feel very fortunate that a company has taken a bold stand for the doctor as well as the patient. It is a simple concept keep overhead down and create a better price point withOUT compromising care. I place over 800 implants a year and have used them all and worked with all the companies. I now use only implantdirect and have had no issue with placement and my referrals are very pleased. Many of you talk about support and implant reps. In my ten years of practice I have had at least 6 or more different reps for all the implant companies. I added it up the number is 28 reps in ten years. So somebody tell me if they think that is customer service or helpful. Many times we have had no rep and other times we get reps that just finished their weekend worrie training camp and my receptionist knows more about implants than they do. I have also found that the reps don't always convey the message that you want to send to your referrals. Yes, I do believe that experience is an advantage with thias system. I practice in an area where we foster the team approach to treating patients which has allowed me to develop a relationship with my referrals so when they have a question they call my implant coordinator. This is what you want it allows you to always be in the loop. I am very pleased with my experience with implantdirect and I am thankful we have choices.

I couldn't agree more that we should have choices and that everyones experience with a representative or company will be different. If a rep is not conveying your "Message" to your referrals then their was a breakdown in your communication. I work with several colleages within the same company all with 5 years experience or more. I continually see high turnover in many offices and implant knowledge is always compromised. MOst case I'm teaching the staff about implantology. My area has only seen 2 different dental reps in the same company over a 15 year time period. These relationships I have are personal, we have shared weddings, graduations, and work experiences alike. Hearing all of the rhetoric about the "How it doesn't matter" about whether you have a rep or not truly makes me feel fortunate. Why does a Dr. using an implant system for years with no issues, switch to mine? New parts and pieces, referral questions, etc. I wonder. Lets imagine all implant systems are created equal then why pick one over another. I have not seen any Dr. lower there fees after switching to a less expensive implant system. Who wins the Dr. or the patient? If you want to do more implants you could simply charge less for the procedure couldn't you? Why does the implant company have to be responsible for lowering cost?

For all who are in the business, you need to open up your eyes to what the large companies I.E. Nobelbiocare can do for your practice as a whole. Set aside from a business development role such as at the level of Roger Levine or David Swab, but higher due to having the ability and influence of so many others in the industry and readily accessable resources. At this day an age, look at any company who has the research for the products they are putting in YOUR patients and tell me how that $100 isn't worth the peice of mind your providing the best solution possible instead of the fly by night Implant direct or some new company around to inhale profits and run.. Wake up everyone!!!

Could it be possibly that in fact everyone is really waking up? In fact, several of the larger companies have promised all kind of marketing campaigns for our specialty practice and none materialized. This makes a lot of sense because how are they going to market one practitioner vs. a competitor to the same referring dentists? Blogs like these allow clinicians to share their positive experiences with implants such as from Blue Sky Bio, the company that I am involved in. The market has changed forever and some companies offering high quality compatible products with lots of innovations are enjoying great success especially in times like these. Blue Sky Bio for example has been in business for 5 years and steadily growing. There are several other companies doing quite well. There is a reason for that. It appears that everybody is in fact waking up. Best, Albert

I am a general dentist who has been placing and restoring dental implants for nearly 20 years. I can appreciate the roll of a company rep to those new in this field, but I have not needed a rep for ages. Like others, I see a constant stream each year of new reps replacing old reps who have not met their sales quotas. While it is true that some companies sponsor training programs, education is best received from one of a multitude of practitioners who have not been bought by some sponsor. Therefore, Implant Direct as you can imagine, is made to order for me and others who have some experience and know what they want. I have placed and restored about 100 Implant direct implants in the last year or so and see no difference in the integration or success rate. The only concern I have had with their products are their larger diameter surgical drills. When placing a wide diameter implant in the posterior mandible, the larger diameter drills tend to "bounce" or chatter off the lingual cortical plate and can bounce the drill to the buccal, distroying the buccal wall. I have replaced the wider drill with one from another company. If you are experienced, then this is the company for you. No need to support large corporations with extensive sales forces and marketing budgets whose products are no better nor more succesful than the products found in this company.

First of all, I want to thank those doctors who came forward with positive comments about Implant Direct's products. My goal in returning to the implant industry after selling Paragon to Sulzer/Zimmer was to offer a variety of implant options with all-in-one packaging through internet marketing, sales and technical support. If the savings per tooth restoration was just $100, there would be little to discuss because the major companies have enough fat in their pricing to come down that and much more. In fact, the savings, list price to list price is $400-$550 when you consider all the components that we provide in one package compared to purchasing them individually from any of the 6 top companies. Of course very few dentists pay list price because of the volume discounts, end-of quarter discounts, trade-in discounts etc. but the low volume users are at a disadvantage in negotiating, and given the economic situation today, why have to tie up your capital just to get a volume discount? I would like to clear up three issues raised in the comments: (1) Implant Direct offers as good or better customer support as any of the major companies. We have 35 inside technical support representatives and a toll free phone number 888-NIZ-NICK to reach these people any time between 6am-5pm PST. I spend about 3 hours a week lecturing to this group and we have two CDTs on staff and two technical support managers with 10 and 20 years in the industry. Implant Direct has embraced the technology revolution by creating 3D graphic animations to cover every surgical and prosthetic procedure with our systems. These are created by our in-house marketing and IT departments. We have a section on our website where most frequently asked questions are answered in detail with graphics and animations. We have a large library of Technical Bulletins. Check out the section on our web called Technical Support to see the depth of our online customer support. (2) Technical support often relates to a company’s ability to communicate what part goes with what and what are the prosthetic abutment and component options. Here, Implant Direct has a distinct advantage over our competition because of our All-in-one Packaging - we give you the cover screw, 2mm healing collar, transfer and final abutment with many of our implant options. Furthermore, we have the industry's most intuitive online shopping cart system that leads you to the right parts for every implant platform and prosthetic option. (3) We have 20 outside reps and are in an expansion mode to end up with 40 reps outside, each partnered with an inside technical sales representative. Our outside and inside sales reps, even the new ones, are very knowledgeable about our products because our online technical support material and ordering system teach them all about our systems and keep them updated. As for a Rep helping to build a referral practice, this is a two-edged sword as reps move from one company to another, they can take your referral doctors with them to doctors using their new system. I suggest you check out our Team Approach section of our website where we have downloadable, standardized “Thank You” letters with links to Team Videos, explaining the use of the fixture-mount as a transfer and final abutment. The fixture mount on the Legacy is aluminum but the Legacy+ system available in a few months will also have a titanium fixture-mount (4)For the doctor that mentioned the jump with the largest diameter drill that is due to the drill being a step-drill with a change to a wider diameter 3mm above the tip. We have changed the angle of this transition and solved this problem so the drill you have is probably over a year old. Contact your rep and ask for a replacement one at half price of $30. Our drills are $60 vs $160 from Nobel with both being made at the same factory in Switzerland. As shown in our February Newsletter, Implant Direct continues to expand its product line and has now launched an innovative concept for every doctor to help grow his or her practice by becoming a RealChoice™ Implant Center providing Teeth-in-1Day™ using Implant Direct’s one-piece ScrewIndirect implants. Your continued support allows Implant Direct to expand its services and products without raising its prices since we first launched our sales in Oct. 2006. Jerry Niznick DMD MSD

I forgot to respond to the question of Dr. K who initially posted the question. "They seem to have lost a battle with Nobel and now require you to purchase their Replace surgical drills." Implant Direct now produces drills for its RePlant implant that has the same body shape as Nobel’s Replace implant. The only battle related to the use of Nobel’s drills for our implant was that Nobel was falsely claiming our implant would not fully seat using their drills and they published an X-ray claiming to show our implant sticking 3mm above the bone to prove their point. The only problem was that the implant had a 3mm healing collar with the implant fully seated level with the crest. With 10’s of thousands of Implant Direct RePlant implants having been inserted with Nobel drills, Nobel’s scare tactics increasingly were falling on deaf ears. Implant Direct decided to make its own drills for its RePlant implants and also market them for use with Nobel Replace implants because of their significant cost savings. Implant Direct’s RePlant surgical kit does not require bone taps, like Nobel’s because we follow a soft-bone, hard-bone drilling protocol.

Good Job Dr. Niznick.

Regarding all those posts who believe having a rep is worth the extra $, consider this: My brother owns a large machine shop (over 100 NC machines). Most of their work is for defense/space contractors. I showed him an implant and his comment was thus...hmmm, about a $4.00 part. Sure the tolerences must be very precise but face it; implants aren't rocket science. I have had less failures will ID implants than I have other big vendors. As for support and training, I must get two or three brochures a week for seminars from the implant 'stars'.Why pay the vendor for 'training' that is biased toward whomever they happen to be hawking for?

Hi everybody. I just want to share with you that I have placed over two years more than 1000 ID Replant implants without any unespected failure and a better success rate that I use to have with Replace. Better quallity, better performance, better price...... What else? Thanks Dr Niznick for wide open our eyes to real world!

A screw is a screw. A sterile screw is a dental implant. A rep is a salesperson.

Several comments by implant reps are attempting to show the value of their big company with the big cost approach. Consider this comment above: "If GMC sold you a brand new Cadillac Escalde today for $500.00 but it broke down next week and someone wasn’t there to help fix it, would you still buy it?" My answer is: Hell Yes!!! I would tow my sweet deal to someone else who would fix it. As for Implants failing and being replaced by their company at no charge. Whooop-de-doo. You save enough on just one implant from Implant Direct to by two or three more if you experience a failure. I am having great success with Implant Direct Replant Implants. I regret paying several hundred thousand dollars to The Big Implant Company over the past eighteen years. Yes, my fees are reduced because my costs are reduced. Patients really appreciate implant restorations over fixed bridges even when their dental insurance will not cover the implant. I am happy to reward their good choice with an implant solution at a good value. The world economy is falling apart and prospects for the future are not good. Yet, despite these dark clouds, I am placing and restoring more implants than ever! and hoping it will continue. People will value their health even in hard times.

Here is some insite into manufacturing costs. I also make parts for Boeing (engine mounts for 737s), Embraer (43 foot main wing spar), Northrop ($500,000 titanium wing hinges for JUCAS), Lockheed (F22 bulkheads)at my aerospace factory www.acromil.com. In that business, the work goes to the lowest bidder that can do the job and if you make 10% profit after investing in multi-million dollar machines, you are happy. This is in stark contrast to manufacturing dental implants, although precision is essential in both industries. I go crazy when I see Nobel charge $399 for the NobelActive, $49 more than they charge for the Replace when neither cost $49 to make. You need to add $58 for the cover screw for the NobelActive whereas the cover screw for the Replace is $49. This is a difference of $9 which is what it cost to make 3 cover screws, which is why I always include it free. Nobel now owns Alpha Bio in Israel, the company that developed the NobelActive Implant. In Israel, Nobel sells the SPI implant, which looks almost exactly like the NobelActive, for $70 including the cover screw. This brochure compares the NobelActive to Implant Direct's ReActive implant on features and price Nobel recently raised the price on the Replace snappy abutment from $191 to $201. They charge $219 for the NobelActive Snappy abutment, which fits into an internal bevel/hex platform like the Screw-Vent connection. It cost less to make an abutment for a hex connection than it does to make an abutment that fits into a tri-lobe connection. Our straight abutment that comes with a snap-on comfort cap and transfer cost $85 and with the ScrewPlant and ScrewPlus ($150 each)or the tri-lobe RePlus ($200, this abutment is included free just by shortening the fixture-mount after it is used as a transfer. Given the professional acceptance and growth Implant Direct is experiencing, I see no reason in the foreseeable future to increase prices. Yes it took a personal investment of $30M to get to this level of manufacturing efficiency and capacity but I am making a nice profit that allows me to grow my inside and outside sales force and continue to expand the product line without raising prices. We do not offer volume discounts so the low volume users are not subsidizing the high volume users who traditionally negotiate discounts. As Gordon Christensen said in his October article in Dental Economics, "Now is the time ...for dentists to partonize companies that produce quality implants sold at a reasonable price."

Well said, respect and well done Dr. Niznick

As a non-dentist, but an investor, I find this thread fascinating. Alot of obsequiousness for nothing spectacular. One is led to believe that Dr. Niznick has discovered a brilliant insight. Namely: Large medical device companies overcharge for their product. Genius? Hardly. Every educated person understands that large medical device companies and large pharma overcharge. Ever hear of generic drug companies? All big business overcharges. They've got MBA's to feed and Wall Street investors (formerly Wall Street) to satisfy. So basically Dr. Niznick has created a "generic" implant company. Revolutionary? Not in the least bit. In fact, several low priced implant companies came before him. Only difference is Dr. Niznick's in-your-face marketing tactics. Smart business? Yes. Particularly, as is evident here, if you are selling to people who worship you because you are wealthy. The irony: Dr. Niznick is obviously a businessman, first and foremost. So before you blink he'll be selling Implant Direct to the highest bidder (most probably a large medical device company) and walk away with several hundred million. Great for his family trust fund. But for everyone else: You'll be right back to where you started: Buying implants from large companies who overcharge. So you see even Dr. Niznick is indebted to the same companies he criticizes, as without their cash from selling an overpriced product he would never be able to sell out. Didn't he actually make his first $100 million by selling to Zimmer? So let's all be honest: If you want to support Implant Direct because they have some great new implant and you love Dr. Niznick, that's fine. If you are supporting him because of some moral sense and outrage against larger medical device companies, let's stop the bs. This is a money-making scheme pure and simple, so outrage against the greed of large companies is the height of hypocrisy.

Are you sure you are an "investor?" You sound more like an employee of one of the companies having a hard time selling overpriced products, with their sales reps having an equally hard time making quota's. Yes there are other companies selling low priced implants but the big companies were never afraid of them because they could not afford to sell a $100 implant while still offering a broad line of products that were both high quality and innovative. Yes it is about business - it is capitalism at its best. Build the better mousetrap (especially if you sell it for a lower price) and they will beat a path to your door. Just having a low priced implant is not enough. If it were, the Brazilian, Israeli or Korean implants would be flooding the market and taking Nobel, Straumann, 3i, Zimmer and Astra business away from these premium priced companies. Implant Direct offers much more than low prices and our customers know it. Give what is making Implant Direct successful, I doubt that any company that would buy my company would be stupid enough to double or triple the prices because it would destroy the company. Fundamentally, dentists cannot, should not and will not pay more than $200 for an implant. I have created a "price-point shift" in the implant market because I have proven that high quality, broad product line, innovation and customer service is not incompatible with reasonable prices. While the title of this article in a business journal, "The Robin Hood of Implant Dentistry", may be a little over the top, it was the characterization of the interviewer who writes for dental journals and not mine. Like the internal hex I invented in 1986, if I hadn't done it, someone would have come along after me and developed internal hex implants. If I had not come along now with a broad line of cost effective implants, how long would it have taken before someone else with the combination of knowledge, money and passion to advance the implant field, came along? Ask yourself whether any of the premium players would be discounting like crazy today to hang onto their business if I had not changed the playing field for them? I am not claiming any altruistic motives here, just good business to recognize an opportunity, but it is an entirely different matter to step up and make the large investment in money, energy and time away from family to make it happen.

Dr. Niznick, Thank you for your well-thought out response. As an aside, I think you need to seriously consider the fact that the audience of people interested in what is going on in the dental implant world is not confined to you, Nobel, and a bunch of sales reps. The world is bit bigger than that. Fortunately, I myself am not a sales rep, hawking implant products in what is becoming an extremely competitive field. As a marketing strategy, attacking your opponent is viable, but at some point it becomes transparent and ineffective. I think you're getting to that point, and assuredly no larger medical device company who acquires you will be able to maintain that marketing approach for sheer "political" reasons. So as your end game approaches, innovation and service may become more important, and it's doubtful you can provide innovation and service at your prices on a much larger scale. But, I guess that depends on one's definition of innovation and service. That said, overall I still don't think that Implant Direct is doing anything special and yet at the same time I do believe that helping push forward the "generic" approach to implants is an excellent business decision. And I applaud you for that. The other implant companies that have predated your strategy, and done so successfully I might add, have not had your capital and more importantly your ego, to push the market for lower-priced, and quality implants, into the mainstream. But, at this point, given your capital and personality assets, the lower-priced implant market is firmly in place and set to grow strongly, with significant long-term negative financial repercussions for Nobel, Straumann, and the other larger implant companies. These organizations remain staffed by MBA's with little entrepreneurial abilities or marketing skills, and the decisions of high-level executives are more driven by Wall Street, than by sound economics, good marketing, and science. So overall they are reacting too slowly to new market realities. It will be interesting to watch how this plays out over the next few years, especially given the presence of private equity in the mix now. Hopefully, you'll cash out soon, so you can spend more time with your family.

Well there Dr. Niznik, drv as an investor seems to have a fair amount of knowledge of you and is paying you some rather strange complements particularly as per the wish to see you cash out soon. A most peculiar commentary.

thank you dr niznik now I have a question ? can I insert implantDirect with Dentium drills? thanks again bayat

Years ago I used to be a dental implant representative for Nobel Biocare and yes their products are very expensive but have very proven products and especially research to back these product types up. Yes, titanium has incredible osseo-integration abilities in healthy patients. So really any dental implant company has implants that will work very well. My purpose as a rep was to show my accounts and future accounts the added benefits Nobel Biocare had to offer them. Those doctors I was responsible for and the doctors I was able to help them see and realize the need and added benefit of having a rep. There are only a few doctors I had to hold their hands, but many were very capable of figuring things out after seeing it once or so. Many doctors switch over to our company for that very reason of having a rep close and who knew what in the world they were talking about. Reps need to do more than offer and sale a product. They need to service their accounts, offer programs for their doctors and labs and bring special offers and promotions to their accounts first before they hear about it from somewhere else. Just take care of them in every way. So my comments are centered around reps and the good companies who have them. So my question is, does Implant Direct do these types of services for their accounts? Do they have reps who are living fairly close? I know their prices are extremely less than Nobel, 3i and Straumann. So are doctors using them strictly for this reason? Also, you hear of many dds offices saying, well if I can buy it cheaper than what you are selling it for then I can offer the procedure to my patients at a better price....YEA RIGHT !!!!! I know how things work, you get a cheaper but comparable product, more money is going into your pocket and your business. Dental procedures will more than likely stay the same and even go up. Oh, dont get me wrong, I would use Implant Direct after hearing the comments on how many of you have had great successes over the years. I just hope they are a company that when you call them they have a living, breathing person on the other end helping you and supporting you.