Straumann 6mm Wide Neck for posterior region: What are your thoughts?

This is the type of comment we do not need. If you don't agree with it, at least use some argument. What would you have done? Patient does not want any kind of sinus lift procedure and want implant supported restoration.

@rsdds The "looks" of an implant are irrelevant because you won't see the implant. What is it about the implant that you dislike, and why would you not have that in your mouth? ... my opinion is that a premolar sized crown on that implant may function just fine. The surface area might provide enough osseointegration to withstand chewing forces. I haven't read any studies on this specific implant but short wide implants have shown to be adequate in the posterior. It's hard to tell from just a single film. What was your torque on insertion? How long has it been in the mouth? How long is anticipated crown height going to be? What does the contralateral side look like? From this image and your initial post, it seems fine, but there's a lot more we'd like to know. Thanks for posting! :)

Yes, this is exactly why I chose to do this kind of procedure. There's a lot of studies that support short implants...

Occlusion will be very critical. Light centric contact, make sure no interferences. Like others have mentioned , small occlusal table on restoration. Looks like maybe you could have gained maybe 1-1.5 mm apically by selecting slightly longer implant, maybe more stability. Hope works out well.

Good suggestion. Type D Finn Implant ( Tatum implant system) is good option in post maxilla . Thanks.

"In the case shown, the implant could have been placed 2mm apically with the osteotomy stopping at the sinus wall. This then would have prevented the distal exposure of the implant and allowed for an excellent emergent profile. Placing the implant above the sinus floor by letting the implant infracture the sinus during insertion, may gently displace the membrane (due to the blunt nature of this implant) and act as a modified Summers Technique without a graft." My opinion is that you need to have pretty good clinical skills (meaning experience) with this technique to avoid perforation. A skilled surgeon can do this. A General Dentist shouldn't attempt it unless they can repair a perforated membrane. And I'm just a General Dentist...

@John Beckwith "I’ve seen these fail after loading." If it does fail, then the patient may be more open to a sinus lift. But on a more serious note, have you been able to determine what the cause of failure was? Parafunction/Bruxism/TFO? Perio? Which brings up the all important question... Why did this patient lose the natural tooth?

Thanks for your comment. I did have a CBCT prior to the surgery. I had 7mm to place an Implant. For now I work only with Straumann and Neodent, so my only option here was to use a 6mm implant. This patient use to have the tooth nº 17 (2º molar) and was extracted in the same surgery of the implant placement, I grafted the socket but it didn't seem to have worked. I read all the comments and now I'm really in doubt of what should I do next. Patient really wants a tooth there. It's been almost 3 months since the surgery and I'm thinking about placing an healing abutment this week and in 15 days some provisional crown so the patient have his tooth. Wait a couple months and ask for a new CBCT to see if I can add an additional implant on the distal to do a partial fixture. What are your thoughts about next steps?

Retro studies are not level 1 evidence. A well-done systematic review or a meta-analysis would be better. Having said that, short implants have their uses; but surface factors will be critical due to unfavourqble crown-height ratios.

Well said Thank you

I doubt that you have any study to back that sentiment up. And the reason I say that is that Bicon has been placing, studying, and documenting the placement of short implants with multiples of crown:root ratio for 2 decades and they work. The reason why is twofold: 1, an implant is ankylosed, not suspended by a PDL like a tooth. And 2, according to Wolfe's law, bone responds to forces placed on it by becoming stronger and denser. Please check out this article by Dr. Rainier Urdaneta for a good overview. http://support.bicon.com/customer/portal/articles/1240252-are-crown-root-ratios-a-factor-with-bicon-short-implants- I agree that the Straumann may not be up to the task due to lack of surface area and aggressive threads. Ankylos and Bicon certainly would be. I would leave the implant in and see how it does. Best- Mark

haha...i enjoyed your post. I'm just also "trying to improve success rates of treatment plans" If you think using straight walled, tissue level implants from 1987 with limited apical engagement and limited threads is the best than great! And if you like paying $400 per implant for that success...than more power to you! Some people enjoy going to Straumann's paid CE's at events and drink the koolaid, and love their lavish parties where they buy out doctors. All of this has to be paid for somehow, and the doctors who buy the products end up paying for it!! Straumann came out with a bone level tapered implant finally and thought they did something great. ID has been doing this since corevent and paragon 20 years ago! Hey, nobody ever said dentists were good business men. One day they will understand....all implants work, with the right patient and right clinician. All this different surface treatments and absurd marketing is useless. Get a good price and good rep, good support, and good product variety.....and that is all. Get a company that can help you across the board, not just sell you overpriced screws.

I chuckle when you say surface treatments are useless. Have you seen your catalogs lately showing off your implant surfaces? You're no different than any other company in drinking your own koolaid. I'm not sure where you came up with the idea I like straight walled implants from 1987 (nothing like putting words in my mouth to justify your sarcastic reply) Actually I like using implants that have research behind them. Your implants are knockoffs of Straumann (Swishplant), Nobelreplace select (Replant) and the nobelactive and nobel parallel conical connection (interactive) so your company is a copier not a leader (I do give Dr. Niznick credit for his larger internal hex for anti-rotation in the 80's with corevent). Compare your design of the interactive abutment for the conical connection against the OEM part from Nobel. Your abutment has a longer hex and a shorter conical portion. It is emphasized in your catalog. The implant abutment interface in a conical system is designed to have maximum conical interaction with the internal of the implant to prevent screw loosening, with the hex there only for indexing. Your abutment mimics the longer hex of the original corevent and minimizes the cone so your system introduces more load to the screw since there's less conical mating surface of the abutment and implant (Nobel literature). So don't throw stones at the premium brands of implants. They are premium for a reason. I work with many different implant systems including yours and other lesser expensive systems. However I do take exception with lesser priced systems touting their superiority to other systems when there's little R and D behind them. Your main selling point is cost, not quality. Not once have I seen you post about your research and why your system is superior to any other. Your company mostly just denigrates other systems and touts the lower cost and the "aren't you stupid to pay too much for a screw" mentality. I agree with you that all the hype of the different surface treatments is there to sell implants and I agree with you that most all of the surface treatments work and was a great advance in improving implant success in weaker bone. It is now selecting the correct implant for the site and making sure the all important abutment/implant interface is precise. With the conical connections available today (instead of the old flat top design) precise machining and mating of the connection surfaces are vitally important for the overall stability and longevity of the screw joint. So, get a good price? How much is the price of screw fracture and failure when using aftermarket products?

What does aftermarket mean? Ive never seen our screws fracture btw.

Please keep comments relevant to the original topic of this post. These particular comments of one implant system vs another are not of value for this particular discussion. Thanks.

aftermarket just means a secondary company made the abutments. And, many times changes must be made to the design to get around patent infringements. Also, many secondary companies that mill abutments are not FDA approved and are not 510k compliant (newest regulations regarding medical device manufacturing). With the new conical connections precise mating is an integral part of the overall design of the implant complex and is very important to the overall success of the implant system. Thank you for your question. Also, unfortunately, all screws break at some time or another. Since I'm a prosthodontist, I remove a bunch of broken screws. One of my challenges is that different abutment manufacturers have different screw head sizes. So when a screw breaks, I need to know the abutment manufacturer not the implant system! Ugh. The nobel head size is different from Atlantis which is different than Implant Direct (the star drive is the same) so I need the correct replacement screw for the abutment. Sorry to get off the topic of short implants but I think this is also an important thing to document in your chart notes. What abutment system did your lab use? oh, and yes, I have had to replace implant direct screws I'm sorry to say!

Right. Well ID is FDA cleared.

Yeah well when I decided to treat this patient and he told me he didn't want to do sinus lift augmentation, I did lots and lots of research about 6mm wide and short implants and I did see lots of favourable outcomes, that's why I did it. Anyway, my main ideia still is to place another implant distally to this one and splint the fixtures. I just thought this subject would generate lots of discussion (and I was right).