Choosing a Dental Implant System

Dr. Kennedy asks:
I have a working class patient population and I plan to start doing
dental implant
restorations next year. I am not planning on making dental implants the focus of my practice. I just want to offer this as an additional service to my patients.

If I am only going to do a small number of dental implants, how do I decide which dental implant system to use? I will mostly be doing single
tooth replacement, small bridges and some mandibular overdentures. Clearly, the cost of the implants and the components will be a factor. Aside from potential number and types of cases, what clinical and laboratory factors should I be most concerned with when choosing an implant system? Thanks.

47 thoughts on “Choosing a Dental Implant System

  1. If you are new to implants I would recommend working with one of the larger, more established companies as you tend to get better local representation and support. Support is key. Call the companies and ask for your local rep and gauge his/her eagerness to help you get going. Reps can also help you locate an experienced specialist to place the implants for you.

    My preference is Straumann – great local rep, very simple to restore and a very proven product. But do what works for you – don’t be afraid to shop around: not for price, but for support.

  2. Having placed many implats from many different makers i would say that if you are planing on doing single tooth and short bridges, go with endopore implants. canadiasn but really good and the rehab on top can be done withbranemark compatibles or with straumann / stage one , depending on the implant model placed. they also have good support and easy lab and great compatibility with 3I in wide platform. Also they are designed to work with little bone height.
    As an extra they are not expensive and the surgery is easy with a steep learning curve, the pressure fit is really simple to do.
    good luck

  3. Before you buy an implant system, take one of the Maxi type courses which will give you a broad back ground in the various implant systems but more importantly the confidence to actually place implants. Arun Garg’s courses offered one weekend a month over nine months is an excellant way to start. I am sure there are many others as well, – the point is continuing education is the answer to your question. Also working class practices like you indicated you have will have some of the highest demand for such services!

  4. As noted by Dr. Berg, I too am currently using the innova system which supplies both the “pressure fit” endopore system and the traditional screw implant called entegra. They also supply the internal connection or traditional external hex. My practice sounds like yours and I took a surgical placement course from “Esthetic Professionals” in Encino,California about 2 years ago. I currently place a couple of implants per month mostly to meet the needs of my patients at a fee they can afford. As general dentists, as we can profit on both the implant and the restoration, we can be a bit more generous than a specialist might choose to be. The Innova endopore system is easy and they claim to have good success with very short implants due to a unique implant surface. I am a bit more comfortable using the traditional screw entegra sytem but in areas of limited bone I have used the endopore to avoid specific anatomical features or more complicated grafting procedures. You will need to purchase drill motor, drill sets, and a stock of implants. You should be thinking in the ballpark of $15,000 as startup costs but it doesn’t take too long to produce revenue to cover initial outlay. Starting out, case selection is key and implant placement is much easier than any typical restorative procedure. The innova representative was very supportive, serving as my chairside assistant for as many cases as necessary for me to be comfortable. I used his chairside services twice and then continued on my own. This was a great confidence builder. Good luck!

  5. Some companies will give you a free surgical kit if you buy sertain amount of implants.No need to go with big names,too expensive.Smaller companies do great replicas to a fraction of the cost.Dont count on doing only small amount of implants,once you start offering them.An implant patient will allways send you 2-3 implant patients.Thats how it started in my practice,and i am in a working class area too.Good luck.

  6. I aggree, with Dr. Leo. However, keep in mind that with the smaller companies you typically do not get the research driven technology that you get with the larger companies. (Straumann & Nobel) If you are looking for a cheap system and do not mind a few headaches along the way (Failures) then the smaller knock-off companies are the best choice for you. I however would reccommend that you spend the extra dollar and bank on a system that has the proven scientific backing behind it.

    Also, the larger companies will definitely offer some kind of a deal when you buy X amount of implants.

  7. Smaller companies may not be around 20 years from now, but the implant you place will be. Make your choice based on what you think will be best for your patients long term. A few headaches is a rather cavalier way to talk about failures from a patient view point. Why the use of an implantable device on people is not driven by research and documentation but a good deal is slighlty offensive. But what the customer doesn’t know won’t hurt them? Although Merrill Lynch has started to worry about what the Lawyers might know regarding poorly researched dental implant products. As for your patient population, how many of your customers own boats, 5th wheels, and take vacations to Vegas or Disney? If you help educate a patient on the benefits of Implants they can choose preserving bone and function over a summer vacation.

  8. Ninety percent is internal hex anyway,so prosthetic parts are compartible in most cases.Big names do not by you security,see Replace(Nobel).

  9. Has anyone used the Nobelguide. This is guided flapless surgery utilizing data from a CT scan. The research sounds amazing and it is definately prosthetically driven. The bottom line is less implants are needed which relates to less cost for the patient and easier restoration for the doctor.

  10. This is NOT a surgically driven discipline. For the clinician in the early stages of implant placement, look at the RESTORATIVE options of the implant system. What type of cases will you be doing? Are they implant overdentures or extraction/immediate single tooth replacement? Will you be loading early or immediately loading the system? Decide on the implant that meets the greatest number of criteria for the cases you are doing. Forget cheap/expensive – you need to make an intellectually honest decision as to what is best for long term success of the patient (functional AND esthetic). There are several new systems that are biologically designed to speak to these changing protocols (i.e. Altessa). If we did not continue to push the natural evolution of implant design, we would all still be driving ’57 Chevys. The thought of using 15-30 year old designs because “the research is there” is fine. But if you change the protocol, the implant design MUST follow. This is not revolution, but the natural evolution of implant architecture that will bring us closer to the ideal.

  11. Dr. Joe:
    Having used the nobelguide system I can tell you that its nice but it is not a prostheticly driven system. It is a great selling point but mainly for totally edentulous patients eventhough Palacci is doing partial cases i dont really see a great future for that area with the technique as is today… I go with flapless surgery only in non cosmetic areas and I still reconstruct papillaes when they are an issue and that is something this system knows nothing about.

  12. For simple cases you are planning to do..go with BioHorizon Internal. The implant company has been around. You get the implant and the permanent abutment together in one package, which will cut down on your expenses. For over denture cases BioHorizons offers specific implants as well. The support is good, and the start up cost is ok. Its a good safe system for a low key practice.

  13. “What is the opinion on Anthogyr’s Anthofit implants?”

    Ask yourself: “If I need parts for this implant in 10 years, will this company still be around to support me?”

    I would stick with a company that has a little more of a track record.

  14. I believe Dr Kennedy was asking about picking a system he plans to restore – not to place.

    I agree with the first post, pick a system with great local support from one of the larger companies (Straumann, Nobel, Zimmer).

    You may also be limited by the local specialist who has a preferred system, but ultimately the choice of system is yours. You’ll find the popularity of a system is very regional.

    Also, don’t think practicing in a working class neighbourhood means you won’t do many implants. If you carefully explain the benefits of implants over traditional crown and bridge, you’ll be amazed who will say yes. I’ve had rich lawyers decline implants and blue collar workers accept them.

  15. I agree with Dr. P. If you carefully explain the benefits of dental implants then the patient will ultimately make the choice that is best for their health. As far as which system to choose, having a good representative helps, but the great representatives will show you the ins and outs of their system. Ask around and have the rep from each company show you why they are the best, then make an educated decision yourself.

  16. As I pointed out,internal hex seems to be the future.Even if a company disapears,you will still be able to restore/repair.I place one system and use another to restore.

  17. Most companies do not warranty the implant if you do not restore using their system. In addition, the second largerst company for Implants in the world is Straumann, #1 in Europe and #2 in the U.S.) which is an internal octagon. You can buy parts from Blue Sky but if something goes wrong you can explain to your patient that you tried to save yourself a few bucks on an abutment. If you are talking about choosing a system and using that system long term it would make sense to select a company that will be around to provide replacement parts as needed. Implants are intended to reamin in the mouth for 30+ years not for the next 2 minutes. Longevity is important for support issues.

  18. BioHorizons – science behind the implant can’t be beat, abutment comes with implant, cost of system and implants is great, excellent customer service, surgical kit is EASY to use.

  19. As a sales rep for 3i, I have lots of experience working with clinicians who are both very happy and very unhappy with the implant systems they have chosen. Here is some no-strings-attached advice:

    1) Choose an implant company with a sales rep that is eager, smart, and willing to work hard for your practice. It is as good as having an extra employee for your practice…for free. They can train your staff and even sit chairside to provide you with technical support with their surgical kit (hands off) and provide in-person chairside support for your restorative doctor (again, hands off).
    2) Don’t let any yahoo tell you that big implant companies are too expensive. Big implant companies can more afford to give you a great deal. I routinely set new surgeons up with 20 implants, surgical kit, and drill and motor unit for $6,000. Other big implant companies can do the same thing.
    3) Never buy into an implant system because the price for the implant is cheaper. Even though my price per implant may be higher than some of the newer, smaller companies, I never sell just one implant. I sell 10 implants and give the surgeon 3 free implants for the order. That puts his cost down into the $250 range per implant. When you buy into a company that sells implants for dirt cheap, you get what you pay for. The common law of business does not allow you to pay a little and get alot. When you do business with the lowest bidder, you should always add something for the risk you run, and if you do that you will have enough to pay for something better anyway.
    4) You must choose an implant system with at least 5 to 10 years of clinical research showing over 98% success rate. Why wouldn’t you?
    5) Choose an implant system that offers you many different restorative options. Your restorative doctors will thank you for using an implant company with options that will allow them to restore any implant patient that walks through the ir door.

    That’s it. I hope I stayed away from promoting 3i with you. Good luck!

  20. The market is changing. It is absolutely important to give your patient the best quality and to do business with a knowledgeable rep and a credible company; one with great research and science behind the product, as well as ease of restoration with longterm success and support for you and your practice. New,smaller companies ARE emerging. A FEW are quite similar to the big companies and may not even offer a “cheap” price; (maybe a little less expensive), but are realizing some of the important differences that may place them higher on your list for not only science, but what a smaller company can do for YOU. Integrity,science and service; it’s what we all need everyday in everything we do. (I am a seasoned rep for one of the top 2 implant companies in the world. Everyone needs to keep focus.

  21. I might as well put my two cents worth into this string. The 3i Rep says:
    3i Rep Says:
    1) Choose an implant company with a sales rep that is eager, smart, and willing to work hard for your practice.
    NIZNICK RESPOSNE:If you are a GP, you do not need a salesman to support referring dentists, and if you are a surgical specialists, the referring dentist that the saleman supports today, becomes his prime target for selling implants to tomorrow. New implant users should learn the skills from dental professionals at training courses, not from a salesperson in his office.

    3) Never buy into an implant system because the price for the implant is cheaper. Even though my price per implant may be higher than some of the newer, smaller companies, I never sell just one implant. I sell 10 implants and give the surgeon 3 free implants for the order.

    NIZNICK RESPONSE: I doubt that 3i advertises a 23% discount with 10 implants. And do dentists really want to have to negotiate every purchase with different discounts based on your negotiating skills. In fact, I went to 3i’s online ordering and no prices are posted – all it does is send an email to the rep for that doctor and I guess the negotiations then start.

    That puts his cost down into the $250 range per implant. When you buy into a company that sells implants for dirt cheap, you get what you pay for. The common law of business does not allow you to pay a little and get alot.

    NIZNICK’S RESPONSE: If 3i is anything like Nobel and Straumann whose financials are published, they spend 40-50% of their revenue on sales/marketing and 3-5% of so called research which is mainly paying oppinion leaders to produe studies supporting whatever the company is selling. Another 30% ends up in profit with ony 16-19% being for cost of goods. A company like Implant Direct can eliminate the sales expenses and pass those savings on to the dentist. It can further add value by providing all-in-one packaging providing the abutement, healing collar and transfer free with the implant which is priced at $150 each, regardless of volume purchases so everyone pays the same.

    4) You must choose an implant system with at least 5 to 10 years of clinical research showing over 98% success rate. Why wouldn’t you?

    NIZNICK RESPONSE: In the case of Straumann and Astra, they just introduced new surfaces in the last two years. Similarly, 3i introduced its new internal connection implant made of alloy when all its studies were done on pure titanium implants – the effects of osseotite etching on pure is different than on alloy. Zimmer may have the longest running implant design with the Tapered Screw-Vent, Advent and SwissPlus – they didn’t change these implants from the time they bought Paragon 6 years ago. I don’t know if that is a good or bad thing.

    5) Choose an implant system that offers you many different restorative options. Your restorative doctors will thank you for using an implant company with options that will allow them to restore any implant patient that walks through the ir door.

    NIZNICK RESPONSE: Your restorative doctors will thank you if you use a system that gives the abutment free with the implant so that they do not need to buy it or struggle to figure out what to use.

  22. In response to Jerry Niznick,

    With all due respect Dr. niznick, Astra’s new implant surface was researched for 10 years before it was released for use. Please get your information straight before you share it with others.

  23. Astra’s clinical studies on Osseospeed were conducted by independent, unbiased groups. Pure science and research.

  24. RESPONSE TO CLAIMS:
    1. Astra’s new implant surface was researched for 10 years before it was released for use. Please get your information straight before you share it with others.
    2. Astra’s clinical studies on Osseospeed were conducted by independent, unbiased groups. Pure science and research.

    Niznick Response:
    1 All Astra’s surface studies show is that their new surface works better in animals than their old surface. There are no clinical studies that I know of comparing side by side their old and their new surfaces, probably because such a study would not be able to demonstrate a statistically significant difference. I was acid etching with HFl acid in 1986 and the trace amounts of Floride left on the implant was measured in a few parts per million. Astra blasts with TiO and the Hfl acid removes the imbedded particals and maybe makes some smaller pits between the larger ones. If there were any increase in bone apposition, it most likely would be do to this removal of surface contamination and creation of smaller pits, not due to Fl as Astra claims. There would be no way to separate the three posibilities anyway but that does not stop Astra from making the false claim that it is due to the Hfl acid.
    2. There are no “independent, unbiased research groups. If a group is funded to do the research, they are bias and would not publish a report harmful to Astra.

  25. “I was acid etching with HFl acid in 1986 and the trace amounts of Floride left on the implant was measured in a few parts per million.”

    Jerry,

    How did you measure Fluoride at such low levels?

  26. I’m researching implants for myself. I’m concerned about microgap bacterial colonization. Since silver is a known antibiotic I’m wondering if it’s used in any implants.

    Also need some recommendations for implant dentists in NYC. Is $1200. per tooth about average? Thanks.

  27. Dr. Niznick,

    There is research comparing the new Osseospeed surface in comparison to the Tioblast surface. Is is available to look at. As far as your reference to HFl being used to clean off the imbedded particles from the surface in completely inaccuarte. There are no imbedded particles on a Tioblast surface. It is a titanium implant blasted with titanium, creating the pit morphology. It is a titanium implant blasted with what it is made out of. This information is accuarte and there is plenty of data to support what I have just stated. The increase in bone apposition is not due to cleaning off impurities, there are no impurities to clean off our surface, unlike your surface and others on the market. As far as your claims that Astra makes false claims, well, like I have stated, there are various independent, yes, independent studies that support what I have stated and what Astra is stating. Please get your facts straight, Dr. Niznick, perhaps you should do some research yourself into what studies are really out there before making such false statements.

  28. Dr.Niznik ,please read this: T. Berglundh, I. Abrahamsson, J.-P. Albouy, J. Lindhe
    Bone healing at implants with a fluoride-modified surface: an experimental study in dogs
    Clinical Oral Implants Research (OnlineEarly Articles).
    doi:10.1111/j.1600-0501.2006.01309

  29. Ste Mc Says:
    February 12th, 2007 at 1:36 pm
    Dr. Niznick,

    There is research comparing the new Osseospeed surface in comparison to the Tioblast surface. Is is available to look at.

    SO WHAT DOES IT PROVE…. CLEANING WITH ACID REMOVES TI PARTICLES, CREATES SMALLER PITS AND THIS MAY PROVIDE AN IMPROVEMENT OVER ASTRA’S OLD SURFACE. THIS SAYS NOTHING ABOUT WHETHER IT IS ANY BETTER, OR EVEN AS GOOD AS TIUNITE, SLACTIVE, SBM OR HA.

    As far as your reference to HFl being used to clean off the imbedded particles from the surface in completely inaccuarte. There are no imbedded particles on a Tioblast surface.

    I SUGGEST YOU LOOK AT SEM PICTURES OF ASTRA SURFACE BEFORE THEY STARTED ETCHING… ANYONE WITH ANY KNOWLEDGE OF IMPLANT SURFACES CAN SEE THE IMBEDDED PARTICLES. WHAT DO YOU THINK HAPPENS WHEN YOU BLAST WITH TIOXIDE PARTICLES…SOME PARTICLES GET STUCK THERE.

    It is a titanium implant blasted with titanium, creating the pit morphology. It is a titanium implant blasted with what it is made out of. This information is accuarte and there is plenty of data to support what I have just stated.

    IT CREATES PITS BUT IT ALSO LEAVES EMBEDDED LOSE PARTICLES. THIS IS NOT MY OPPINION.. IT IS WHAT YOU SEE WHEN YOU LOOK AT AN SEM

    The increase in bone apposition is not due to cleaning off impurities, there are no impurities to clean off our surface, unlike your surface and others on the market.

  30. You are completely wrong. Maybe what you are looking at is the calcium phosphate immediately adhereing to the surface which is imperative for osseointegration. Those are the only particles seen on the surface. It leaves pits but no imbedded lose particles that need to be cleaned. Your statements are innaccurate.

  31. Doea Astra claim they have Fluorine (or some compound containing Fluorine) on their implant surface?

  32. Yes, Osseospeed is a chemically treated surface. treated with fluoride ions on the surface. The fluoride is released from the surface when placed

  33. With regards to NGU’s post from last year, Anthogyr has been in business for 65 years. We continue to grow very rapidly and have recently introduced a state of the art facility. We will be around to service and support all of our products.

  34. These conversations are amusing.I would listen to Dr. Niznick since he is by far more knowledgeable than the rest of these other contributors and has researched,developed and placed way more implants than all of them together.Anyways if you are restoring or placing implants take the Maxi Course or Carl Misch course.Don’t take a one weekend seminar or merely be instructed by an implant representitve.

  35. Does anybody know anything about the A&B system? How long has it been around? How reliable is it?

  36. There is 11 important factors for choosing an implant system you should consider.
    1-presence of small & big , short & tall fixtures.(2.5-6/more mm for diameter & 4.5-15/more mm for length as in BTI system).( http://www.bti-implant.com/implants/TINY-Implants-narrow-platform/301)
    2-(Important) presence of tall-big treads & deep grooves such as Nobleactive & biohorizons
    3-presence of microtreads in crestal zone of fixture.
    4-Good hydrophilic surface texture such as straumann slactive .
    5-Available good prosthetic components such as aesthetic abutments / ceramic-on abutments/screw abutments.
    6- platform switching (ability for use abutment with smaller platform/diameter than platform of fixture)
    7-Not to be technically sensitive as ITI is( is sensitive because of loosening the implant mount during the final insertion of fixture if torquing more than ~35 Ncm)
    8-Having color-coded length drills or stoper oring drills.
    9-Internal irrigation drills or low speed rate in drilling(50 rpm)
    10-color coding platforms of fixtures.
    11-prices of hole implant system.

  37. Have any one of you tried Korean Dentis system? References I have so far are very good, they have wide variety of implants, platform switching and they are quite cheap. I’m also choosing my first implant system and my patients aren’t usually well situated, so I’m choosing between Meissinger (clones of older Straumann), Dentis and Czech ImplaDent from Lasak…

  38. Yes we have used Korean implants – Neobiotech and Osteem. Very good in all respects mentioned by many clinicians in this discussion. Sound technologically. Very user friendly.

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