Nobel Responds to Dental Implant Critics

I haven't seen any studies about this or anything other than a press release a while ago. what have been the results of others using this implant? is there anything published or even more news about this?

I have personally worked with Tomas Albrektsson for 15 years and know his ethical and scientific work to be beyond reproach or question. He is one of the world's top researchers in the field of implant surfaces and osseointegration.

This absolutely makes me apprehensive about their up and coming product lines.

I have done several cases, no failures so far, but I have to say than as a periodontics I do not understand the way this fixture may be restored properly by GPs to which it seems is intended for, without leaving a hanger that retains plaque and is difficult to keep cleaned. I have stoped using them for these reason. I have a failure rate less than 0,4% for all implants so I desagree than Dr Oestman's performance is an explanation for his results; I do not know him but I believe this comment from Nobel is very nasty. I will review my cases and send information about the evolution.

First they blasted roughened surfaces, then Tiunite was the second coming, Nobel Perfect was marketed with more marketing muscle than anything before with so many promises made, and what? Nobel Direct is now under fire.... And Nobel Guide is not as easy as they say. Meanwhile training GPS to place implants in 2 days. Buyer beware is one person opinion.

I have been placing implants for over 21 years. I have experienced problems with Sterioss rough TPS coated surface that broke down after 3 to 7 years. They lied to us. They claimed that the TPS was the 1st comming. Then Ti-Unite ...the 2nd comming. Will this surface break down also? They use us as guinea pigs to test their products. Now they are trying to copy the Astra system with the Groovy and again we are the field test. I also think that the company made a big mistake marketing the 2 day surgical course to GPs and now I don't do Nobel any more. They were my #1 company before but not now. I think the dollars blinded them and the direction of the company makes me very uncomfortable.

I would like to see documentation about the failure of the new Nobel implant. What is so interesting is that some people are adding the added step of adding PRP to the implant before placement. For people doing this, this changes the normal placement and may or maynot add and substract to the success. My reason for bringing this up is that when placing this implant it is very important(I think) to avoid compression necrosis by over torquing the implant...beyond 35 ncm. If we follow their protocal exactly will we get the results that "they" are getting or as all dentist do....add or subtract step that are important. Another example is tapping the site. Many of us do not tap type 3 bone and should we. To add to this long post. Many implant companies are not forth coming...ask about Dentsply Friadent

My experience with the NobelDirect implant has been less than stellar.I must qualify that I am using this implant only in very narrow spaces like small Max lateral incisors and Mandibular incisors. Contrary to my initial perception,as an experienced implant surgeon, the 3-0 mm. NobelDirect implant is very difficult to place in the mandibular incisor location. This is because often a periapical constriction of the bone is found just below the root apex and a redirection of the body of bone occurs at that location!usually you have one shot at placing this implant. If you don't get primary stability, you might as well forget it and do a conventional bridge since bone grafting in this location is difficult to do. Unfortunately as the previous poster mentionned: Marketing is preceding engeneering too often at the expense of the patient and the dentist! Nobelbiocare should consider reversing their course as it stinks of greed and it is turning off their loyal customer base.It might also open the door for class action lawsuits....The lawyers are salivating already.... My 2 cts.

Where 10 years ago, before the merge with SteriOss and before the Canepa story, it was difficult to be "allowed" with the Brånemark system. Now it has become the implant K-mart company where they look afterwoods if the implant succeeds or fails. One can trust people such as Sennerby and Albrektson, they earned their good names in research! Implantologists all over the world should mis-trust the money greed from this Swiss lady! All the new products they tore out of the ground so quickly, promise more than their performance right now. There was a day that nothing left this Nobel company before well tested. Even P.I. Brånemark took his nameaway from Nobel Biocare since he didnot believe in this agressive marketing strategy. Nowadays there are several good implant-companies performing at least as succesfull, or even better with less circus!

The one piece Nobel direct implant must take some form of immediate loading because it is exposed. Also, because it is not always easy to obtain ideal angulation in narrow ridge situations, the implant will generally require some form of supracrestal preparation of the metal in order to place a provisional crown. These two factors may be compromising and having an effect for some operators on the percieved sucess of this implant when compared to a traditional two stage approach. I have used this implant on a few cases of congenitally missing laterals with good success. I have not seen the bone loss alluded to during my 2 years of follow-up. As with most situations good case selection and careful technique will go a long way to minimize negative outcomes.

When a company has got more than 50% world market shares, I suppose they can say and do as they please and we will beleive it

I haven't even considered Nobel after Steve Lewis, the developer of the UCLA abutment parted ways with them. He was a big Branemark proponent and is a world renowned speaker.

In my opinion, we are watching the downfall of a great company right before our eyes! Greed is readily apparent. All you have to do is read Barron's magazine article last year to see the unashamed announcement of greed and proud of it! No mention of quality leader or anything like that. I find it quite interesting that at the Astra World Congress in April that president of the scientific committee is Albrektsson and other names like Tarnow are on the committee and I heard from the Astra rep even Branemark is involved. Add this to Carl Misch even using Astra and selling biohorizons, the way NB is treating their reps, it is the cycle of large companies. We'll see how Astra, Straumann, and 3i and Dentsply (the next biggest market share companies) respond or if some "upstart" like blue sky bio at $95 each starts gaining market share. If you get ignored at $300 an implant, why not get paid attention to at $95 per implant? fmn

I ABSOLUTELY agree with the above post, the only mistake is that with bluesky's $95 implant, you wont get paid attention to, because they have No reps or clinical support. All the big names in research and development have gone to Astra, there's a reason for it!!

What is everybody bitching about Locante published an article describing design that is more specific for immediate function,based on bone compression research and biomechznics,NobelDirect, this implant is not designed for immediate function. Just read Brunskis article (75 pageslong).or better yet take Locantes course on immediate function and it all comes clear.It is a function of Bone architechture,Implant design,surgical approach,opposing occlusion,and provisionalisation. Nobel Direct is not designrd for immediate loading,

For the last 3 years i have been trying to figure out why our team has been experiencing cover screw exposures in more than 30% of our implant cases, accompanied with a 2-3mm bone loss, even two months after surgery. I have been trying to get answers from the nobel people but with no luck. was it until one cover screw was given for physicochemical analysis, when we finally reached some conclusions because of the diversity of the chemical structure of the cove screw. should be noted that we use four diferrent implant systems and we sometimes experience bone loss only after the reestablishment of the biologic width and limited to the first thread. we stopped using tapered replace implants in the lower arch and we had the same problems with straight nobel implants. i am starting to wonder seriously whether we are paying for a mercedes and we receive a Fiat.

There is no evidence that Nobel direct implants fail, but there is not also evidence that they do work. Nobel apparently want to be the Microsoft of the computers, but soon they will respond to many problems,because the way they are marketing is clearly uncommon in (another)a dental product .

I've had a periodontal practice for 30 yrs, have done about 2600 implants, and do about 300 a year , I can't afford to cause problems for my referral base. My system is affordable on both ends, has an elegantly simple design, no screws, employs a locking taper preventing bacterial leakage (no micro gap) between the abutment and implant. If placed properly, there is no routine bone loss to first thread, but great anterior esthetics are routine, it's perfect for tight spaces, or minimal bone height. No need to be concerned about platform switching , this system has already has the platform others are switching to. I'm too old for the Nobel type problems mentioned here. Check out Bicon.com , system works great.

The issue here is Nobel Direct System and the relevant comments from Dr. Ostman ( being friend or not from Dr. Albrektsson)...the fact that this appear to be a page to write how succesful we are with one or another System is not also relevant.The fact is that we did accept a Company with no studies and a huge quantity of products.We did allow the Dental Industry to be over our clinical expertise and to me is very dissapointed that great colleagues are playing that game...for money? ....for prestige....Branemark thought also in money and prestige, but being scientific and hard worker. Today all this is like a Milan Show fashion.... I will not place a Nobel direct to one member of my family nor because of dr. Ostmann appreciation, it is because of the lack of scientific data.I do not belive in the rapid multycenter studies from the company Nobel Biocare AG (Aktien Gesselschaft)

I totally agree with you Albert, the implant Industry, specially Nobel, has done a lot of damage to the proffession. The lack of evidence, the fact that our patients are the lab pigs of their products, the marketing strategies stating that it is simple, easy , predictable and highly esthetic, and that anyone could do it, has done a lot of harm. They got the money, hence they are running the show, but as long as a few of us are critical and objective, We can still deliver a message to the dental community. I just hope it si not too late. How many failures will be accounted with this nobel direct lie? We will never know, but hey they will always have an explanation....our fault.

Interesting. All this talk and you would think the industry is going to you know where in a hand basket. Meanwhile, more implants are being placed than ever, and overall industry failures are going down, not up. Maybe we should all pay attention to the "Got Milk" folks and try to elevate the industry so the public has a good perception of dental implants...versus create a stain so all can be fearful? Do you remember which breast implant company was the villain back when breast implants went out of vogue? Yeah, most in the general public just learned that breast implants weren't good, not that some particular company had a problem...and it killed the industry for many years. I place about 250 implants per year, and I just want the field to be recognized for the good it does, and for the patients to keep wanting treatment. We all keep this ridiculous gossip going and I guarantee it will hurt us clinicians, no one else!!!

I've place 4350 Nobel implants since 15 years and lost 17 up to date. No implant company will ever be responsible for an implant loss. Only clinicians errors or misjudgement will. I've never placed a NobelDirect implant... because I dont trust the design. Is this design a mistake ? I dont know. Historicaly, Nobel is the only, remember, the only company who cared for long term research. Historically, no company can match the quality records of Nobel. Can any company avoid mistake forever ? Have they lost their touch ? Futur will show. No company, Astra included, can replace your clinical judgement. If you don't have one, don't place implants !

I have been placing implants for over 15 years and not all Nobel,however, I believe in immediate function and Tiunite. Nobel Direct 3.0 has been a true product differentiator. Everyone should think about who has an axe to grind and use their own common sense to come to their own conclusions. It is my understanding that the top three Dr's making allogations were refused contract renewal by Nobel Biocare for various reasons, talk about a Bias!!! What is that saying...opinions are like assholes, some bigger than others! Show me some hard evidence, studies and I will listen. Otherwise act like the professional you calim to be!

I'm a periodontist placing implants for ten years, and one of the things I pride myself in is basing my clinical practice on research - what I read, and what I have learned as a clinician. I think most in the industry stand for the same. Why then do you all use the anecdotal evidence provided by these Drs. to create hysteria over the implant? My Nobel rep has presented me with a multi-center (5 centers) study that thus far shows a greater than 98% success rate for Nobel Direct,one year out. I have also called some colleauges who use it and they report no problem. I agree with the Got Milk guy, we're only shooting ourselves in the foot with this anecdotal poppy-cock. I want a healthy implant industry, cause I've got years of practice ahead of me! Wish we were all so passionate in getting our GP friends to stop prescribing 3-unit bridges and dentures...

Jack Hahn responds to items posted Jan 10-Jan 17 concerning Nobel Direct and Nobel Biocare as a company. In my thirty-five years of active involvement in implant dentistry and having placed over 35,000 implants, I have come to the realization that implant devices don't cause failure. How we utilize these devices contributes to failure. Nobel Direct is an example. I have placed nearly 200 Nobel Directs beginning in April, 2003 to the present time. Four Nobel Directs failed to integrate. In two cases, the provisional crowns became loose and the patient hyperfunctioned causing early movement of the implant. The other two implants became mobile within the first six weeks due to not having primary stability of 35 mm/cm to 45 mm/cm. My fault, not Nobel's fault. To date, I have not experienced any adverse reactions with Nobel Direct. The soft tissues are pink and stippled with very shallow sulcus depths. Forty implants are presently in my Direct study. Radiographs are taken every six months and there has been absolutely no bone loss. I have offered to show these cases and radiographs to the practitioners who are the Nobel naysayers and they weren't interested. It is like anything in life. A thousand successes, one person knows about it. One failure and a thousand people know about it. Why am I successful with Nobel Direct implants? I learned not to "push" the system. Achieve primary stability without overtightening. Prepare the abutment portion using new sharp metal cutting burs with copious amounts of water. Construct a well-fitting provisional restoration and use a cement with good adhesive properties (Improv). I am one of the clinical advisors for Nobel Biocare. In all my years in implant dentistry, I have tried to exercise care in which products I utilized. If I found a problem with a certain product, I abondoned its use and notified the company about my concerns. Many practitioners who have been in implant dentistry for a long time know that I was involved with clinical development of implant devices for Steri-oss. The chief attribute to the company was that it could innovate new products to the market in a relatively short period of time. Under the leadership of Mrs. Canepa, Nobel Biocare has continued this philosophy. As far as clinical studies, no company in the world does more. Nobel presently has over one hundred university based studies. The accusations made in OsseoNews are just that--accusations. If Mrs. Canepa was greedy, she would have sold the company as the stock is over $220. Her philosophy is to develop products that more practitioners can use in their daily practices and that patients will first consider implants instead of three-unit bridges or slipping, uncomfortable dentures. The last issue that I want to debate is the question of two-day courses for GP's. Implant dentistry is not a specialty, and in my lifetime it probably will never be a specialty. For the past seven years I have been doing hands-on courses for GP's. We teach safe, simple predictable implant placement in areas of adequate height and width of bone. To date, our participants are practicing safe, successful implant dentistry. Even the practitioners who decide not to do implant surgery become more aware of the benefits of implant dentistry to their patients and refer more patients to specialists. I normally don't comment on the various implant chat lines, but felt I had to respond to this one.

Placing implants is like paintig pictures. Nobel Biocare philosophy is to convince as many dentist as possible: they can be good painters. Do you belive everybody can be good painter. Do You buy any pictures painted by poor artists?

"Why am I successful with Nobel Direct implants? I learned not to "push" the system." Jack Hahn These words from a doctor with 35 years experience say everything . Dr. Hahn please tell nobel biocare that you have experienced bone loss problems with Nobel Direct (even ,if it was your fault or not) and also tell Nobelbiocare that they can not "push" the system to all dentists, specially de GP´s. Finally I am against of your position toward an Implant Company.It is not healthy for the profession that we are bought by CEO,s and boards of people trying to rise stock prices.Remember that you are NOT the company and they will never be you the owner or the best investor!....even ,if you wish... Nobel Biocare is a new Company with insufficient data, very innovative,too much money for quick multy center studies...and the worst thing is that they do not respect the other companies...older than them...Nobel Biocare will be a very incident company (scientifically) in 25 years. Commercially they are the best.They are such good that they convinced doctors with 35 years experience and make them talk as the company itself.

the same problem (insufficient data) is coming with nobel guide. A lot of problems with surgical guide/tray breaking during procedure. NB tells me the material will be changed soon... Better late than never, I've spent some money on their computer program...At the clinic we place over 600 implants every year and seems will avoid NB. What about NPerfect? the same story.

I have a patient with four NobelDirect implants in the edentulous mandible. They are integrated but none can be used because of their placement. Do I count these as successes or failures!!!

Question ? Who places more implants in the United States, specialists or G.P.'s ( sheer numbers of implants ) ? Answer.... GP's, that's right, GP's ( if you don't believe me just ask Dr. G. Christensen ) !! Implant success rates of 90+ percent are based on placement of these very same implants............so why shouldn't companies that sell implant systems market them to GP's. Nobel Biocares strategy for marketing to GP'S is ABSOLUTELY CORRECT. In its current state, implant dentistry is just TOO EXPENSIVE for the average middle class patient. This needs to change and the only way it will change is if more G.P.'s do them !!!!! Nobel Biocare ( and others ) realizes that the future of implant dentistry lies with the G.P.'s. That IS the future of implant dentistry and there is no stopping it........

Dokchop, I agree, implant dentistry is expensive for the average dentist. I have found other systems that are FDA approved and cost a third of what nobel is charging. Do not get me wrong, I think nobel is a good system but the cost is extremely high if not the highest.

Everyone is entitled to their opinion. No matter how many tens of thousands a practitioner claims to have placed, the profession KNOWS FOR A SCIENTIFIC FACT that implant companies have gone extinct because they have "pushed" product which fail at regretable rates.

There is a lot to successful implantation, the science, the device, procedure protocol and long term stability. I think the reported failure/bone loss to the one-piece nobel direct lies with the design of the device and the recommended procedure protocol,not to mention that the company is marketing it as simpler implant. The design of the implant device is not well thought out, for example, the abutment portion is too long and when you place the one-piece long and straight screw in jaw bones that have different trajectories, the abutment portion usually sticks out into the buccal in the maxilla and ligually in the manbile, this is compounded by the fact that the recommended placement procedure is a flapless approach. The dentist is placing it blindly. I suspected that the exposed portion of the abutment now being obvious that it cannot be restored with it at different trajectory than adjacent teeth (ie parallel to adjacent teeth) the tendency of the operator might be to forcefully realign the abutment in a more ideal position... in other words, the operator becomes more worry about the position of the abutment more than the implant (which it should be for a prosthetically driven approach). With the flapless approach, it is very possible that implants were forced through vestibule areas in the maxilla, ligual perforations in the mandible, and buccal or lingual alveolor plates fracturing etc.etc., The bottom line is that this device and procedure have not been clinically validated with the intended use before marketing. For the lasted 6 years, I have placed and restored over 700 one-piece implant devices. From follow ups, the osseointergration rate is no different feom the 2 stage protocol, however, the crestal bone loss is substantial less then the two piece implant, but most important clinically is that the prosthetic complication is less than 1% over the last 6 years for the 700 implants that are in the study. Norman Kwan

Too Expensive for most middle class customers????? I guess that is why the Rich only have Plasma TV's, Boats and vacations to Disney World or Ski Resorts. A vast majority of patients can afford dental implants. Some dentists are afraid to sell them on the benefits versus that 60 inch Plasma they want to stick in the basement.

I have placed approximately 150 Nobel Replace Select and just a few Direct with good results...However, I have begun to use the Groovy lately and have had several complications...Three implants failed to integrate and two implants actually fractured at the head...one could not be retrieved (one 4.3 and one 3.5)....I have been told by NB that they had not heard of this happening before....Has anyone else has this experience?

It is interesting to note the number of responses to this negative focus of one of the major players in implant dentistry. What I do agree with here is that being a major player, like Walmart, doesn't equal premium product or service. I would be embarrassed to continue using a product if I had these same feelings or experiences represented here. Implant dentistry is a boutique service and should be controlled by boutique players.

With standard titanium srew shape implants, like 3i's or Nobel's or good clones, and with TiUnite ones also, it's easy to maintain 98 to 99% long term success. I do since 15 years ( 4 or 5 with a few thousands of TiUnites) and I'M JUST A GP !!! Imagine ! I'm just amazed by all that gossip from all those loosers who can't work properly and put the fault on others. Also, I wonder when specialists will stop thinking that their degree came with a second brain as a bonus. Inflatable heads ! So silly !

Stay calm Chausse. I have had 2 fractures on the 3.5 mm. It is happening often and I really question a company like NB that is still having a fracture issue 40 years after inception.

Interesting.! I am not a user of the Nobel Direct. I will watch to see how all of this unfolds,howerver please don't give all "the Big Names" so much credit! Thomas Algrektsson, when still with Nobel was speaking at our study club in San.Francisco, he was adamant- only machined implant,only extrnal hex. and only his buddy in Sweden would do an implant for him! I asked about internal connection,(tri channel), immediate load he was against everyone and everything! I called him on it and l also suggested that this guy should never be asked to lecture with the study club-and he has not! Funny, he surfaces with a new look - Astra. It is a fine implant but if they are serious at all they will soon have a tapered option! Yes, and he will move to were ever he can find a job; I would, but you don't fool anyone Thomas! At least no one that heard you only a few yars ago.

Fine all companies have their head up their own....Nobel is no different. They have lost several excellent practitioners because of tri-channel fractures in the 3.5 series. All companies can have complications but only Nobel developes a fantastic Retieval Kit and never tells those placing implants that it even exists! That is B.S. Unfortunantly it is what we all expect from this company today.

I had also a fracture of the three chanel 3.5 mm NP implant. but just ONE. I was among the first user. after that, Nobel started advising on the package not to torq over 45 ncm to avoid fracture. no reason now to break a second one !

Chausse, so you deal with a company that has known faults on the NP 3.5. You continue to use the product eventhough there is a different protocol for a fracture issue!!!! Is there any other company out there that tells you to do this? It is like driving a high end sports car but be careful on the hairpin turn as the wheel might break off!!!

The new, poorly researched implant products like Nobeldirect exempify the de-evolution of implant dentistry. This is a very sad situation in the opinion of this surgeon with extensive experience in implant surgery. Nobelbiocare has become totally market driven and there is no reverence for the patient. We as clinicians have a fiduciary duty to never harm a patient and to only use products that have been proven safe and are backed by sound scientific research. Porfessor Branamark espoused these humanistic principles but, now, it seems like these nobel (no pun intended) principles have gone by the way side. The only way things are going to change is if we as clinicians put our foot down and only use safe and well-researched products on our patients. I have switched to the Straumann and AstraTech systems because these are the only two remaining systems based on decent research.

Fracture of narrow implants head is a well documented problem, whatever the design, whatever the manufacturer. In the case of the three lobed NP Replace implant, the weakness can be a problem at installation. the osteotomy must be ajusted in order to avoid the need to torq it over 45ncm to take it in. once installed, those implants just won't brake on the long term! Like many products in dentistry, narrow implants have the proven potential to help patients on the long term, if wisely used... Clearly, some of the criticism we read here come clinicians who don't have the experience or the knowledge to understands what it's all up!

I have just heard of this blog and decided to read through a bit of the chatter -after learning of the results from the Swedish medical body on this issue with Nobel Direct. I have to laugh! A company shouldn't worry about their stock price? Really?? If they do, it's greedy?? Please! In addition to having a DDS and specialty in periodontics, I have an MBA. In my classes, I always learned that companies took care of their stock price primarily by coming out with quality product! Not by throwing shoddy product over the wall into the marketplace! You have some failures? You have some fractures? Do you know how much damn torque it takes to fracture an implant? Only us annointed specialists should place implants?? Why, cause it's such a specialty? Reality is no matter what we say about these companies, or who is placing implants, the success rate of implants remains damn near perfect...certainly better than other procedures such as endo. Did we all enter the field of dentistry thinking things would be perfect...and if not, by God, it would always be someone else's fault! We're pathetic, I really think after reading this that we're pathetic. Thank God none of my patients know how to find their way into read this ridiculous diatribe!! I am a shareholder in Nobel. Yes, in addition to placing implants, I bought stock in the company about 6 years ago cause I was using their products and it seemed a logical step - have done pretty well. In any event, I follow the anaylsts reports and learned last week that after review by the Swedish Medical Agency that Nobel's research on Nobel Direct was considered to be very solid by the agency. On the other hand, the research by Albrektsson, et al, involved a smaller number of patients than originally suggested, and apparently was quite questionable. The word by the analysts leading up to this hearing was that either Nobel would have to take it off the market, change their instructions for use, or that no action would be taken. Despite the gnashing of teeth in this blog, the agency ruled that everything was in order - no action needed to be taken. Now what do we complain about?

vioxx-released and stock price invreased but did it harm patients?...YES!!! you sound like you work for Nobel Dr. MBA. Your speech is worthless.

What went wrong with Branmark NOVUM ? Any one ever used the system ? What were your results ?

Here are the facts: Review these carefully. 1.ever since the inception of the Replace implant, clinicians have had bone loss issues with the tapered Replace implant, whether it be x-hex, internal camlog, or the tapered nobel direct. 2.First Steri-Oss, then nobelbiocare have changed virtually everthing concerning this implant system due to 1 thing PRESSURE NECROSIS. Why is that you ask....because if you review the PROTOCOL for this REPLACE system, you will note the taps were changed, the drills were changed the armamentarium was changed then they added a TORQUE WRENCH to the surgical kit that you were not supposed to place this implant with more than 35Ncm...why, because there is and always has been the side affect of PRESSURE NECROSIS SYNDROME. Why are there DENSE BONE DRILLS???? Could it be that Nobelbiocare does not want to admit fault for a poorly designed IMPLANT. Think about something, before this implant system was on the market, the term PRESSURE NECROSIS did not even exist. Also, they use to have a surgical hand driver that we utilized for actually placing the implant which was awesome, they took it off the market because they said that it created too much torque around the coronal aspect when placing the implant. Why.... primary stability is key, however due to the type of threads that are on the implant as well as the DIMINISHING 1/3 aspect of the apex portion....you create all the pressure on the coronal aspect, thus the term PRESSURE NECROSIS. Remember, they even had us back out the implant a 1/2 of turn to RELIEVE THE PRESSURE around the coronal aspect of the implant. Why is it that we see bone loss issues around implants that have not even been restored. Full integration to the top of the implant is a misnomer with this implant, even if it is coated to the top, I still see implants that are 2/3rd's in bone and 1/3rd PRESSURE NECROSED AWAY. Then when you talk with the rep, they say its a surgical problem, BULLSHIT, it is a coming clean problem with Nobelbiocare. 3. CAN EVERYONE SAY....MICROGAP????? No matter what we do to this implant, there is a microgap, just like the external hex which everybody loathes now, I hear people say, External hex is the worst design because of all the supposed design flaws with that implant....Let me tell you, that is nothing compared to the DESIGN ISSUES OF NOBELS REPLACE TAPERED IMPLANT....in all connections or designs. Summary: I see clinicians WHO ARE PAID AND RETAINED BY NOBEL to post RETORTS to the problems we are having, here's the bottom line, ONCE YOU ARE PAID BY A COMPANY....YOU ARE NO LONGER UNBIASED!!!!!! You are biased due to the $$$ signs that are helping form your opinions. God knows nobel has plenty of those. Once again bottom line....NOBELBIOCARE DOES NOT HAVE THE PHILOSOPHY OF NOBELPHARMA...do not get the 2 companies confused.....they are nothing alike!!!!Nobelpharma was not only concerned with RESULTS....they prided themselves in them, the results here FOR NOBELBIOCARE are that PROFITS not CLINICAL RESULTS are whats driving them. So lets see which RETAINED colleague will respond to these FACTS............check your history and old catalogs!!!!!!

Someone has stated in a previous post that he has placed 35,000 implants over 35 years. Let's do the math. 35 years times 240 business days a year equals 8,400 days. 35,000 implants divided by 8,400 days equals an average of 4.1 implants every business day for 35 years. Condidering that modern implant dentistry (predictable implant dentistry) did not begin until 1982, the daily average would have to be much higher for the recent past. These comments have to have been made in an attempt to lend credibility and thus justification to the product being used. Facts are helpful. Hyperbole is not.

Given all the baiting going on here it is fair to note that not all dentists are created equally. Something our patients do not know. When the Professionals demand research and studies but then purchase clones you may wonder why some companies focus on marketing instead of documentation. It would be nice if so many GP's and Surgeons throwing bombs here actually behaved the way they speak. If they did we would not have around 64 Implant companies with maybe 4-5 Novel Implant designs which are cloned by the other 59 and sold for a discount, without any of the research and studies being demanded here. Of course most of the people here complaining about marketing still wait at least 3 months to restore an implant because that is what they were trained to do by NB regardless of the system they use. Ironic or just sad?

So, a shorty (7mm implant) was created by Nobel not Innova or Bicon, a groovy was created by Nobel not Astra, a speedy was created by Nobel not Biohorizons, A select was created by Nobel not Kirsch and Camlog with its connection and ITI did not create the single stage format, direct was created by Nobel not a group of european companies first. Give it a rest Mr. Nobel. YOU HAVE BEEN MARKETED!! Do some research before you post. Not ironic or sad just ignorant.

Hi, Lots of mystakes are posted here. To everyone: I have almost 200 NobelDirect implants placed and just lost 2 of them. The reason isnt't the implant per se. I would lost them if they were Replace, Branemark, ITI or Astra. The bottom line is that: If you have lincense to drive, does doesn't meen that you are able to drive a Ferrari. This implant is completely diferent in Philosophy and Practice. Just follow "the cook book" and you can make the receipe.

I have also experienced fracture at the fixture head with two 4.3 mm Groovy implants and I had placed many Replace Selects prior to that without any fractures. The company rep said thy had never had any reports of fractures.

Doctors, I am about to get 2 implants for my upper central incisors. Can you please tell me which is the most reliable brand and model to get?

My wife just had #8 extracted and the Dr grafted the socket with GEM21s and covered with a collagen plug. She will wear a flipper. In four months a 3i implant will be placed. This was the recomendation of the specialist and I have seen his work! Top-Notch

I have not placed many implants ,but have assisted and refered most of my cases to perio/omfs.I feel that a general dentist with proper training is more than capable of placing implants. When a recent grad of a specialty program graduates he cannot possibly have much experience and must do as I did when I graduated,rely on mentors and personal experiences. There seems to be quite a bit of anger from both sides of these issues. Also it seems that some indivduals are taking exception with nobel marketing there products and there marketing toward gps, I went to all the major implant web sites and it sure seemed to me that they all market!!! and that they all are actively recruiting gps. I am sure that all the indivduals that are posting negative commets about marketing products do not market any products to there patients. And finally from the research end, I am sure that most not all research supplied by the implant companies has been supported by each and every implant company. Last I heard,all implant platforms have failures that may be design issues or operator issues.

The Paragon Implant booth in the late 1990's had a rotating sign on the top. Intelligent Design for Discerning Dentists. I use to say that I had a niche market...Discerning Dentists. Based on the intelligence shown in the comments above in this long blog, I think that discerning dentists are no longer a niche but a growing force in the industry. Here is the reason Nobel Replace implants fracture. The wall thickness of the 3.5mmD implant is only .oo9" thick and when they made the 4.3mmD implant, which one would expect to be made stronger because wider implants are used in the posterior more, and therefore subject to more load, they also made the cross-section of the trilobe larger, leaving only .012" of wall thickness. That is just a little larger than 1/4mm (.010") and a human hair is measured at .004" so it is 3x wider than a human hair. But that is not all.... TiUnite can not bond to Titanium alloy, so while the HA coated RePlace implants are made of alloy, the Tiunite coated implants are made of CP Titanium, which is weaker. There were reports of Screw-Vents fracturing when they were first introduced in CP titanium in 1986. It then had a wall thickness of .016". I quickly widened it to .020 (twice what a 3.5 Replace is today) and introduced the implant in Titanium alloy. By 1990 I stopped sellingCP Titanium Screw-Vents. Another contributing factor in solving the fracture problem, was the introduction of the 4.7mmD and 6.0mmD Screw-Vents in the early 1990's, keeping the same 2.5mmD hex but thickening the walls by .020" with each succeding increase in size. Therefore, the wall thickness of a 4.7mmD Screw-Vent was .040" or 1mm vs .012" with the 4.3mmD Replace today. These are the dimentions I have fallowed along with the same taper as Zimmer's Screw-Vent, for my ScrewPlant and ScrewPlus implants but my new RePlant is designed to match the platform and body diameter/taper of the Nobel Replace. I only use alloy to add strengh. The big differences between the Replace and the RePlant are the thread design (RePlant has double lead and mini-threads) and the cost ($150 vs $367 including cover screws). If you are going to get screwed, at least don't overpay for it.

I have a Nobel implant. I am not a dental professional. I am concerned at the emotional rhetoric above from a profession I trusted. Is there any reason why the Swedish Medical Products agency mentioned above should not be correct? I would have thought they would base their decision on science and clinical studies...

"This implant is completely diferent in Philosophy and Practice. Just follow "the cook book" and you can make the receipe." A study DOES follow the cookbook. That's why the bone loss is alarming. Please note, it's not about survival it's about success (bone loss). Nobel had had credibility issues with me ever since they changed surgical protocol 7 times without admitting any problem over two years with Select...then changed the collar 3 times in 3 years. If you don't think they're experimenting with your patients, you're not paying attention to what they are changing.

The biggest thing I have learned as a GP since taking some Nobel courses and starting to do my own surgery in selected sites, is that its no wonder my surgeon was driving a Ferrai. I think the finger of greed is pointing at these losers who are down on Nobel Biocare for becoming "GP friendly" I think they are worried it may be the death of their little Golden Goose. If it was left to these guys we'd all need a masters to place buccal pit amalgams

Wow! Some palpable anger there, huh!? I think the concern of most specialists, including myself, is that dental school + CE courses do not a surgeon make. How many implants did you place in dental school? In fact, how many did you restore? Going to a Nobel week-long course may allow you to obtain malpractice coverage for your implant surgery, but aren't your first 20-30 or more patients just experiments? When training is done in a residency setting, a supervising surgeon is holding your hand until you are ready to do them on your own. Then, treatment planning is all supervised by an attending surgeon. Only at the end of the residency can a budding surgeon begin to fly solo. Patients generally are not experiments. With CE training only, I don't think anyone should be assuming that they are ready to attempt that type of surgery--it's just not fair to our patients. So, no, you don't need a master's degree, just more training than dental school and CE courses offer.

I agree that having a mentor is a great way to gain experience and very safe for patients. A residency is oneway of obtaining this but I would suggest a group dental practice with some expericed practioners is even better. Many of the "specialists" periodontists and oral surgeons who are placing implants today did not get there implant training in their residency. They did their residency 15+ years ago and learned their implant skills through CE courses and by gaining experience through sucess and failure. A residency is a good thing if you have three years of your life to burn. 1 year will be profitably used learning the techniques you need. The other 2 years will be used sequencing the DNA of an ameloblast and teaching you about how much better you are than these dodgy GP's and how to set your fee's so that only 5% of the population can afford your superior services

Most residency programs don't have a research component to them and involve mostly clinical training. The point to remember when claiming that "older" periodontists and oral surgeons gained their training via CE courses, etc. is that they were fully trained in surgical technique and surgical anatomy prior to going to the CE course. Example would be laparoscopy--general surgeons all know how to remove a gall bladder or appendix via the traditional open approach prior to doing it laparoscopically. Through a surgical mentor/partner or whatever, they learn how to use the new technology. A GP is not a surgeon and is not equally trained or qualified. "Mentoring" by a non-surgeon is still experimentation at the expense of the patient and patients should be fully aware of this fact. That "burning" of three plus years is what differentiates a surgeon's skills and ability to provide proper care for the patient from a GP. You can't possibly believe that a CE course and another clinical GP "mentor" can in any way make you the surgical equal of someone who has invested time and effort to become a surgeon via the proper channels.

Not when it comes to removing a parotid tumor but when it comes to placing dental implants experience is king. Not 3 years having your passport stamped. A GP is a "dental surgeon" and has more than adequate knowledge of the relevant anatomy.

Not being a Nobel user ,not all is bad and the failures exposed above could happen with other Implant Companies. The company opened the $$$$ sign of GP and specialists Sure it is easy to place implants with fully indications of that, we have allowed Nobel company to make manuals going over the right Diagnosis and indications.They are marketing to make it simple and "affordable".It came to my attention that they have also courses of Marketing. All is valid, the only thing we must keep is our Diagnosis the rest will be in charge of companies.... It seems that we are teaching software programs and not Diagnosis. Implants, Nobel guide, Simplant, groovy, perfect, tiunite, osseospeed, osseotite, switching plataform, etc, et do not work for alone. We need expertise dentists to be responsible in front of such offer and variety of "tools" to replace a natural tooth in the close natural way.

Franck Renouard, Bo Rangert "Risk factors in Implant Dentistry-Simplified Clinical Analysis for predictable treatment" An excellent text for anyone who has had problems with fracs of any implant system

Just a short list of notables in the implant field who overcame the shortsightedness of "real surgeons" in order to advance implantology as we know it today: Scott Ganz - Prosthodontist Jack Hahn - General Dentist Carl Misch - Prosthodontist, Fellow Academy of General Dentistry Gerald Niznick - Prosthodontist Hilt Tatum - General Dentist Phillipe LeClercq - General Dentist; Check out the incredible skills this particular general dentist displays in Paris: www.siopa.fr under the Professionnels or Engilsh sections (French section has much more). When oral surgeons who "were fully trained in surgical technique and surgical anatomy prior to going to the CE course" were placing implants anywhere they could get bone, restorative dentists slowly changed the order of thinking from surgical to restorative. Hilt Tatum even invented surgical techniques and instruments for adding bone where he needed it. Let's not make this field a turf war. Rather let's ensure that clinicians of all backgrounds are trained properly, which can mean mentoring or in a residency. Implant placing skill is dependent upon individuals, not groups of dentists.

The list of dentists is great--all talented doctors. In response to your comment "trained properly, which can mean mentoring or in a residency", I would ask what the criteria for proper training is? In a residency, that is determinted by CRET (Committee on Resident Education and Training) for oral surgeons. There are similar bodies in Perio, Implant Dentistry residencies, etc. If a program does not meet expectations, it is put on probation or eliminated if enough procedures in all categories are not met. What is the criteria for training via a group practice setting? A Nobel course? Who determines if the doctor is ready? Is it not a conflict of interest with a company like Nobel to tell a potential customer who just finished their course that they may need more training? Bottom line--is it ethical that the patients of these "doctors in training" via group practice or CE are truly just part of getting a few cases under one's belt. In dental school we all were supervised. Same with residency. Not the same with CE or "mentoring" by someone not in the same office or not chairside during the procedure. The training is not the same and the care rendered is not the same. The list of doctors you presented includes Dr. Misch, who mentored under everyone he could find and got the best training he could. Going to a Nobel course and then placing on your patients does not put you in the same category as Misch or anyone else on that list.

We all had to get a few cases under our belt and if you haven't learned from a few less than perfect results, then I don't want you placing my implants regardless of what your qualifications might be. This crap might be convincing for yourself and some of your patients but don't peddle it to us we know better. We've seen some of the results you highly qualified "solo flying professionals" send back to us to restore. It's one of the reasons (together with the fee's you charge our patients that put's the treatment out of their reach)that has made us decide to start placing the Implant ourselves.

Graduating with first class honors from a prestigous dental school in Australia it was left to my first "mentor" a GP with 25yrs in practice to tell me that I should actually dry the root canal with paper points before obturating. The prev 10-20 endo's I had done patient's were just experiments even though I had passed the accredited courses and was told I was ready to fly on my own. Looking back 11 years later I couldn't even properly diagnose a toothache until after the first 2 years. Whether it's Dentistry or Medicine we are all on a lifelong learning trip and I guess this makes all of our previous patients to some extent experiments. Over the years we come to admire the skill of some great clinicians many of which have formal post-graduate training. Most of the truly great ones don't view there formal qualification as what defines them as being better than others. It is usually the average clinicians that seem to want to rest on this laurel to distinguish them from others.

I am worried how some dentist and the implant companies state success. they look at success as implant loss. well, we as a dentist should look at success in the eyes of the patient. I have seen some of of the so call "successes", they look and function as CRAP!! just because the implant has not been removed from the patient does not mean success. I can't beleive some of the statements that being made by some of the dentist. Hey, be honest with with yourself and the rest of us!! These PAID speakers are paid to make the rest of us buy the products--Hahn included. JPS

I work with several specialists in myh area. some of whom I have grat respect for, some of whom should look for employment in another line of work. It is the same with general practitioners. I don't think that blanket statements by some on this blog about who should be doing implants are accurate. I think you need to do your homework, take ongoing CE and hone your skills constantly. GP dentists can place implants, perform endo, ortho, perio, do full mouth reconstructions and so on. Specialiast are certainly needed to perform more demanding treatments. Implants can be learned by anyone with the desire and a moderate skill level. There is so much conflicting data and change going on in all areas of dentistry, that sorting it out is quite challanging. The bottom line is experience, and failure are great teachers. It is what you do with your failures that determines how you grow. Success can make you comlacent and you can lose your edge. I am just begenning to place implants, and I thank Nobelbiocare for the opportunity to learn the basics. I will be using other systems as well because I do not feel any one company has all of the answers. I have attended many lectures and taken courses from many different camps. I think it helps one discern trends. When I hear conflicting comments, I have an opportunity to think. I think Nobel Direct has uses. I think it will be a great help in certain situations. It is certainly simple to place and patient friendly as well as easy on the wallet, since no abutment is needed. Other manufacturers will certainly pick up on this. I think the mini implant has a place also and many more manufacturers will pick up on this. Nobel biocare is like GM. Thae tried to have the perfect auto for everyone. Well they do not have the perfect implant for everything. They do have a lot of good products and when used properly, will perform very well. They also will have some dogs. The dogs need to go. I don't think that Nobelbiocare wants to try and mass market defective products. That would be very short sighted. Like GM Nobelbiocare needs to look at GM and see what happens when they lose focus and stop innovating. There are some dental companies that I will not deal with as they have proven repeatedly that all they want to do is take a concept and mass market it to death without backing it with a quality product. Den-Mat and Discus Dental (Zoom) come to mind. It seems that there are many people on the lecture circuit and publishing who have "the answer" to all of the problems associated with implants. They all have their success illustrations. What we often do not see are their failures. As I become more discerning, many of the "successes" are far from perfect. So how do you want to define success for yourself and your patient? perhaps your definition changes with time. Is an implant with some bone loss better that any 3 unit bridge? Is a 3 unit bridge witha little recession around the abutments and iatrogenic endo better that a partial. Is a cast metal tooth supported partial with some wear and recurrent decay better than a flipper. Is a flipper better than a denture. is a denture better than nothing at all. Who should decide if it a success, the happy patient or the frustrated dentist or specialist?

First off I would like to say that I have not read every single response. But I have been placing Nobel Biocare implants for ten years now. With the old "replace" tiunite or even ha coated I had great success. In seven years I think I lost three or four to "failed to integrate". I would also like to say that two of those were in one patient who smoked and understood the risk of failure and misinformed me that he had quit. Now for the flip side. I am comfortable placing Nb's implants. I know them. I like my rep a lot. I make them lots of money. I make lots of money. However, lets discuss groovy implants for a moment. I feel just a little "back door" on this one. I read the research, of course provided by the company, before starting to place them. Now, there was NO great importance placed on torque or pressure necrosis. In fact my rep when he was refilling my kit "you really don't need those dense bone drills, just use the taps". In the past with the other designs I used neither and had good success so I didn't give it another thought. Then the land slide hit. I learned the terms pressure necrosis leading to fibrous encapsulation. I am sure that a good percentage of the responses here are spin doctors from the companies. And I am also sure that there is more than likely not a company in the world that has not put out a product at one time or another and it didn't go quite as planned. But when it affects YOUR patients and your bottom line, something smells. Over night the torque became an issue. I have never broken off an implant and could not imagine the force it would take to do so. But, since many of my patients are type I dense bone in the anterior mandible, I would have never dreamed of having these failures, six implants out of forty in the first four months of placing groovy's necrosed and failed to integrate. All of a sudden the packaging on the implants themselves started showing up with a sticker warning about torque. I started using dense bone drills, taps, and watching the torque on placement and presto, back to great results. But for the few that should not have had to endure failure. I am disappointed. One last thing. I am still comfortable placing NB's implants. We all LIKE what we are comfortable with. I think the only time things can go poorly on a consistent basis is when a clinician with a little bit of knowledge starts short cutting based on anecdotal evidence of others. I myself have published research and have been involved with others doing the same. We must be careful because there is much bad research out there and it is hard to tell the difference. The words "standard of care" come to mind. The complexion of implant dentistry is changing so quickly that the standard is shifting almost yearly if not more. I think that pushing the envelope is important. But, it must be done slowly and in a controlled manner, not just based on published research of clinicians on the payroll of a particular company.

The reason for pressure necrosis with a tapered body design like the Nobel Replace is that the taper is not even all the way up the implant. The taper widens quickly from the apex to the midpoint of the implant where the major diameter is reached. This is in contrast to an implant like the Tapered Screw-Vent were the implant taperes from the apex to within 3mm of the top, or the ScrewPlant (Implant Direct) with the taper extending over the entire length of the implant. When I developed the Tapered Screw-Vent in 1999, I introduced it with a soft bone and hard bone protocol using straight step drills that allows for bone expansion in soft bone, and with ample bone removal so that in dense bone the implant can be inserted without a bone tap. If you are "comfortable" using the Nobel Replace implant, now that you know how to vary the drill diameters for dense bone consider moving from your comfort zone to your profit zone by using the RePlant implant which is 60% less expensive, while being inserted with the same Nobel Drills, and has the same tri-lobe platform.

Much of the discussion goes back to what one describes as a success. To me progressive bone loss is still not acceptable even if the implant is stable currently. The implant does not have to fall out of the mouth to know that you are in trouble. Secondly the studies are only as good as the people doing them.

Jerry, Would you please comment on the microgap of the Nobel Replace and will RePlant still have the same microgap? I have placed many Nobel Replace tapered implants without a single failure, so I'm not seeing any compression necrosis. I did have concerns about the microgap and switched to Astra implants. I have liked Astra implants, but they have gotten a little pricey and with their "new" delivery system, it seems that costs are going up even more. I'm anxiously awaiting the comencement of sales from Implant Direct and was considering going back the the Replace clone - RePlant. Maybe I've been lucky with Nobel in the past, but I still have concerns about the microgap. If the microgap in the ScrewPlant or ScrewPlus is significantly lower, this will be my new choice of implant systems.

There is a marketing book entitled "Differentiate or Die." Dental implant companies raise concerns such as speed of bone healing, or micro-gaps, or bone recession, or loose screws, and then claim to have the best or only solution to that problem. Astra's claim of reducing or eliminating micro-leakage by its conical connection is but an example of Astra trying to differentiate its products. Micro-leakage was a problem with external hex implants because the screw would flex with the abutment tipping off the shoulder of the implant. This does not happen with internal connection implants. The Astra 11 degree conical interface is no more sealed than a butt joint as metal can only hit on three points at any time. While the one-piece abutments tightened down on an Astra implant my provide some frictional contact, this would not apply to a 2-piece abutment with Astra where the abutment just seats on the bevel and is retained by the screw. In any case, the same frictional interface would occure with a one-piece abutment on a Replace or RePlant implant, but one-piece abutments are seldom if ever used with cemented restorations with either Astra or Nobel Replace.

Jerry, Nice response...I agree with you points but the question I read relates to micro gap. I could be wrong but I believe the main point here is biological width being established at the micro gap. Does your implant have the abiltiy to be platform switched? If not, does your implant have it built within its design. This is important because there is a lot of clinical studies showing no or very little crestal bone remodeling when an implant is platformed switched or has it built within its design. What are your thoughts?

There are two options for platform switching within my new product line. The ScrewPlant has an external bevel with 3.7, 4.7, and 5.7mm Platforms. If you select our Legacy (Screw-Vent compatible) abutments, rather than the ScrewPlant abutments, you get platform switching because the Screw-Vent has 3.5, 4.5 and 5.5 platforms. Another way is the RePlus implant I just added to the product line. It has the same body 3.7 and 4.7mmD as the ScrewPlant but with the 3.5 and 4.3 tri-lobe platform, providing 44-66% greater wall thickness than Nobel Replace, plus platform switching.

Correct me if I am wrong, but from the information you provided the abutment to implant connection difference is only .2 mm. From what I have read in the studies, this is a lot smaller then what was proven to work. Do you have any information contradicting what I have said? Also, do you have any clinical studies past or present that show the effects of platform switching with your suggestion posted above? Thanks for your reply in advance.

Dave... You are right about the .2mm difference for the 3.7mmD implants but the difference between the 4.7mmD platform of the RePlus and its 4.3mmD tri-lobe platform is .4mm. As for your comment that "this is a lot smaller than what was proven to work", I do not know what study you are referring to or what you mean by "work?" I believe that platform switching is an aberration of companies like Bicon and Ankylos whose conical connections have to start medial to the outside diameter so they argue that the "better" results they claim to be getting with regard to preservation of bone, must be due to this unnatural contour not found in natural teeth or other implant systems with equally good histories of bone preservation. The VA study of the 1990's proved that if there was more than 2mm of bone buccal to the implant, there would not be any bone loss - and this was on implants without any platform switching. Further, 3i rationalized that medializing the margin connection would reduce bone loss typically seen with the Branemark external hex implants, but let’s not forget that that bone loss was often attributed to the wider neck of the Branemark implant which required countersinking. Also, this wider neck of external hex implants (and some poorly designed internal hex implants) has been shown in photoelastic studies to cause stress concentration at the crest which can cause bone loss - that is why Astra and Implant Direct use micro or mini-threads near the crest and why Fridadent's Xive implant has shallower threads near the top. Also I believe that the Bone loss to the first thread of the Branemark implant was most likely caused by its smooth machined neck and/or its very wobbly external hex connection that caused the abutment/implant interface to open and close, percolating bacteria as the fixation screw flexed until it eventually worked loose. IN OTHER WORDS, PLATFORM SWITCHING, IN MY OPPINION, IS JUST ANOTHER ATTEMPT FOR IMPLANT COMPANIES TO DIFFERENTIATE THEIR PRODUCTS WITH NO SCIENTIFIC EVIDENCE, OR EVEN LOGICAL AS TO IF OR WHY IT SHOULD WORK, ESPECIALLY WHEN THE CAUSES OF EXCESSIVE BONE LOSS WITH THE EXTERNAL HEX IMPLANTS CAN BE OVERCOMING BY ELIMINATING THE EXTERNAL HEX AND SMOOTH NECK AS MOST IMPLANT COMPANIES HAVE ALREADY DONE. IMPLANT DIRECT OFFERS PLATFORM SWITCHING ONLY SO IT DOES NOT HAVE TO EXPLAIN WHY IT IS NOT NEEDED, AS I HAVE DONE HERE.

I am not a dental professional. I saw a commercial on TV about Nobel implants and thought that I might be able to have this done since my dentist has pulled almost all of my molars and I now find it hard to eat, but now after reading all the retoric I am very confused and afraid of what could happen. I live in a small city of 107,000 people in Visalia, Ca. and I don't know where to look for a dentist who is specialized in this procedure. Can someone help me? Do you have any suggestions? Thank you. SG

I have the good fortune of working with Dr Ostman. I was trained by him and Dr Hellman.They are extremly talented and etical clinicians.I was the first British Surgeon to use Ti unite before it was marketed in UK.Their clinic has a very close relationship with Nobelbiocare.The amount of data they are collecting and the number of patients they are treatening are phenomenal.I believe every word Dr Ostman said and I share his concern about the failure and bone loss. Its a shame that Nobel is alledging that DR ostmans success rate is below average. If thats the case then their implant is surely well below average.

SG, Most of the arguements given on this site are from advocates. They advocate for or against a product that they use/sell/speak for. Know that for the most part a Periodontist or Oral Surgeon in or near your town will do a good job of placing implants and most are looking to place the implant that they feel is best for your situation. In other words they are not interested in saving $50 over your long term outcome. The top four implant companies are Nobel, Straumann, 3i and Zimmer. With an implant from one of these companies you can be fairly confident that your choice to go forward with treatment will be supported with long term data and financial stability. Meaning if problems do come up the company will be around to support their products for the 30+ years you are hoping to have the implant in your mouth. As for the Noble Direct implant it is hard to find a surgeon in the U.S. who is using this product line. The Nobel Replace line is commonly used and does not have the data issues that the Noble Direct line currently has. By the way I am a salesperson for one of Nobel's competitors listed above and I wouldn't be worried about a Noble Replace implant in my parents mouth. I might get mad at my parents for not giving me a call...

SG, above the gentleman listed the top 4 companies in market share not in recent research studies on a product that you want placed in your mouth. We are currently watching the downfall of the top 2 companies in this industry. Greed is very obvious with NB but what some don't know is that Straumann is following closely. Maybe not with the failure rate of NB but as a company. If you are a Straumann customer you already know that your discount has been cut, had a lack of education support this year, and a lack of rep support. Lack of pros versatility...when is that zirconia abutment coming out again?? Maybe 2009. 3i has what, upset reps with platform switching with no scientific research "just to differenciate" like Jerry said above. These are examples of the vicious cycle of a large company spirialing down. The kind unknown Rep above says to be confident in the top 4 companies. Because why?? They have been around awhile. These top four companies are not under the same management as they were when they were in thier prime with well researched new products. Try something new and researched like an Astra or Thommen Medical. More so Thommen, a better implant all around with excellent prosthetics. Look them up. They have the SPI Direct which is an execellent replacement for the Nobel direct which started this whole blog for the small percent that need a direct type implant.

Jerry, Here are several articles that discuss Platform Switching. How do you explain these results. This is what you wanted, correct. PLEASE HELP ME UNDERSTAND Medialized Seating Surface/Platform Switching™: 1. Chiche F. Espace Biologique Implantaire Et Esthétique. Le Concept De Platform Switching. Hors-Série Esthétique 2005;May (France). 2. Gardner DM. Platform Switching As A Means To Achieving Implant Esthetics. NY State Dent J 2005;71:34-7. 4. Baumgarten H, Cocchetto R, Testori T, Meltzer A, Porter S. A New Implant Design For Crestal Bone Preservation: Initial Observations And Case Report. Pract Proced Aesthet Dent 2005;17:735-740. IT IS COMMON FOR TWO PIECE IMPLANTS SYSTEMS TO HAVE BONE LOSS 2-3MM FROM THE CONNECTION POINT. WOULD YOU AGGREE THAT MOST OF THESE IMPLANTS ARE PLACED CRESTALY/SUBCRESTAL? SO, IF PLATFORM SWITCHING IS SHOWN TO PREVENT THIS BONE LOSS OR AT THE VERY LEAST MINIMIZE IT, WHY ARE YOU SO AGAINST IT. DID YOU REALLY INCORPORATE IT INTO TWO OF YOUR IMPLANT SIZES JUST TO APPEASE OTHERS? PLEASE GIVE ME YOUR EXPERT OPINION. DAVE ANDREWS D.D.S FALLS CHURCH, VA

Dave...I am happy to try to answer your questions. First, although I have not read these articles, I doubt they prove anything. From the title I can imagine that Chiche's article is talking about the "concept of Platform switching" maybe from an esthetic standpoint as that is his interest. I doubt that he or any of the other authors are reporting side-by-side comparisons of implants with and without platform switching and measuring differences in bone losses. Correct me if I am wrong. The Gardner article is also talking about esthetics rather than bone loss. There are certainly tens of thousands of esthetic cases done on implants without platform switching. The third article includes authors like Meltzer and Porter, both paid consultants/speakers for 3i. Last year I heard Meltzer talk about Platform switching in a lecture in Germany for the EAO. Once you get paid to lecture by a company, you can forget being objective. Contrary to your statement, it is not common for two-piece implants to lose 2-3mm from the connection point. That may have been the case with poorly fitting Branemark External hex implants, but many two-piece implants now claim little if any bone loss includes BioHorizons and Astra both based on selected cases. The real cause of bone loss has to do with how thick the labial plat of bone is at the time of implant placement. It was proven in the VA study that with 2mm of labial plate, the implant did not lose any bone. Straumann with its junction moved 2mm above the crest of bone, will lose bone as predictably as any two-piece implant if the labial plate is thin. You do not hear Straumann marketing on no bone loss... only on faster healing with SLA. You hear Astra marketing on no bone loss because of their micro threads... but I have posted x-rays on my web showing bone loss with Astra. YES I REALLY INCLUDED MICROTHREADS AND PLATFORM SWITCHING BECAUSE I RESPECT ALL IMPLANT RELIGIONS AND HOPE THAT THEY WILL COME TO MY CHURCH/SYNAGOGUE/MOSQUE AND LEAVE A NICE DONATION. I also include things in my implant system that are really important for clinical success, like prosthetic and surgical options, precision fit two-piece implants, 3 different one-piece implants, all-in-one packaging, and low prices.... the Spin stops here, as Bill Riley says.

Jerry, Please read the articles before you pass judgement. BTW to THROW AWAY MELTZER AND PORTER ARTICLE BECAUSE THEY OFTEN SPEAK FOR 3I IS PRETTY IRONIC. LIKE MY MOTHER ONCE TOLD ME 'PEOPLE WHO LIVE IN GLASS HOUSE SHOULD NOT THROW STONES". I HAVE NOT SEEN LITERATURE THAT SHOWS MICRO THREADS PREVENTS BONE LOSS. YES, I AGREEE IT DOES INCREASES SURFACE AREA AND THEREFORE BIC...BUT THAT IN ITSELF DOES NOT SUSTAIN BONE LEVELS. PLATFORM SWITCHING DOES SHOW LESS CRESTAL BONE REMODELING. THIS IS PROVEN TIME AND TIME AGAIN. IF YOU READ THE ARTICLES AND CASE STUDIES YOU WILL FIND THAT JUST BECUASE YOU PLATFORM SWITCH, IT DOES NOT INSURE THE BONE LOSS FROM HAPPENING. YOU NEED 3MM OF REQUIRED TISSUE DEPTH. WHICH IS BROKEN DOWN BY ATLEAST 1MM OF SULCUS AND THE REMAINING 2MM IS BIOLOGIC WIDTH (1MM EPITHELIAL ATTACHMENT 1MM OF CONNECTIVE TISSUE ATTACHMENT) WITH OUT THIS YOU WILL NOT GET THE SAME RESULTS. YOU STATE THAT SINCE SOME OF THOSE ARTICLES ARE DISCUSSING ESTHETICS IT DOESN'T APPLY TO BONE LOSS. I KNOW YOU REALIZE THAT IF YOU ARE ABLE TO PRESERVE CRESTAL BONE YOU WILL THEN BE ABLE TO PRESERVE TISSUE (PAPILAE) THERE IS A CORRELATION, WHY DO YOU SO EASILY OVERLOOK IT? PUT A STANDARD TWO PIECE IMPLANT THAT HAS MATCHING COMPONENTS NEXT TO A PLATFORM SWITCHED ONE AND THERE IS A DIFFERENCE. THRE REASON WEE SEE LESS BONE LOSS AROUND ASTRA HAS EVERYTHING TO DO WITH ITS MEDIALIZED CONNECTION AND NOT THE MICRO THREADS OR FLOURIDE THAT THEY STATE.

JERRY, CONTRARY TO WHAT YOU SAY THERE IS BONE LOSS AROUND EX AND INTERNAL HEX IMPLANTS THAT REPRESENT 2-3MM. THIS IS COMMON AND ACCEPTED. I SEE PLENTY OF 3I, NOBEL AND ZIMMER IMPLANTS THAT SHOW THIS. THIS IS ACCEPTABLE TO ALL IN THE INDUSTRY AS NORMAL. NOW HAVE I SEEN SOME THAT SHOW NONE, YES. BUT FROM THE LITERATURE I READ THIS IS ACCEPTABLE BONE LOSS, ATLEAST UP TILL NOW. WITH 3I PREVAIL, ASTRA AND AYNKLOS AVAIL WE NO LONGER HAVE TO ACCEPT SO MUCH BONE LOSS AND WE CAN NOW HAVE MORE PREDICTABLE RESULTS. REMEMBER "TISSUE IS THE ISSUE BUT BONE SETS THE TONE" BTW HOW OFTEN IN THE ANTERIOR MAX DO YOU HAVE 2MM OF LABIAL BONE AFTER PLACING THE IMPLANT.

Dave...you are spouting 3i's marketing claims as if they were proven facts so you must be an employee of theirs or just auditioning to be one of their paid opinion leaders. 3i is notorious for making claims about bone attachment to Osseotite while referred to studies of blasted implants. I am making no claims - just observations and expressing my opinion based on 25 years of experience in the implant industry (+ 10 years of placing implants before 1982 Core-Vent). Although I obviously have a financial interest, I can be objective because I can make any design I want but would never consider making a copy of the Prevail. I do end up with a platform switching interface on my RePlus implants but that was because I widened the implant body (not neck) for greater strength while still offering the tri-lobe platform compatible with Nobel Abutments. I added this option for the reason I stated, and saw that it also provided those who believe in platform switching, an option that is less radical than the Prevail design. This does not stop me from questioning the efficacy of platform switching, especially in the 3i design where there is a much wider neck than the body of the implant. Therein lies my objectivity compared to someone who gets paid for making "scientific claims" on anecdotal information. I don't need to read the articles to know that 3i would never do a side-by-side, blind, peer reviewed study of different design implants, as I did with 3000 implants in the VA study. Therefore, there can be no serious claims of reduced bone loss compared to any other design. I did not say that internal hex implants did not lose bone - the VA studies, published in peer reviewed Journals including JofPerio and OS Journal, showed bone loss if the labial plate was less than 2mm thick. External hex implants were notorious for losing bone to the first thread, due in part because of the wider neck of the implant concentrated stress at the crest... very similar to the wider neck design of the "Prevail" platform switching 3i implant. The external hex Branemark Implants also had an unstable connection - 6.7degrees of wobble per Binon compared to 1.4 for internal connection. This was eliminated altogether with my development of friction-fit abutments, and more recently, with the development of precision manufacturing procedures that result in less than 0.5degrees of rotational wobble without friction fit connections. The flexing of the fixation screw and rotational instability of the external hex connection of the Branemark implant has been recognized as a contributing factor to crestal bone loss because of leakage in and out of the internal shaft of the Branemark external hex implants. Platform switching is an attempt to solve this problem... but the internal connection, with its more stable interface, has already eliminated this cause of crestal bone loss, and at the same time, allowed the implant to have a narrower neck, eliminating the stress concentrations in the crestal area induced by the wide neck of the Branemark Implant. This undesirable feature has apparently now incorporated into the 3i Prevail Platform Switching implant. I think that any dentist now using the Prevail implant, will soon be more interested in implant switching than platform switching.

Jerry, I am a dentist and i use several systems in my office due to the specialists i use. You don't address my points above and you keep referring to a 1990 study. Read the Articles Jerry, they are relevant. My implant rep told me the Prevail implant is based on their XP implant design which has been around for over 6 years, so what are you going to say now. Keep referring to stuff back in 1990. APPLES TO ORAGES JERRY. BTW show me the studies that micro threads work???? but you incorporate that. Your opinion is becoming less relevant because you are so blinded by your ego. Let it go, MAN. ITS OVER. Address my points or stop replying. I like Astra to, should i speak for them. Not everyone has a financial interest in what we say, unlike you. We about patients. LOOK AT THE STDUIES JERRY after all you asked me to reference them. Poor fitting abutments are a thing of the past, quit referencing items that are no longer an issue. So, tell me Jerry...You don't get bone loss around your implants of 2 mm. I am talking about when there is less then 2mm of labial bone?

Famous last words...."my implant rep told me..." I am targeting a niche segment of the market of discerning dentists. If you want to rely on what your 3i rep told you, assuming that you are not a 3i rep yourself (no last name), then you do not fit into my target market. Let me give you something that you can really understand: $536 vs. $150 for implant, abutment, healing collar and transfer. It is no wonder your 3i rep needs to tell you a story about bone loss, platform switching, Osseotite surface, an abutment that clicks and studies from paid opinion leaders.

Jerry, How can you compare your implants to the larger implant companies or suggest that your implants are clones? After viewing your not so informative website, it seems as though you did what you did to simply skate around patents and claim to have developed a better implant. Every post you answer here you revert back to your system and how it's so much better.....Give me a break Jerry. You have now lowered yourself and standards to become no better than the implant companies you used to slam. I will admit that you "DID" develope a fantastic implant system. But, you did sell it to Zimmer along with the patents which is why your current implants will never be remotely close to Zimmer, Nobel or Strauman. Good thing for patents...... Ps......Ever thought of selling implants on Ebay?

Nice thing about patents.... they expire and in many instances, a knowledgeable person can design around them. It is a little ludicrous to compliment me on the "fantastic implant system" I developed and sold to Zimmer and then to think that I haven't had any new ideas. In fact, I have filed 8 new patents in the last 3 years. The ScrewPlant is the next generation of the Tapered ScrewVent and the ScrewPlus is the next generation of the SwissPlus both very popular implants for Zimmer. The ScrewPlus is much better than Straumann's as anyone can see comparing feature by feature on my web. As for Nobel, my RePlant and RePlus implants with compatible tri-lobe connections offer many advantages to Nobel's Tapered Replace, including strength, micro-threads, self-tapping insertion etc..and if that doesn't convince a doctor, consider that if he bought 200 implants and abutments from me instead of Nobel, he would have enough money saved to buy a new Mercedes every year. In any case I see that you do not even post your first name any more...tell us, are you a Zimmer rep or a 3i rep. I guess my 65% discount and better products are making you a little nervous. If you were really a dentist you would be far more respectful for my pioneering contributions to this field, and thrilled to see me back causing a price point shift in the implant industry. Nobel has given away about $15M this year alone to buy influence at universities... where do you think they got that excess cash? If you want to debate, then why don't you come out of the closet and admit you work for one of the ocmpanies. Then I will tell you what I really thing of your products and prices. Otherwise this forumn is not for you. As for selling on Ebay, I would have no problem with that, although I think we have a much better shopping cart system, including ordering by charting cases with inventory control and team communications.

Jerry, The post above was not mine, so pick on someone else. My last response I asked several questions which you failed to address. Why not try answering them instead of blabbering about your inventions. ANSWER THE QUESTIONS IF YOU ARE REALLY TRYING TO HELP!! and here is another one. Since your parts are so cheap do you advise on passing those saiving to the customer?? You see JERRY, in my practise I bill for chairtime, my hard costs are then charged to the patient. So, I don't mind paying what the implant companies charge becuase that cost is a pass thru. As long as i am making my chair time number. As for using your knock off system just to save money, no thanks. Your point about having enough money to buy a mercedes every year is funny and sad. I wonder what all of our patients would think of your points!! You are greedy and think way to much of yourself. Take your money and run you are making as ass out of yourself.

As to your question: LOOK AT THE STDUIES JERRY after all you asked me to reference them. I would say to you: LOOK AT THE JOURNALS DAVE 1. Biologique Implantaire Et Esthétique. 2. NY State Dent J 2005;71:34-7. 3. Pract Proced Aesthet Dent 2005;17:735-740 None of these are serious peer reviewed sicentific Journals like Clinical Oral Implant Research, JOMS, JP, JOMI, JPD. If you think your patients don't care about saving money, then nothing I say will make any sense to you. I don't care if you use the savings to buy a car or pass it on. In either case you would be doing them a favor if you never used a 3i product again. Surface is too smooth, walls are too thin, they don't index their abutments to the flat of the hex so you end up needed custom abutments when you could have used a stock abutment, and the Prevail Implant looks like a tomato on a stick. First 3i promoted the concept of emergence profile...now it is the opposite.. platform switching with a wide top. As I said, my target market is discerning dentists who are looking for high quality innovative products at reasonable prices... I think that leaves you out because you do not care what it cost your patients or yourself, and you are certainly not discerning if you rely on what a 3i rep tells you about research.

Dr. Niznick you are the Implant Direct rep so why should we rely on what you tell us about research? You have an economic motivation just as the 3i rep does. You are arguing from a commodity based marketing viewpoint while others disagree and argue from a value added stand point. Is it of value to decrease healing times for restorative options when one can not do immediate load? You argue no. But then your not selling the solution to the patient who doesn't want to wear a flipper for an extra two months or a Referring Doctor who wants to place the crown as soon as possible. I think most people understand that you want to provide a commodity option from a price point view and that you have bias along with your knowledge, creativity and experience in the dental implant world.

Hi, I hope this is the right forum to ask. I'm a patient with missing #10. I'm considering an implant. My dentist recommends the guy who offers 3i implants. In your opinion, would this be a good choice or should I look for something else?

Unfortunately many journals that publish implant-related 'research' are absolutely not worth the paper they're printed on. It shames me to say that most of these journals appear to be American in origin and are kept afloat by the industry. Much 'research' that some people here keep referring to is an absolute load of rubbish (including a lot of the peer-reviewed stuff) and is designed with the desired results already in mind. Some would say that some research is better than no resarch, however the Thalidomide and Vioxx victims of such bent research would likely disagree as would those people who paid for those disastrous Straumann implants of yesteryear. We need to be a lot more cynical about what many journals/implant companies and implant reps tell us. If someone's making claims that sound too good to be true, then they probably are too good to be true. Rant over and no offence intended to any of you researchers!

I am a surgeon in New York. here are my comments..Dr. Hahn gave some good comments above. However, here's the state of Implant Dentistry: Implant dentistry is not about drilling a hole and getting an implant to integrate. Given certain tried and true implant systems, we can get them to integrate. Failures come about by early or late bone loss, poor site development, esthetic and prosthodontic failure. In my opinion, GP's may be capable of placing implants in sites that require little or no site development. Can a GP go to the OR if needed and harvest iliac crest bone? There are some instances when this is needed. If they harvest a lateral mandibular graft and they have a mandibular fracture or the graft dehisces, can they treat these complications? We will see more and more cavalier treatment of patients as time goes on. It's hard enough to expertly restore implants in a variety of situations let alone start doing the surgeries. There are many "wannabe" oral surgeons. So what. Excellent care and being careful not to under or overtreat is crucial. I just came back from the Chicago AAOMS Dental Implant Meeting. If the GP's who place implants attended this meeting, they would have a better appreciation for what it takes to be well trained and why doing a 4 year oral surgery residency has NO substitute. There are GP's that do conservative cases and do them well. There is however a trend for folks to do implant surgery with inadaquate surgical skills, didactic knowledge and experience. And by the way, Dr. Niznick is running a business,yes, but trying to provide quality products as prices that keep implant dentistry available for patients that otherwise could not afford them..additionally, the prices for implants to purchase is getting exhorbitant. Additionally, not every case requires cone beam scanning as these companies are trying to tell you. I firmly believe cone beam scanners belong in a hospital setting without radiologist readings (read by the implant surgeon),and formatted for manipulative software for planning and surgcial guide construction when needed (surgical guides are almost always needed as weel as waxups for occlusion) but cone beam generated guides are not always needed. Doc

Seems many are bashing Nobel but as a young practitioner I respect those who have the experience. I recently spoke to a prosthodontist from South Jersey who has placed AND restored over 10,000 implants. He switched from Zimmer to Nobel and is quite happy with his results. I plan on buying Nobel's system because I also believe it to be a quality product.

I think that a Nobel Direct implant is just a Replace implant whith an attached abutment. I cannot understand how could develop more problems that a implant and a healing abutment. Perhaps oclussion factors?. Perhaps excessive heat meanwhile preparation?

RESPONSE TO: Dr. Niznick you are the Implant Direct rep so why should we rely on what you tell us about research? ANSWER: I am not generating studies or articles to support the sale of my products... I only pointed out that the articles you cited are anecdotal, written by company funded lecturers and published in non-peer reviewed journals. RESPONSE TO: You are arguing from a commodity based marketing viewpoint while others disagree and argue from a value added stand point. Is it of value to decrease healing times for restorative options when one can not do immediate load? You argue no. But then your not selling the solution to the patient who doesn't want to wear a flipper for an extra two months or a Referring Doctor who wants to place the crown as soon as possible. ANSWER: Companies like 3i argue that their value added feature is platform switching reducing bone loss, but there is no credible research to back that up, so what value are they adding for their $300+ implant. I offer platform switching options as well but I don't tell you that it will provide any benefits. Companies like Straumann claim that using their new surface SLActive will shorten healing time but again they can not prove this to justify the extra $50 they charge. As for my not offering the solution to shortenning healing time, the fact is that in type 1 and 2 bone quality, where initial torque of 35Ncm can routinely be achieved with any screw implant, a dentist can do immediate provisional load and eliminate the flipper right away. In type 4 bone it can not be achieved with any implant design and full healing period should be observed. Where my products offer an advantage in shortening the time to loading, over companies like Straumann, is in type 3 bone where the soft bone surgical protocol of inserting a tapered implant into an undersized socket prepared with a straight drill, may allow achievement of the required initial stability (35Ncm)for immediate load, whereas a Straumann implant will be hoping that with its SLA surface it can be loaded in 4-6 weeks - So I offer a solution that beats that time and it is available for 74% less than Straumann. RESPONSE TO: I think most people understand that you want to provide a commodity option from a price point view and that you have bias along with your knowledge, creativity and experience in the dental implant world. ANSWER: Good - then I am getting my message through, but I am offering, along with low prices, the highest quality, most innovative implants in the industry, with alll-in-on packaging for ease of ordering and convenience of use. I am betting on the intelligence of dental professionals to see through the BS of the high priced implant companies, their paid opinion leaders and sales people who just repeat what the company line is to sell their products at a high price. FROM A NEW IMPLANT DENTIST Response to: I recently spoke to a prosthodontist from South Jersey who has placed AND restored over 10,000 implants. He switched from Zimmer to Nobel and is quite happy with his results. I know who you are talking about and he switched because Nobel gave him hundreds of thousands of dollars to build his implant training center and Zimmer refused to give him that money. He gets about a 40% discount which you will not get as a new user. High Prices and endorsements from paid opinion leaders are not good reasons to chose a system. Implant Direct makes an implant called the RePlant, a surgically and prosthetically compatible implant to Nobel Replace Implant and sells it for 1/3rd the price. We make it out of alloy rather than CP titanium that Nobel has to use because TiUnite does not bond to alloy (their HA coated implant uses alloy.) Even using the stronger material, this design is subject to breakage because the cross-section of the tri-lobe is greater than an internal hex, leaving the walls of the 3.5mmD and 4.3mmD implants very thin. I have made another implant with the Tri-Lobe connection called the RePlus, using the 3.7mmD and 4.7mmD body design of the other Spectra-System implants I make, thus increasing the wall thickness by 44% and 66% respectively.

As for Nobel Bashing, the Swedish Medical Products Agency just came out with its final report on the bone loss associated with the NobelDirect and NobelPerfect implants. It will be posted on Monday under the Controversies section of my web site www.implantdirect.com While they did not ask for a recall of the product, they were very critical of Nobel's marketing claims and required that Nobel provide adequate warnings on the labeling of these products. No need to do Nobel Bashing when the Swedish Medical Products Agency is doing for the industry.

Jerry Niznick would make a good car salesman.

Comment from some no-name posting: Jerry Niznick would make a good car salesman. Response: It is always interesting to post a blog and then try to figure out which implant company's salesman got his feathers ruffled and responds with a cheap shot. Nothing wrong with a car salesman, especially if he is good. The same goes for an implant manufacturer, as long as he makes a high quality product that meets the needs of dental profiessionals at a price that leave the competitors only throwing spitballs like this Nobel salesperson.

hi jerry, can i ask roughly when your implants will receive ce approval and you will sell to the uk.thanks.

Dr. Niznick, 1. I did not list any articles, and you may be projecting your own bias on to the research of others. Not all researchers sell an answer to the highest bidder. Most report exactly what they find, and most people can determine if a study was designed well to provide useful information. 2. You then declare that your tapered implant is better than a Straumann implant in class 3 bone. Where is the proof? Are we to take your word for it? Will your next response have clear research comparing your tapered implant to the Straumann TE or will it be more of the same. My understanding of SLA is 6-8 weeks healing in good bone without a torque requirement of 35newtons at placement. No backing the implant up to get the tri-lob in the right place or going deeper than intended to reach the 35newton requirement. But again, where is the evidence, and it must include the hybrid design from Straumann and not just tapered vs. conical? Otherwise you are just delivering a marketing message. You always fall back to an immediate load conversation as if 95% of cases are candidates for immediates. But given that you do not intend to spend money educating the marketplace how will you change the reality where a vast majority of cases are delayed. 3. In your final post you again make points about another companies design weakness stating what appear to be facts. Where is the research? And even if you did the research haven't you allready stated that all company research is bought and paid for to come to the desired conclusion. So even if you did research with claims of failure due to wall thickness how do you differentiate yourself from the New York dentist who you hammered. You constantly deliver your opinions as if they are undisputed facts. In most instances they are just your opinions. When you try to quote a fact you undermine your own arguement by calling all company sponsored research garbage. Which is it? Good factual research on immediates or company marketing information dressed up as research? You can't have it both ways. As for something being cheaper, that is not the first thought that comes to my mind when I think of implantable devices.

I'm amazed Nobel have got off with barely a slap on the wrist. I remember when NobelDirect was launched it was billed as the answer for new GP surgeons - flapless surgery, single stage, so easy even a four year old could do it. Now they're being told they have to change this to recommend its use only in experienced hands. Now they're telling us that "groovy" implants are better based on one rabbit study. When will that shoe drop? I refuse to to any further business with Nobel until the science backs the claims.

QUESTION FROM mpWILLIAMS: jerry, can i ask roughly when your implants will receive ce approval and you will sell to the uk.thanks. ANSWER: We passed our iso audit and should have ce approval by January.

NIZNICK'S RESPONSE TO ANOTHER NO NAME POSTING STATEMENT: Not all researchers sell an answer to the highest bidder. Most report exactly what they find, and most people can determine if a study was designed well to provide useful information. NIZNICK RESPONSE: I GUESS THAT IS YOUR OPPINION OR DO YOU HAVE RESEARCH TO BACK UP YOUR CLAIMS ABOUT RESEARCH? STATEMENT: You then declare that your tapered implant is better than a Straumann implant in class 3 bone. Where is the proof? Are we to take your word for it? NIZNICK RESPONSE: YOU DO NOT HAVE TO TAKE MY WORD. THE RESEARCH SHOWS THAT INSERTING A TAPERED IMPLANT INTO AN UNDERSIZED SOCKET IN SOFT BONE RESULTS IN INCREASED INITIAL TORQUE, INCREASED REMOVAL TORQUE AND INCREASED % OF BONE CONTACT. THIS WAS PROVEN IN AN ARTICLE BY SHALABI COIR MAY 2006. If an implant can gain increased initial stability in soft bone, to achieve 35Ncm then it can be loaded immediately. Even if it is not loaded because it falls short of this target, the increased initial stability and bone attachment translates into the same type of claims Straumann is making with its SLActive surface. (this article has been reprinted in on www.implantdirect.com > about us > libary. STATEMENT: My understanding of SLA is 6-8 weeks healing in good bone without a torque requirement of 35newtons at placement. NIZNNICK RESPONSE: NOTHING UNUSUAL HERE...YOU CAN DO THAT WITH ANY ROUGH SURFACE...EVEN A SMOOTH ONE LIKE OSSEOTITE HAS DEMONSTRATED SUCCESS AT 6 WEEKS LOADING. STATEMENT: You always fall back to an immediate load conversation as if 95% of cases are candidates for immediates. NIZNICK RESPONSE: :YOU MISS THE POINT... IF AN IMPLANT CAN BE IMMEDIATELY LOADED AND BE SUCCESSFUL, THEN IT CAN LOADED IN 6 WEEKS AND ALSO BE SUCCESSFUL. THE CONVERSE IS NOT ALWAYS TRUE. QUESTION: But given that you do not intend to spend money educating the marketplace how will you change the reality where a vast majority of cases are delayed? NIZNICK ANSWER: AGAIN YOU MISS THE POINT. I DON'T CARE IF THE IMPLANT IS LOADED IMMEDIATELY OR IN 4 MONTHS...BUT IF THE ARGUMENT IS ABOUT WHAT SURFACE OR BODY DESIGN OR SURGICAL PROTOCOL CAN BE LOAD EARLIEST, THEN THE IMPLANT THAT CAN BE LOADED IMMEDIATELY IN SOFT BONE MUST WIN, AND NEITHER NOBEL OR STRAUMANN ARE MAKING THAT CLAIM. QUESTION: In your final post you again make points about another companies design weakness stating what appear to be facts. Where is the research? ANSWER: ALL I DID WAS SIGHT THE SWEDISH PRODUCT AGENCY'S REPORT WHICH REPROTED ON STUDIES BRINGING INTO QUESTION NOBEL'S STUDIES AND CERTAINLY THEIR CLAIMS. WHERE INDEED IS THE RESEARCH TO SUPPORT NOBEL'S CLAIMS ABOUT ITS NOBEL DIRECT AND NOBEL PERFECT IMPLANTS. QUESTION: You constantly deliver your opinions as if they are undisputed facts. In most instances they are just your opinions. When you try to quote a fact you undermine your own argument by calling all company sponsored research garbage. Which is it? Good factual research on immediates or company marketing information dressed up as research? You can't have it both ways. ANSWER: YOUR LOGIC ESCAPES ME. YES I AM EXPRESSING MY OPPINION FOR WHATEVER WEIGHT THAT CARRIES. NO I AM NOT SAYING THAT ALL RESEARCH IS GARBAGE BUT AS FAR AS I CAN SEE, THE RESEARCH SPONSORED BY THE IMPLANT COMPANIES SERVES PRIMARILY TO CREATE MARKETING MATERIALS AND PROVE VERY LITTLE WITH REGARD TO REAL CLINICAL ADVANTAGES. QUESTION: As for something being cheaper, that is not the first thought that comes to my mind when I think of implantable devices. ANSWER: NOR SHOULD IT BE. I ASKED A DOCTOR WHY HE SWITCHED TO MY NEW SYSTEM AND HE LISTED 5 REASONS IN DECENDING ORDER OF IMPORTANCE. I am currently using both Astra and Nobel Biocare Replace Select. The majority of implants I have placed in the last two years have been Astra. The decision factors I used in my decision to make the switch are (in order of importance): 1) Quality of manufacturing (based upon your historical record), 2) Internal hex connection (I have not really liked the tri-lobe connection of Replace Select nor the butt joint type of connection fit of the analog), 3) Cost of implants and abutments, 4) Simplicity of design in the abutment/impression post (simplicity tends to be overlooked – thanks for the innovation), 5) Ease of ordering (i.e., online ordering with live support if needed). You’re right that your new system will be difficult for major companies to deal with, not only with price but also with the simplicity of abutment design. Included a fixture mount that can be the impression post and direct abutment is outstanding. If you were a public company, I’d certainly buy stock.

what kind of abutment to implant connection is there on your implant, is it a conus type like astra?

The RePlant and RePlus implants from Implant Direct have a flat top with a tri-lobe connection that is compatible with Nobel's abutments. The ScrewPlant and ScrewPlus have an external bevel and the Legacy has an internal bevel. We are achieving precision fits with less than 1/2 degree of rotation which means that you can not even fell rotational movement between the parts. I think the connection with the external bevel offers the greatest strength, stability and prosthetic versitility.

thanks dr niznick, i am concerned about screw lossening and bacteria leakage at the ia interface. also astra has a long cone type connector to move loads down the implant. thanks for any information.

Two peices of metal can only make contact at 3 points at a time. There is no magic to a conical connection vs a beveled connection vs a butt joint connection with regard to achieving a sealed margin. Microleakage comes from an unstable connection and the connical conection of Astra or Straumann are no different than an internal hex or tri-lobe connection in that they all are capable of achieving good stability, depending on how close the machining tollerances are. I make a tri-lobe butt joint, an internal and an external bevels with hex connecitions and all of them are machined to tollerances that achieve less than 1/2 degree of rotational wobble. This is in contrast to the external hex Branemark Implant which was documented in a Binon article to have 6.7 degrees of wobble. With an external hex, the fixation screw takes the stress and when you couple that with a sloppy fit, you get micro-leakage. Any of the common internal connections on the market can eliminate any clinical significant problem if their tollerances are good. Companies like Astra were more stable than Nobel and therefore used this as a marketing claim but this advantage it does not apply to other internal connections which are just as stable. The problem with Astra's connection is that you can not use the internal double hex for screwing the implant into the bone because it is too close to being a circle. Don't fall into a company's marketing claims.

The last posting was mine although my name did not register

I stumbled across this site while trying to do some research. My wife went yesterday to have her permenant crown installed on her implant (no we don't know the brand, as lowly laypersons we were never made aware of the fact that there are different brands). During the procedure, she was told "the screw broke and they can't get it out, so it looks like she may have to start all over again" Wow, I wonder who gets to pay for that? I felt that I needed to respond to this site since I have learned a great deal about the dental implant business. Thanks to the couple of posters that actually sounded like there may still be some concern for the patient and not just the bottom line.