One Piece Dental Implants: What’s Your Experience?

One piece implants will not succeed. They will be a niche market for those doctors that do not understand that implant dentistry does not have to be 'dentistry'. It is a far better service to patients and doctors to take fixture level impressions and do eveything out of the mouth. Why would you prepare titanium in the mouth if you don't have to? Besides, the interface is not the problem. It is the motion of the interface that is the problem. And the better systems have overcome that. Think like a machinist, not like a dentist.

I can not think about how to get the angle correct so I do not have to over prep the implant and I am concerned about the heat......But many are successful

This implant design, such as the NobelBiocare NobelDirect, is very useful in sites with limited interdental dimension. The typical site is the maxillary laterals. Two piece narrow implants were used before one piece implants were available, but the inherent weakened walls of the two-piece narrow implants presents a structural problem. I have seem two two-piece narrow implants fractured. My restorative team has not have particular problems with this design; but of course angulation, depth, and placement position are critical factors that need to be controlled well.

Two good postings. Thanks to Jeffrey Hoos for angled comments. If we encounter a space so small that a one-piece implant is required, then it is imperative that the surgeon place the implant so that no angled abutment is needed...EVER. If a house built on a hill collapses because the pilings were not engineered correctly, the fault lies with the person placing the pilings. It's not the fault of the house or the slope. So it is with implants. Because something works does not validate the belief that it should always be used in similar situations. Furthermore, there is some evidence that the bony response to a one-piece implant is not the panacea that we might think. We must keep open minds. The 'theory' of biologic width is being called into question also. We have assumed that implants respond like teeth, when in fact, that may or may not be the case. Time will tell. I direct your thought processes to the Strauman model vs. the Astra model, vs. the 3i 'platform switching' model. There are still teeth in my practice that cannot be successfully restored with anything BUT amalgam.

Those implant designs, such as the NobelBiocare NobelDirect are under question right now by two professors from Gothenburg University, Nobel don't accept that claim as they publish in their home page, but seems convenient to wait and see. To preserve crestal bone avoiding the micro gap, 'platform switching' concept, seems more promising, and allow to use a broad range of prosthesis options to the patient...

I agree with you Mark on your first comment. The one-piece may sound like a great idea in theory, however, there are problems such as those noted in other posts. In addition to those issues, one of the particular one piece implants noted above has also been experiencing greater than normal bone loss in certain cases and is currently under investigation. Do your research, gang.

We should open a thread about implant fixtures and 3i's concept of the set back abutment. The biological width comment has real merrit because of the lack of bone loss seen with implants that the abutment is "back" from the edge of the implant and the microgap is not a problem. I have a case in which I used the "wrong" abutments because of a time factor with every intention of replacing them at a later date......no bone loss down to the first thread. Now we see what 3i is promoting a "step" back abutment. The one piece concept may make no sense at all if the implant systems, Astra, ITI, Bicon, and others have a "transmucosal" abutment...an old name that shows no bone loss. Sorry for the long post. I am a Nobel fan and teach their system but just because a manufacturer promotes something does not make it good for private practice. Happy New Year to all....

I would just like to point out that although 3i is takeing credit for "accidentally discovering" Platform Switching in 1991, it has been an intentional design feature of the Bicon System since 1985. It has been referred to as Sensible Biological Width. If you were to look at the trends of the changes in the implant designs over the past 30 years or so, you might be suprised that Bicon has been a pioneer in many design features that others later took credit for or later quitely adopted. The designer of the Bicon system and its predecessors, Tom Driskell, was and still is a brilliant engineer in the field of implant dentistry and bone regeneration. It is a shame that he may not receve the recognition that, in my opinion, he truly deserves. (I am a Bicon and Astra customer with no financial interest in either of the companies)

Having a non segmented implant such as a Nobel Direct very well may be putting the bone to implant interface at risk. Even more so with a high strength ceramo ceramic restoration.

Some of the implant manufacturers are now simulating Bicon's design with abutments narrower than the implant fixture platform. Platform switching has become one of the new recommendations for reducing bone loss. Nobel Biocare has two new one-piece implant designs that are not marketed yet and encorporate the Bicon style of narrowed platform neck. What is the experience with Bicon?

Well, I think the one-piece dentla implant is useful when indicated, and when we are able to get over 35 N toruqe, and we are able to prevent lateral movements, and when there are no angulation problems, the biggest advantage of this system is to preserve the dental papila using the flapless surgery, as almost no gengival retraction is noticed and eliminating the micro gap which have been proven to be a nice place for bacteria to grow, plus no edema pain and reducing the work time are of big benifit to patient as well as dentist. I have been using the system for about three years now, and I am quite satisfied with it. Should the dentist choose cases carefully and decide best system to be used.

has anyone seen the NobelBiocare designs that copy Bicon?

A one piece design requires immediate tempoization and no matter how much out ofocclusion you make it, there is still too much risk of micro movement. Does not the literature show greater risk?

Think like a mechanic.... that is the most ridiculous thing I have ever heard..... in implantology you better think like a scientist, dentist and engineer and combine proper and true knowledge and not manufacturer driven crap.WE REALLY DO NEED TO MAKE IMPLANTOLOGY A SPECIALTY.

I agree with that last comment, I have been using 1 piece implants for 10 years... actually I have helped develope the one I use, we are in its 3rd generation and when used in the appropriate bone densityand case selection they ARE SUPERB.But you cannot blanket 1 piece immediate function we need both 2 piece and 1 piece.... whenyou truly understand the parameters of the 1 peice concept they are as successful and have no more morbidity than our successful classical 2 piece....and that is the truth. One of the best courses and articles written on this topic are by Dr. Bill Locante.

Thank you whoever wrote that 'thinking like a mechanic' was the most ridiculous thing he or she had ever heard. If that is truly the most ridiculous, then you need to get out more. My comments are based on my lecturing for a major implant company for six years and seeing the angst that many dentists have about torquing abutments and implants in general. Perhaps your further elaboration on thinking like a dentist, scientist, engineer is well stated. However, I think you got my drift. Implants will never, in my opinion, be a specialty...nor should it be. I don't see that 'cosmetic dentistry' has gone too far in becoming a recognized 'specialty'. Implants are another tool in the hands of any dentist qualified to restore and/or place them. One of my favorite sayings in life is 'If it's being done, it's probably possible'. The fact is that many of us G.P.s are restoring and placing implants successfully. The last time I checked, Michaelangelo did not have a degree in art history. Your passion, doctor, should be directed at improving the profession and not finding fault with some brief e-mail from a colleague. I wish you all the best in 2006.

If your experience is based on your lecturing for a manufacturer you proved my point, since you are almost compelled to regurgitate what they want you to say so 1, you will be asked to speak again,2, to help sell implants.... free thought usually is no allowed. I have lectured for over 20 years...I base my comments on experience My practice has been limited to implants for a long time. The angst that you speak of comes from all the misinformation that has been propageted over the years mainly from manufacturers. common sense has gone out the window.... Oh and as far as getting out is concerned I have lectured and taught in both hemispheres of this earth.Maybe its you who needs to get out more.

Great conversation here. Let´s try to refrain from ad hominem attacks, and focus on the issues. Thanks.

To do it in only one piece i think is a "dirty" work. To spent a litle less money, but those money is more important, is like the all on four and all on six, it is all about money. Some inovations are good others only sells because you always think like the implants seller. i Think,...

In the case of the bacterias, they live and allways live in implants. There many implants in two pieces that have already more than 20 years in mouth (branemark). Is the gap juntion that important? If we do it in good materials with good impressions and good fit it realy doesn´t matter.

Dear Dr Cardoso, Have you ever read artciles about the micro gap claiming that bacteria in this gap and two stage surgery cause bone resorption up to the level of the first thread of the dental implant? If not I would rather advice you to do so. I do not think any of the threads above have mentioned the low cost(which is not true, as one peice implant is more expensive than conventional implant) as an advantage for one-peice dental implant! Finally, if you have a patient that is not willing to undergo bone graft procedure for what ever reason, would you refuse to provide treatment if you are able to make the same case with all on six or all on four?

Is there any logical reason why NobelBiocare's NobelDirect implant should result in greater than normal bone loss? Doing my best to think like a mechanic and dentist at the same time and my head hurts!

I must admit I drew the ire of at least one dentist when I said we should think like mechanics and not like dentists. My apologies for my passion. Please understand where we have come from and why and where we are today with implant dentistry. No company has bought…or developed…an external hex in years. Nobel purchased Steri-Oss, BioHorizons has introduced an internal hex, Straumann, Astra and the likes have had an internal hex for some time. All these systems, including any of the orthopedic models, are based on the Morse taper, invented by Stephen A. Morse in 1864, who also invented the twist drill. His concept was a taper of 5/8” per foot for easy insertion and removal of machined parts. A web search of orthopedic technology will lead you to many references to the Morse taper and its use in hip replacement surgery. Prof. Branemark was a genius in what he accidentally discovered…the ‘osseointegration’ of titanium and bone. The hex fit was, and still is, an excellent method of placing fixtures into rabbit tibias as well as head bolts in all automobiles. The likening of implant dentistry to machinists is not demeaning…it is in fact a recognition of mechanical principles applied to dentistry that have been in place for quite some time. The external hex implant is dead. May it rest in peace. It has been dead for some time, and declared dead by greater minds than mine for some time. And yet we as dentists continue to use it…albeit less and less world wide each year. Old habits and paradigms are hard to let go of, and so it seems with the restorative platform of dental implants. So when you are deciding on an implant restorative platform to restore, ask yourself as simple question…’I am using an external hexed implant over an internally connected Morse taper/cone fit implant because ________.’

The microgap should not be an issue in the posterior, non-esthetic areas with the availability of segmented systems designed with transmucosal polished collars for one stage protocols (like zimmer's Swiss Plus and Advent).

In situations where eldery patients with an overdenture are no longer able to maintain good oral hygiene, caused by physical or mental retardation, peri-implantitis and pain may occur. In case of a two-piece implant, dismanteling the implants by removing the abutments and superstructure is a simple treatment. A one-piece implant needs a very complicated treatment since it has to be removed completely or reduced to bone level. Besides I do not see any advantages of a one-piece implant exept financial ones.

Dr Miller: you´ve raised a great controversy with your comments. Personally I agree with most of them. Mainly with the "mechanical" one: succes of dental implants is directly related with the application of successful principles of mechanics. Titanium osseointegration discovery has more than 40 years. Future perspectives must be focused on "mechanics" of implantology. For those who were offended with Dr. Miller comments: We agree that dentistry is mainly a science, but it isn´t an art too? doesn´t depends on expertise and personal skills too? do you really think that "mechanics" is not a science too? it is not based on physics, chemistry, etc? it is only empiric?

I had a Branemark implant. it is not vertically implanted, but angled towards one tooth. A normal abutment does not fit. I search web, but could not find information about Branemark angled abutment, how will it be attached to fixture(implant)? Some pictures would be very helpful. If anyone has some information, please help me. Thank you very much.

I'm confused. Does the Bicon implant do away with the bacterial issue around the microgap junction?

One piece implant prooved highly successful as two pieces implant ,my experience with, is the difficuly in placing in anterior areas to get proper esthetic and in case of long span bridge implant supported but by experience can be excellent performed so you have to start work with as I did. Acually you will solve the problems of two pieces implant connection for complete seatings and others. Lastly this is the next generation.

I have been using one-piece implants for about 5 years alongside two-piece implants. IMHO there is a place for both to co-exist without all the controversy. It is all about diagnosis and treatment planning as always. My successful one-piece cases are every bit as successful as my two-piece cases. I do not have 100% success with either one-piece or two-piece. I just know I would hate not to have one-piece systems in my armamentarium for the cases to which they are well suited. For the information of those without any experience of one-piece implants - They all still tend to lose bone back down to the first thread!

Have you tried the Zimmer One-Piece Implants. They have contour integrated abutmnets which vertualy eliminates the possibility of having to prepare the implant. They also have a vertion of platform switching and of course 'no micro-gap'.They have the added option of an angled abutment option too.A try in kit that represents the angled and straight abutment portion of the implant, is available to be seated in the initial pilot site. so as to predetermine the use of either one of them.Has anyone had experience with them??

Hopefully someone on this board might be able to help me. I am missing 6,7,8,9 and 10. I have a new denist that referred me to an oral surgeon who recommended implanting 6,7, and 10. I asked him what implant system he would use and he told me they were all good and not to worry but was a major stock holder of an implant system he help develop. I cancelled the surgery and went to a peridonist who recommended four implants using the astra system. He took impression for a special denture for a surgical guide. I went to my denist today and he told me I was wasting alot of money on the special partial(denture) and that the Astra system had a terrible failure rate. Now I am confused. Any advice would be much appricated. I am leaning towards sticking with the peridonist and firing the denist.

hi can we get help with payment for people who are on child tax credit and working tax credit thank you

Francis, A surgical guide is always a good idea even if it is only used occasionally during the surgery for reference. It is especially useful when placing multiple implants in the esthetic region where positioning and angulation are important. At least it shows you the surgeon is paying attention to detail. The Astra implant system does not have a higher failure rate than any other system on the market. It is a well reaserched system with a large, financially fit and reputable company behind it. It also has a potential advantage over many other implants in bone height preservation around the neck of the implant and this can positively influence health, prognosis and the esthetic result. Depending on jaw bone width and height, and your bite, You may be just as well off with only three implants as the OS had suggested. Otherwise the periodontist seems to be on the right track. Good luck with your treatment.

I have utilized the Zimmer One-Piece Implants with great success. Over 60 placed without a single failure. The system allows for a verification process using the “try-in” implants to evaluate whether you need the straight or 17 degree angled implant. The unique feature here is that it has a “contoured” abutment that I have never had to prepare in the mouth! This then allows for the best part of the system….the snap on components. Temp Cap, Impression caps etc. This now becomes a SCREWLESS system for the restorative phase which is better biologically for maintaining crestal bone levels and enormously effecient for the clinician!! Easily the best Unibody system on the market today!

What are your thoughts on Nobel Active external morse taper impant? Is there an abitlity to take transfer impression with it? If not, then what is the advantage over one piece impalnt? I can see only one - interchangeable abutments. Does anybody knows of an external morse taper system that would allow accurate transfer impression to be taken?

There is a good discussion about NobelActive over at DDSGadget.com. Below is link: http://www.ddsgadget.com/ddsgadgetwp/nobelactive-initial-impressions/

I have recently started using the osteocare dental implant system with great success. I have had a very good results with the one piece and two piece implants using a flapless technique.

I've used the Sterngold ERA implant. It is one piece. It combines an overdenture abutment and an implant with 3.25mm threads.

All implants with a treated surface work fine. There is too much angst and proprietary posturing going on. Whatever works in your hands, do it. I personally have a heck of a time prepping one piece implants. The sulcus around implants is not the same as a natural tooth, so retraction is difficult if not impossible. Therefore, my crown "margins" are not subgingival and esthetics suffers. One piece implants (narrow diameter) may have their place in small tooth situations, but I prefer the flexibility of a two piece implant. I also like the "medialization of the microgap" or "platform switching" in that it seems to help keep bone closer to the implant flange I like Dr. Millers comments, he seems rationale. "Anonymous" should probably stay that way since he seems like a proprietary obnoxious individual. We all need to understand that implants work and we are still figuring out the microgap vs. biologic width issue. Stay tuned for further controversy and conversations regarding this issue!

I also use OsteoCare implants, there maxi Z one piece and midi implants are great for immediate loading as they are designed to be placed into an undersized osteotomy (sometimes one drill in soft bone), so during insertion you get bone condensation and compression which increase initial stability and also you get expansion in thin ridges... that's done in a flapless way. But they key for success in using all one piece implants is to know when to use them and when to load them. For example if initial stability wasn't suitable for immediate loading then leave the implant as if it is a one stage implant. Also if you need angle correction of more than 15 degrees, use a two piece implant.

just curious. I am a grad student at University of Massachusetts studying medical devices. Reading the comments, I don't see anyone mentioning Straumann which is located here in MA. I thought they were one of the leaders in the market, but don't see anyone mentioning them. Any feedback?

Jeff there is a little confusion about "one stage "implants and "one piece implants" Strauman was the first to introduce the one stage surgical technique,breaking away from the original Branemark protocol of 2 stages of surgery . One stage surgery leaves a "man hole cover disc" at the gum line By contrast a one piece implant is a structure that not only is the implant plus transmucosal component but includes the abutment as well in "one piece" The most common ones other than the brands mentioned are the Imtec MDI mini implants that are one piece All one piece implants have their limitations..ie only one abutment position and immidiate load Case selection is important (surprise surprise) They also have their unique uses ..like every other proffession great to have another sting to our bow

I just want to share my experince and this is not a advertizment. I have been using o-company dental implants for 3 years for all kind of cases (Upper,lower ant and post. ) and from single to full mouth cases. O company is still a small company,recently growing so fast as a one body specializing implant company. It has a two way lociking system (micro thread and auger tip to get maximal stability) and ITI type solid abutment. From my experince of placing about 2000 one body implants, I feel pretty comfortable to use almost 70% of my patients except the cases of bone grafting and more than 30 degree angle correction. Some cases I was not able to get enough stability(45Ncm) such as max. and man. 2nd molar areas. However most of the cases I did using one body implant, I do not have any problem to get 45Ncm. I think that is from minimal preparation of bone and bullet style fixture with dual stabilzation. I do make immediate temporary crown without contact for few weeks. That is for protecting soft tissue. Also,from my experince I think even the uncontact temps can give some of function of bite and give comport mind to patients. For the angulation issue, If the miss angle is not more than 30 degree, I do not have any problem to correct by just cutting with first carbide burs and then diamond burs. Due to the solid titanium, I could prep pretty wide range and the cutting was easy and fast. If you place two implants together or more and the angle is not more than 30 degree and you can get more than 45Ncm, I stronghly recommend to use on body implants and I know you will know why those systems are so easy and safe. Thanks

I agree with Q Lee. OCO has a good product with the ISI one piece dental implant. The founder of the company has placed thousands of these implants which are designed to be prepped in the mouth with light pressure and water/air spray. I believe if you pubmed the literature on prepping implant abutments in the mouth you will find that you can have good results without overheating the bone and correct angulation.

I started to use one piece screw dental implants since 1998, the diameters were 3.0, 3.4, 4.0 and 5.0 mm with the length of 8,11, 13, and 15 (except for the 3.00 mm which the lenghts were 13 and 15mm) Also I started to use one piece cylindrical dental implants with the angulated abutments for Maxillae only. I as the founder of the system, have a great success with the follow-up more than 10 years. I do believe it has higher success rate in the smokers. For a high success rate, the understanding of the bone quality and the proper use of the surgical set is important. Using the drills, taps and bone compression techniques properly will increase the success rate. The prosthesis part, using carbide drill and conventional impression and the use of high tech machinery for the lab, make the dental implant more friendly for the dentists and the patients. just imagine you are a patient and want to replace 4 upper anterior teeth. how many sessions of your lecture would be jeopardize, the aesthetics of the lips and the self-confidence and for how long. S N Nik PhD (Dental Implantology)

I have been working with the OCO one piece implants. The thing I like about them, I do not have to worry about a micro gap, abutment screw breakage, screw loosening, second surgery, and I use a punch through technique (less trauma & I don't loose periostial irrigation). IMO and (Wolf's) immediate load is beneficial to the bone all Orthopedic surgeons know this. Yes it does reduce the prosthetic flexibility with proper planning this is not an issue