Return of the blade implants?

Blades are wonderful. The main problem with the blades was Doctors' inability to place them properly. Now with the Piezo Technique, blades are now a tremendous option to treat narrow ridges without having to do grafting. In fact, 2-Piece blades are one of the best options for this type of treatment. I have cases with over 25 years of excellent success and no bone loss. I did a presentation on blades at the AAID annual meeting in Orlando presenting a number of cases with over 20 some years of success. Raul Mena DMD

Blades were used in the 70s and 80s but after the NIH conference they lost market share. They are a successful fixture but they are press fit and need to be placed sub-osseously. Mini implants may be better and easier in some situations. When there is adequate bone screw type are probably less problematic. But blades have been OK'ed again by the FDA.

Blade implants returning? I didn't know they ever went away! I have several patients that had blades place in the early 1980's and have managed them well. Different mindset for sure but I did see most last @18 years....but some still are OK pushing 40.

Just a question : are still FDA approved blade-implants ( one- and two- stages) in USA ? And if so : would you be so nice to tip me some models and marks of them? Thanks. My mail : dr Roberto Rovelli studiorovelli@live.it

absolutely agree with above. witnessed lots of blades placed while in residency in early 90's Russia. both successful and not really. technique was a bit crude and restorative part not convenient either. By the time root form implants took over I saw some blade implant systems developed restorative interface similar to tissue level Straumann, which made them 2 piece one stage. And now definitely, with piezo help, it should facilitate narrow ridge cases(unless one is eager to do block grafting or GBR:) in any event, one more arrow the quiver

When one has been involved with implant dentistry for as long as I have and attend meetings of the AAID and ICOI on a regular basis, one gets to meet and befriend the pioneers of our profession. After graduating McGill University Dental School in 1966, I joined the Oral Rehabilitation Department,( now called the department of Prosthodontics) of the Hebrew University Dental School in Jerusalem Israel, where many of the top clinicians in the world would come for a few days and give us a course in their specialty……… one such person was a charming fellow from New York City, named Leonard Linkow, who told us he once had ambitions to become a professional baseball player, but because of the love he had for his mother, Rose, he decided to study dentistry, and would try to find a solution to her suffering, because she had lost her teeth at an early age, and was miserable and could not wear dentures comfortably. The chairman of our department was an elderly man named Professor Julius Michman, who was educated in Germany, had no sense of humour and had written numerous articles on prosthodontics with a focus on complete denture therapy. ….he introduced to our faculty, this charming good looking New Yorker, Dr. Leonard Linkow, who had the gift of the gab, and for sure could have been very comfortable working in the automobile industry selling used cars. Dr. Linkow’s lecture was going to be on Implant Dentistry, a subject not one of us in the room had any idea what this would be about. One of the first cases Dr. Linkow presented, with xrays and colour slides, was that of an elderly Jewish Rabbi who had no teeth, and very poor edentulous ridges to support dentures. Dr. Linkow showed us how he took medical grade titanium sheets, stamped out blade shapes with fixture heads that would come though the gums and support the dentures……what was dramatic in this case was that the blades he made himself, were in the shape of the Star of David, the symbol of the Jewish Faith………so the final panorex xrays showed that the rabbi had 8 stars of David supporting his dentures. Sitting next to Professor Michman at this lecture, I heard our beloved Professor say in a low voice in Hebrew…..”Who is this Mishugina (translation = Crazy Fool)….get him out of here!!”…….such was the beginning of the acceptance of this new type of dental treatment…….. and about the same time LInkow was delivering lectures and promoting immediate loading of dental implants…. In another part of the world, Swedish physician and research scientist Dr. Per Branemark, not a dentist, set up a surgical protocol that specifically stipulated that a dental implant must lie dormant and under no pressure at all for four months before it was uncovered…….the profession criticized Linkow for his immediate loading technique. Years later…….sitting at an AAID lecture given by the highly respected and regarded Dr. Carl Misch……..Dr. Misch was to lecture on his experience with immediate loading of dental implants. He told us that the public did not want to wait for four months to have their final implant supported restorations done…… they wanted them immediately….. and so a very successful banking executive in his home town, contacted him and told him that he had fractured his lower cuspid tooth, and wanted to have the tooth removed and an implant placed at the same time and have the tooth placed immediately on the implant,….. after all, this important executive had no time to come back for additional dental appointments. Dr. Misch showed us via color slides and xrays, the fractured cuspid, the extraction of the root, the immediate placing of an implant, taking the final impression, and placing a temporary crown….. all done at one time and this high powered executive would come back for his second and final appointment on the weekend after Dr. Misch had received the finished crown a couple of weeks later. On the Friday before this last appointment, the banker called to say that he was experiencing some pain, and he thought the implant screwed on temporary crown may have loosened…. But he would show up for his appointment on the Saturday. Dr. Misch showed us at this second appointment with the banker, that the immediatle loaded implant had failed, the banker would now need a bone graft, have to wait four months for the site to have been regenerated in order to place a second implant, wait an additional four months for the implant to be osseointegrated….and finally the last step of making the crown……a clear example of how sometimes “Haste makes Waste”….. and he had to absorb all the additional costs……..so this taught us that even the most talented and experienced people involved in implant dentistry do have failures, and that how the implant world has turned full circle, with respect to Dr. Linkow’s immediate loading…. First criticized, now it is acceptable. The point is that with new technological advantages, troughs can be cut into a narrow ridge with Piezo Electric diamond blades, the blades can now have removable heads, but the credit still has to go to people like Leonard Linkow and Carl Misch, they put us on a path and we must continue to expand our knowledge from what they taught us. I hope this tidbit of information is useful to you.

Blade implants have been continually available for over 40 years. They are well suited in narrow arches. The problem with the early ones was they were one piece so you were committed to loading them at placement. over 30 years ago some companies were offering them as 2 piece devices where you could delay loading and then later place an abutment head. The two piece also allows one to use angled heads should that be prosthetically necessary. As with any implant type knowing when to use a design or not use one is key to clinical success and that depends on what bone is available.

Park dental research from New York has a great system , based on the use of piezo surgery, the design is fresh and a prosthetic interface is compatible with their regular system .

I testified before the US FDA in July of 2013 for the reclassification of Blade/Plate Form endosseous dental implants. There are two manufacturers of these implants in the USA. Any competent and motivated clinician can learn how to effective place and restore said implants. I am more than willing to teach doctors how to place and restore blades for a fee. I like the ramus blade for the mandibular distal extension situation. I still prepare the osteotomes with a high speed hand piece. Blades are a great solution for the ridge that is deficient in height and width to a point. I will admit that most patients can easily be treated with root form endosseous dental implants. The outlier cases require subperiosteaal or blade treatment.

Interesting to have this treatment as an option, when there s no chance for standard treatment. Where can i get training in blade implants? And what about the periosteal implants? I saw a case placed in the U.S. 6-7 years ago. are they still on market?

I testified before the FDA for blade dental implants. The US A implant societies are not interested in blade lectures. I am willing to train people.