Working with Multiple Implant Systems: Thoughts?
I’m a general dentist with 20-years clinical experience. I have been working exclusively with the Nobel Biocare system, restoring implants for 10 years.
I’ve recently moved and the local Periodontist places Straumann implants. There is a local MFOS who places both Straumann and Nobel Implants.
My questions for the restorative docs:
1. Should I invest in a second system?
2. Should I try to convice the Periodontist to try Nobel?
3. Should I just refer to the OS and request Nobel implants?
4. Do most restorative docs work with multiple systems?
My questions for the Periodontists:
1. Do you work with one system or multiple?
2. Would you be willing to invest in a new system if you have a GP ask?
The Periodontist has been in the area for 30+ years, and his son has recently joined their practice (within the last 5 years). I’ve thought about contacting the son directly to see if he had any Nobel training in school.I spoke with the OS and he prefers Nobel, but he’s almost an hour away. The Periodontist is only 15 minutes from me.
I’m open to any and all comments. Thanks!
16 Comments on Working with Multiple Implant Systems: Thoughts?
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implant guy
1/5/2018
Tell him to use Implant Direct, and you both save money. If he's using the tri-lobe, they can use that kit to place implant direct. Your tooling stays the same as well. If you are using the active conical connection, restorative tools also stay the same. It's a no brainer.
Mwj dds,ms
1/5/2018
The question wasn't about implant direct. The surgeons are working with perfectly good systems. To answer the real question, both answers are viable. Most surgeons work with multiple systems. Depending on how many implants you refer to the surgeon will depend on whether he/ she is willing to tool up for another system. It is much less expensive for us restoring docs to get a couple new impression copings and a screwdriver than it is for a surgeon to buy another system. But both systems you describe are excellent systems. I prefer the Nobel parallel cc system instead of the trilobe because of the internal connection and platform switching. Straumann has the same features on their bone level implant.
Keep using quality!
OP
1/5/2018
I agree about the platform switching, and I've transitioned over from tri-lobe to conical connect, especially for the ability to do screw retained anteriors through the lingual with the Omni-grip driver.
I'll talk to the Periodontist and a Straumann rep. Are the torque recommendations similar betwen the two systems? Anything dramatically different, or just fractions of a mm in diameters?
Thanks!
Dennis Flanagan DDS MSc
1/5/2018
You are the case director. The specialists should put in any brand you direct. If they won't comply refer to someone else.
Rand
1/5/2018
Good advice!
KEITH GOLDSTEIN
1/5/2018
Nobel and Straumann torque is the same - 35Ncm. The torque on multiunit is 20 for Nobel and 15 & 20 for Straumann multibase. You will need a driver since it is a torx (looks like Nobel star driver but a little different). I have them in both latch style and 4x4 square ($35-$45) vs going to Straumann and paying double. You do not need another torque wrench. I also have angled OMNIGRIP solutions for both Nobel and Straumann too (called Aurum- Angled screw channel ti bases), plus a full line of Nobel and Straumann compatible components and FDA approval.
implant guy
1/5/2018
agree with Dr Flanagan.
Gumdoc1
1/5/2018
I am a periodontist so I will answer the two questions that you posed to the periodontists.
1) I do use one system and it is Straumann for over the last 18 years. I have experience with other systems. I do place Nobel implants if that is what the referring doctor determines the case requires.
2) I would be willing to invest in another system based on developing the referral relationship and on the number of potential cases. As mwj pointed out above the initial surgical start up investment to bring in another system is higher for the surgeon than the restorative doctor.
I hope that you and the periodontal practice can have a good discussion and work through your questions and develop a working relationship that benefits you and your patients.
Michael
1/5/2018
In my city, Biomet 3i has been the major player for over a decade. There is one periodontist who advertises as an "implant surgeon", but uses only Straumann. (Personally, I think if you wish to be an "implant" practice, you'd better not be a one-trick pony.) Another periodontist is the lone Nobel guy. An up-and-comer among the younger surgeons particularly is Dentsply Astra. As the restoring dentist, I've learned all four systems, and quite frankly I sort of like the Dentsply system the best, although none of them are technically much different, particularly with open-tray impressions. If I'm not mistaken, each system's rep (except 3i) has provided me with the drivers and torque wrenches at no cost, so it's only about impression copings, screws, and spare healing abutments to use for bite relations. Not sure what the big deal is.
Bruce Smoler, DDS
1/5/2018
Michael, Agreed. As a place and restore full arch GP doc, I find many of my referral sources are comfortable with what they know. There is a certain level of 'if it ain't broke-why fix it' mentality with their approach and I don't find fault with their mindset. With 3 systems I place and lecture for, multiple lines of componentrly can be more complex, but just requires a modest additional amount of organization, systems and money to stock items, IMHO
Tarek
1/5/2018
When it comes to restoring implants, the Clinician should have multiple systems and must be familiar with major systems. All you need is Torque and multiple screw drivers!!
When it comes to the dentist placing the Implant, it is more common to have one system. Especially, there is a lot of instruments involved (surgical kit, Guided surgery kit, .......etc)
In my office, I place and restore implants and I use BioHorizons. However, in some cases patients come in with implants already placed and they need restoration. We restore any system they walk in with!
Check Salvin they have a kit includes Torque and drivers for major Implant systems.
Hope this is helpful!
Raul Mena
1/5/2018
I fully agree with Dr Flanagan, and I go a step further.
The restoring dentist should be in charge of the Treatment Planning and the type of implant that should be selected for the treatment.
Lets be clear, implant dentistry is Prosthetic driven with a Surgical components.
That is why the dr doing the prosthesis should be trained in the surgical phase of implant dentistry.
That does not take away the importance of the surgeon when the case is going to be treated by a team.
Dr. Rayment
1/6/2018
Many excellent comments. When referring cases to a specialist I prefer to let them decide which implant to place. She is the one doing the surgery and they should be comfortable. That being said, I would think most specialists would be happy to discuss different systems. I also think we GPs need to be able to restore anything that comes in our door. Talk to the local rep. I’m sure they would be happy to get you a restorative kit if you plan on using their system. The specialist can probably ask the rep to come meet with you as well as they have a lot of contact.
Super G
1/6/2018
It sounds so much more complicated than should be...If there is an unfamiliar implant placed, have that surgeon make the custom abutment , then the GP will take direct impression just like natural crown and bridge...
For the easier case (posterior teeth, I just order company's anatomical direct abutment/ or even zirconia abutment ) then take direct impression.... Look great, fast delivery, less complication....Patient loves it....and referring many more....
Super GP
Raul Mena
1/7/2018
I like the idea of the Super Implantologist.
2 simple options:
1) The Dr that is going to restore the implant should be the one that does the restoration.
2) The Dr that places the implant should be the one that restores the case
This will eliminate many negative results, and Will also eliminate passing the blame to the other member of the team when there is a bad result.
Nothing wrong with a Super Implantologist.
OP
1/8/2018
Thank you all for your excellent advice! I have schedule a lunch with the Periodontist so we can discuss the systems, and I am waiting for the Straumann rep to call me back. I appreciate all your help!
-OP
