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Major Paradigm Shift in the Dental Implant Market?

posted in Dental Implant News

« Waiting Period After Bone Grafting? | Mini Implants in the Maxillary Arch? »

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In an interesting new study on the state of the dental implant market, Millennium Research Group reported that the big four dental implant companies are beginning to lose market share to new competitors.

Specifically, Nobel Biocare, Straumann, 3i, and Zimmer Dental, the “big four”, held 73.7% of total dental implant market revenues in 2004. By
comparison, in the first quarter of 2006, the big four garnered only 70.1%
of all revenues.

Is this the start of a major paradigm shift in implant dentistry? Will the host of newer competitors continue to steal market share away from the big four? What factors will determine the market share breakup in the future? Is there really a system lock-in here or will lower pricing convince existing dental implant practitioners to move or even try another dental implant system? Perhaps, the expanding use of dental implants, by even GP’s, will ensure a more fragmented market in the future. What are your thoughts and what factors do you consider when evaluating the newer dental implant systems?

Note: For more information on this recent study by Millennium Research Group, please visit: www.MRG.net

27 Responses to “ Major Paradigm Shift in the Dental Implant Market? ”

• Robert J. Miller June 6th, 2006

  
  

  Cost is certainly a factor in this shift. No one wants to pay for a big companies marketing program. But the big shift stems from OUR shift in paradigm. Early and immediate loading, super aesthetics, and bioactive materials are driving this change. Our ability to design biologically driven rather than engineering driven implant designs renders many of the old styles obsolete. We are tired of the implant du jour from the big companies who wish only to maintain market share with little or no science. Matched with a speaker of high visibility, most implant dentists flock to these new designs becuase of the marketing network, NOT the implant design. Implantologists are now looking at these designs with a very critical eye on performance, not hype.

• Jerry Niznick June 6th, 2006

  
  

  While the major implant companies may be collectively losing a few percentage points of market share, they are growing their total sales by expanding the market and by price increases. This does not represent a paradym shift from the major companies with large sales forces and educations programs to less expensive, smaller companies because the major implant companies are growing at 20-25% per year. They are expanding their customer base and their profitability.

  THAT IS NOT TO SAY THAT CHANGE IS NOT COMING.
  The major implant companies have made only minor modifications to their product lines in recent years, primarily to differentiate from the competitor’s products and to justify price increases. These price increases bear little relationship to increased cost of goods which has gone down from 20% to 17% for both Nobel BioCare and Straumann over the last few years as a percentage of gross sales, while profits have risen to 30%. The major implant companies operate on the historic economic reality that raising prices generates added income that in turn can be used to expand sales forces and buy greater influence with opinion leaders, universities and implant organizations. Nobel recently committed $5,000,000 to the University of British Columbia Canada. and another $3,000,000 collectively to two other universities. Publically traded Swiss Companies do not indulge in philanthropy in a foreign country unless they see a payback. They have found that the sales they lose from higher prices are far outweighed by the sales they gain from having a greater marketing presence. The smaller companies, who sell products for more reasonable prices, lack the technical resources to produce a broad, high quality product line and the financial resources to produce adequate inventories or conduct extensive marketing to establish a significant customer base.

  None of the major implant companies price compete with each other. Instead, they focus on what features differentiate their products from the competition, and claim that that must be the key to their high success rate, whether it be in poor quality bone, immediate or early loading, or in the hands of GPs placing their first implants. The features they point to include TiUnite surface (Nobel - the same company that hyped the machined surface CP implant for 15+ years), new wet surface (Straumann - who hyped TPS and then SLA surfaces as the be-all and end-all of surfaces), Microthreads and a “Osseospeed” floride treated surface (Astra - known for years as the only company blasting with Titanium), Platform switching an a connection that clicks (3i - don’t talk much about their acid etched surface, Osseotite, with its 3mm machined neck because they abandoned that when Nobel extended its rough surface to the top), or the company selling the original Internal Connection with Friction-Fit Abutments (Zimmer Screw-Vent).

  There are a host of smaller companies (BioHorizons, Innova, Friadent, Bio-Lock etc.) who differentiate on threads, beads, laser lines or some other gimmicky feature, as well as being priced below the Major companies. Eventually these medium priced companies build a customer base and then start to raise their prices so they can market with the big boys with symposiums, salespeople etc.
  There are smaller companies that market on price alone and try to be similar enough to the major companies’ products that you do not have to think too much about their research history, not that research matters any more when Nobel’s idea of research now consists of having 3 studies underway. The small companies selling at $100-$150 can’t afford to offer broad product lines and can’t afford to maintain adequate inventory levels to supply their customers. Quality is also a question if they are not making their own implants.
  And then there is a new company with the design, and manufacturing experience as well as the capital to challenge the Major Implant companies, potentially creating a price point shift in the impant industry. Just click on the banner ad on this website to find out more about what could really represent a paradym shift in the implant industry - Application Specific Implants sold on the internet at factory direct prices. When you challenge the major companies’s on innovation and value, you better be able to make a high quality product because the multi-billion dollar companies will be looking for any way to be critical in order to compete without actually lowering their prices.

• JPS June 7th, 2006

  
  

  There is a big shift!! The implant users are tired of the lies by Nobel and boys. The Doc’s are also TIRED of the lies about the bone loss problem. This is a real problem and with the systemic problems of the periodontal bacteria, someone is going get the you know what sued out of them for using an implant with an open microgap that harbor periodontal bacteria that will add to a systemic problem. Read the medical articles, they do not like the dentist implanting a non-cleansable device into their patients.W e as dentist have been asking for years for help from the big boys, but they are only intersted in boosting their sales. All of the programs are now paid speakers to sing the “company song”. We as members of the socities shoud be allowed to hear the truth!!!!!!!!!!
  ENRON is coming to the dental implant industry.

• Albert Hall June 7th, 2006

  
  

  We all know what are we doing.
  The best is that we do not beleive in companies like Nobel and its marketing.
  Once they begin to increase prices other companies will appear with similar implants and prosthetic options to cover the gap.I give Nobel only till 2007 for everything, then they fire Cannepa and Co, and they will be sued, many employees will be fired….and too many “sorry (ies)” will appear, and bla,bla,bla….

• GC, Tahiti June 9th, 2006

  
  

  one answer among others is to educate the implant dentists worldwide thru universities-based programs and not commercials from the factories!!!!
  for example , a french Institute of Technology helds a one year postgraduate program in Mechanical Engeenering in Oral Implantology: most lecturers are renowned speakers from
  international aerospace companies , engineers specialized in corrosion or screw designs, computer modelizers and are not paid by nobel straumann or any one in this industry.
  they dont know about bone but their analysis of current implant mechanical concepts seen from the outside can be disturbing.
  Tkink about it for a second, invite a mechanical engineer to your next study group, some may not smile.
  To end this long post,education of your patients by your opinion instead of companies’brochure can help some times.

• Jerry Niznick June 9th, 2006

  
  

  The last posting refers to learning about “mechanical concepts” of implant design from speakers working for “aerospace companies.” The difference between making structural parts as long as 43 feet, for jet airplanes and making dental implants that are .43cm long, is primarily a matter of size. Both manufacturing processes use 3D modeling to create the programs that run the CNC machines and both must manufacture to very stringent tolerances on a highly consistent basis.
  Acromil Aerospace Company (www.acromil.com) has a 100,000 sqare foot factory that machines titanium and aluminum structural parts for Lockheed, Boeing, Israeli Air Industries, Northrop and Embraer. Implant Direct Dental Implant Company and Acromil Aerospace Company have a number of things in common - for one, they are both owned by Niznick Enterprise and have the same CEO. What implants and airplane parts have in common is the requirement for absolute precision and consistent quality. The big difference between the dental implant industry and the aerospace industry, is that in the highly competitive aerospace manufacturing business, the primary competitors (Boeing, Lockheed etc.) require competitive bidding and the manufacturer makes a 10 percent mark-up if he gets the job and does it right. In the dental implant industry, the primary competitors (Nobel, Straumann, 3i, Zimmer, Astra etc.) do not price compete and are able to price their products to give them an average 5X mark up. They allocate approximately 50% of gross revenues to sales and marketing in order to differentiate one company’s 8-16mm titanium screw with a rough surface and internal connection, from their competitors’ 8-16mm titanium screw with a rough surface and internal connection. What is needed in the implant industry is a company that applies the manufacturing efficiencies of the aerospace industry, and the discipline of marketing products in an industry where it is illegal to influence the decision makers by other than quality, on-time delivery and fair pricing.

• Dan Shapiro DDS, MSc. June 9th, 2006

  
  

  Interesting Dr Niznick, We have to grant you the benefits of internal connection, You may be very well documented with a wide knowledge in the field, but to market your new company here, after having made millions of dollars in the past with your former corevent system, and now back in business is just wrong. Thanks for your comments, and I hope you can convince your new customers, but please be a little honest. Attacking, nobel, 3i, straumann etc is your favorite entertainment.

• Jerry Niznick June 9th, 2006

  
  

  Dear Dr. Shapiro
  Thank you for acknowledging my product development and scientific contributions in the dental implant industry, as well as my commercial success with Core-Vent Corporationa and Paragon Implant Company. I do not appoloogize for “attacking Nobel, 3i, Straumann” for their marketing claims and pricing policies, as well as their limited product innovations. It is clear from the many postings on this Blog, that I am not alone in that regard. As for your statement that having been financially successful in the past somehow makes it wrong for me to now come back into business, is somthing I do not understand. Who better to challenge the establishment in the implant industry than someone who has been doing exactly that since 1984 when Nobel first took issue publically with my interpreting their published research as proving the long-term predictability of osseointegration with titanium screw implants, regardless which company made the devices. As for your comment “please be a little honest”, if you were specifically referring to my comment that the major companies “allocate approximately 50% of gross revenues to sales and marketing”, I would refer you to a Merrill Lynch report that is posted on the “News” section of my website, dated January 26, 2006 listing Nobel’s “Selling” expenses at 48% and Strumann’s at 54%. (http://www.implantdirect.com/pdf/DentalImplantUpdate26January2006.pdf).
  As for your “hope that I can convince (my) new customers,” I do not know exactly what it is you expect me to convince them of. The design innovations, significant price advantages and on-line ordering system for my new products will appeal to some and be of no interest to others. Given the size and growth in the implant industry, I have already bet $20,000,000 before selling a single product that I will appeal to enough dentists to make a good return on my investment. There will be no salesperson, training courses, international symposia, paid oppinion leaders or free products used to persuade dentists to buy my new products. I am only targeting the knowledable, experienced and open minded clinicians who already realize that Nobel, Straumann, 3i and others have failed to adequately address all their clincial needs at prices that allow the benefits of implant dentistry to be enjoyed by the majority of their patients.

• Anonymous June 13th, 2006

  
  

  Big 4/ Niznick fact “are able to price their products to give them an average 5X mark up”

  Big 4/ Niznick fact “allocate approximately 50% of gross revenues to sales and marketing”

  Implant Direct/ Niznick fact “There will be no salesperson, training courses, international symposia, paid opinion leaders or free products used to persuade dentists to buy my new products”

  Honestly Dr Niznick, If you are successful selling your implants without all cost associated I do think your markup and profit will be much higher than the big four…. Maybe your implants are not as cheap as you claim

• Anonymous June 15th, 2006

  
  

  I just verified the numbers on Sales to selling expenses MISQOUTED by Niznick

  Nobel in 2005 had slaes of 484.5 versus selling expenses of 156.3 or roughly 32%. In 2004 Sales of 388.4 versus selling expenses of 132.9 or 34%. I am not sure why Dr. Niznick decided to include administrative costs and R&D into his inflated percentages but the cost of running a CNC machine is not considered part of Sales and Marketing.

  AS for Straumann their Sales to Sales Expenses were roughly 37% for both 2004 and 2005.

  If I did not have to ask my Sales Rep to walk through an impression with so many of my referrals perhaps I would like to see a lower ratio of sales to selling expenses but the reality requires support from a sales rep in order to reduce the amount of time I spend on coaching allowing me to be more productive in my practice.

  I am not sure why so many promotional comments are being allowed by Dr. Niznick on these discussion threads but he has launced his implant with about 1/3 of the cost compared to the bigger companies. 1/3 of that savings comes from selling expenses another 15-20% will likely come from savings on R&D and Administrative expenses. Since this is not a publicly traded company their will not be stockholder demands for return on investment that publicly traded companies face allowing for additional price pressure savings. Sounds to me like buying direct gets you about what you get from the larger companies only the Implantologists get to shoulder all of costs and risks associated with problems that arise. Which is maybe the way it should be?

• Dan Shapiro June 15th, 2006

  
  

  Dr. Niznick….Not only your new system but many other new ones claim to have a really innovative design, claim to answer all possible mechanical or even biological failures, claim to be design to withstand forces for inmediate loading and even more Dr Niznick are even cheaper than yours…………But the only truth about it is your and all the others financial interests. It is a multimillion dollar business, and you are aiming to take a share of that…That is OK…But Show us real scientific evidence, based on Lab and clinical research with enough long term data then I will be convinced. Yes I Granted you your innovations in the past but I have also been here long enough to realize that at the end, It all comes down to just dollars. That is all you care. And again you are not being honest when you are using these pages to self promote yourself or your company.

  Thanks for your comments, but again move aside please.

• Jerry Niznick June 17th, 2006

  
  

  Response to anonymous June 13 posting ”

  “Honestly Dr Niznick, If you are successful selling your implants without all cost associated I do think your markup and profit will be much higher than the big four…. Maybe your implants are not as cheap as you claim.”

  Response: You may be right but note the word “if” in your question. The prices I am selling for are based on establishing a production level capable of producing 1,000,000 implants and/or abutments a year. If my sales meets my production potential because dentists appreciate the $20,000,000 investment that I have made before selling my first implant, and support my concept, the prices may be able to be lowered or more services added. If I can not achieve unit volume sales matching at least Zimmer, the number 4 implant company, then it will take me years to recoup my investment and the prices could go up instead of down.
  Great investment deserves great rewards so other than implant companies that have to compete with my prices, I don’t think too many dentists will be worrying about how much I am making if they are getting a 60-70% discount from what they are paying now.

• Jerry Niznick June 17th, 2006

  
  

  POSTED JUNE 15 BY ANANYMOUS:
  “I just verified the numbers on Sales to selling expenses MISQOUTED by Niznick. Nobel in 2005 had slales of 484.5 versus selling expenses of 156.3 or roughly 32%. I am not sure why Dr. Niznick decided to include administrative costs and R&D into his inflated percentages but the cost of running a CNC machine is not considered part of Sales and Marketing.”

  NIZNICK RESPONSE:
  I was quoting a ML report that I provided a link to on my posting. Your confusion arises from the fact that while selling expenses are 1/3rd of gross sales, they are 1/2 of all expenses. Nobel, like Straumann end up with profits equal to about 1/3rd of their gross sales with the balance being equally divided between production/administration/research expenses and sales/marketing expenses.

  COMMENT ON JUNE 15 POSTING:
  “If I did not have to ask my Sales Rep to walk through an impression with so many of my referrals perhaps I would like to see a lower ratio of sales to selling expenses but the reality requires support from a sales rep in order to reduce the amount of time I spend on coaching allowing me to be more productive in my practice.”

  NIZNICK RESPONSE;
  There are about 100 Nobel reps in the US. That is 2 per state. I doubt that they devote one to helping your referring dentists take impressions. There are a number of solutions to this problem that would allow you to take advanage of buying implants at Implant Direct’s prices.
  1. Most of the sales support is not in showing the GP how to take an impression. It is in helping them order the right parts. Implant Direct’s interactive on-line ordering system solves that problem. If they need info on taking impressions, send them a link to the 3D animated computer graphics that will soon be posted on our web site showing the impression procedures.
  2. Simplify the abutment attachment, selection and impression procedures by attaching the abutments (or use one-piece implants where possible) and by sending the patient back to the referring dentist with a snap-on transfer. Here is a wake up call to surgical specialists -I met yesterday with two GPs in Vancouver who each place about 500 implants per year, mostly from referring GPs who like sending to “implantologists” because these guys do everything for them short of cement the final crown.
  3. Buy half your implants from the company giving you the service and the other half from Implant Direct.

  COMMENT ON JUNE 15 POSTING: 1/3 of (Implant Direct’s) savings comes from selling expenses another 15-20% will likely come from savings on R&D and Administrative expenses. Since this is not a publicly traded company their will not be stockholder demands for return on investment that publicly traded companies face allowing for additional price pressure savings. Sounds to me like buying direct gets you about what you get from the larger companies only the Implantologists get to shoulder all of costs and risks associated with problems that arise. Which is maybe the way it should be?

  NIZNICK RESPONSE:
  I paid for 20 years of R&D to get the knowledge of what to make and how to make it. I funded the VA study in the 1990’s for over $4M that resulted in special issues of OS and Perio Journals. With over 1,000,000 Screw-Vent implants sold, making implants with the same taper, thread pitch and surface hardly needs to be considered untested. That is why the FDA grants marketing approval if you show that your product is substancially equivalent to something on the market. How much R&D do you think was done before the Speedy Groovy or Speedy Shorty Nobel implants were introduced?

• Jerry Niznick June 17th, 2006

  
  

  POSTED BY DAN SHAPIRO JUNE 15
  “Dr. Niznick….Not only your new system but many other new ones claim to have a really innovative design, claim to answer all possible mechanical or even biological failures, claim to be design to withstand forces for immediate loading and even more Dr Niznick are even cheaper than yours…………But the only truth about it is your and all the others financial interests.”
  NIZNICK’S REPONSE:
  It is in the financial interests of all the companies to come up with innovative effective products. The ones that have a marketing machine capable of persuading dentists there products are unique can reap the financial rewards of maintaining high prices. Those marketing machines, including paid opinion leaders, sales forces, and symposia etc., Dentists get a lot more critical at looking at marketing claims from the major high-priced implant companies, when a company like mine provides “innovative” products at significantly reduced prices. You be the judge whether Implant Direct’s implants offer really innovative designs. These innovations are documented by 7 newly filed patents. For example:
  1. a one-piece implant with an angled head and a scalloped margin
  2. Double lead threads and quadruple lead mini-threads,
  3. Screw-receiving abutments with a snap-on transfer and comfort cap
  4. A one-piece implant with a similar screw-receiving platform.
  Innovations not covered by patents include six different implants all with the same body dimensions and taper allowing insertion with the same set of drills and all-in-one packaging (implant, transfer, abutment, healing collar).
  But what is really innovative, is to offer a high quality, complete implant system that is compatible with Nobel and Screw-Vent drills and abutments, at about 60% less than these (and other) major companies charge.
  POSTED COMMENT
  “Show us real scientific evidence, based on Lab and clinical research with enough long term data then I will be convinced.”
  NIZNICK’S RESPONSE:
  If you are the type of doctor that requires long term studies, then you better stick with the Branemark machined surface external hex implants because Nobel’s Speedy Groovy, NobelPerfect and NobelDirect implants (with TiUnite to the top because Nobel claims this provides soft tissue integration) do not have long-term studies, nor does Straumann’s SLActive new surface or Astra’s Osseospeeed new surface. Ask yourself if you are comfortable paying $350-$400 more per single implant case, because Nobel, Straumann or 3i tell you they have scientific credibility. I am betting that there are enough discerning dentists that will understand the advantages of my designs and appreciate the cost savings of buying factory direct over the internet.
  POSTED COMMENTS:
  Thanks for your comments, but again move aside please.
  NIZNICK’S RESPONSE:
  Sounds more like you work for one of the major companies or are one of their paid opinion leaders whose income may be in danger if these companies can not deal with price competition. Sorry but “moving aside” is not in my nature.

• Anonymous June 19th, 2006

  
  

  Dr. Niznick,

  SLActive is SLA, which has 8-10 years of data regarding the stability and performance of the surface. Straumann did not change the thread pitch or the location of the roughened surface, which allows for at the very least a 1:1 comparision of past performance of the SLA surface. New claims on SLActive are in the process of being published and appear to be in the 2-3 year range.

  I have noticed that you try to lump all companies under the same umbrella. Nobel is having some problems with the Direct and the Scalloped implant but you try and Tar, Straumann, 3I and Zimmer etc.. with the same lack of research brush. In life you get what you pay for. Which is why mosts dentists don’t drive Yugo’s, or listen to “me to claims” in their personal purchasing life.

• Jerry Niznick June 19th, 2006

  
  

  When SLA (Sand blasted with Large grit followed by Acid etching to remove the aluminous oxide particles) came out in the late 1990’s Straumann claimed in its advertisements that its new surface cut healing time in half. They based this not on comparative clinical studies, but on their claims that with the new surface, you could load the implant in 6-8 weeks instead of 3-4 months that was then recommended by Nobel for unloaded healing. 3i played the same marketing game with its Osseotite surface. You may remember the Straumann advertisement with a Samurai cutting a clock in half with a sword. I think the real reason Straumann introduced SLA was that when the porous TPS surface became exposed from any bone loss, it caused soft tissue problems. Of course Straumann had to give a reason for its change in surface other than saying they screwed up for over a decade with putting too rough a surface right at the crest of the bone when everyone was keeping a relatively smooth neck to allow for bone loss. Straumann’s TPS screws were used for immediate load and their other implants could just as easily be loaded in 6 weeks as the SLA implants. Straumann never did any clinical comparison clinical studies showing the that SLA implants could be loaded in 6 weeks while the same implant with TPS surfaces needed 12 weeks. They just took what everyone knew… that you can load implants in good quality bone earlier than 12 weeks, or even immediately, and then claimed that the shorter healing time was attributable to the change in surface from TPS to SLA. Now Straumann is doing it all over again, packaging the SLA implants in sterile saline, raising the prices by about $50 per implant, and claiming that now you can load them in 3-4 weeks. Where are the side-by-side clinical studies comparing SLA to SLActve and showing a statistically significant difference in success? They cannot do it because they know that in good quality bone, both implant surfaces can be loaded even immediately, and heal with an osseointegrated interface. A clinical study of about 300 Straumann SLA (old) surface implants presented by Wilson at this year’s AO meeting in Seattle, showing 98% success with immediate load in extraction sockets. I asked him from the audience if he would expect to get 99% success with SLA active… he did not answer this rhetoric question, because the answer shows the fallacy in Straumann’s claims of earlier loading with SLActive. Conducting an animal study in miniature pigs (Buser et al. J. Dental Research: Vol 83, 7, July 2004) showing a significant different in implant bone contact between SLActive and SLA at 2 weeks (before the bone is mature enough to carry load) and at 4 weeks, but with less bone contact at 8 weeks with the new SLActive surface compared to the original SLA surface, hardly justifies Straumann’s claim that SLActive cuts the healing time needed prior to loading a dental implant, in half. I will give Straumann more credit for doing research before it brings a new product out, than I would give Nobel but Straumann’s SLActive surface studies primarily serve to create marketing sound-bites rather than prove any clinical significance to their new surface. In that regard, I do not see any difference between the exaggerated claims of Nobel and the exaggerated claims of Straumann, both serve the single purpose of justifying exaggerated prices.

  Your posting claims: “In life you get what you pay for. Which is why most dentists don’t drive Yugo’s, or listen to ‘me to’ claims in their personal purchasing life.” This statement does not happen to be true when purchasing implants from Nobel, Straumann, 3i and any other company with large marketing budgets and huge profits. Yes, you do not get a Mercedes car for the price of the Yugo, but to paraphrase Lloyd Benson in the VP debate against Dan Quayle, I drive a Mercedes and the Straumann, Nobel and 3i products are not the Mercedes of the dental implant industry. They are not a Yugo either but more like a Buick selling for Bentley prices. Implant Direct’s marketing strategy is not based on “listen to me” claims, but to say listen to your own good judgment and common sense. For every dollar they spend with Straumann or Nobel, about $.17 goes for cost of goods, $.33 for sales and marketing expenses, and $.33 for profits. That equates to about $200,000,000 in profit for Nobel and around $100,000,000 in profit for Straumann every year. That is great if you are a shareholder but not so great if you are the dentist paying Nobel $46 for a cover screw that other companies include free with their implant, or paying an additional $50 to get your implant delivered in a sealed container of sterile saline. At Implant Direct, the savings in marketing expenses are passed on to the consumer for 60-70% savings over the list prices charged by the major implant companies. Dentists going to Implant Direct’s web site to view 24/7 operations on 5 live cameras will reach the same conclusion Merrill Lynch did in its June 10, 2005 published report to investors in medical industry after visiting our factory. ML published report, concluded that Implant Direct is a “Serious and Dynamic operation” further stating that they were “impressed with the precision engineering and the attention to detail.”

• Anonymous June 19th, 2006

  
  

  After the AO meeting in 2006 Merrill also said they do not believe that Implant Direct will have an appreciable impact on the current Dental Implant marketplace . You have posted over an over about SLActive and it is clear that you do not understand what Straumann is claiming nor the technology behind the innovation. Sterile Saline protects what has been accomplished with the surface, it is not what makes the implant hydrophillic or chemically active. In addition, you talk about roughened surfaces as if they existed in a vacum. Implant surfaces have impoved over time as have implant designs. Your Internal Hex design, for example, that is currently got to have the folks at Zimmer wondering what they paid for. TPS was an additive surface while SLA is subtractive. Straumann researched the morphology that osteoblasts cells seemed to prefer and came up with a design that was supported by that research. Right or wrong they documented outcomes and published those results for everyone to read and agree or disagree. 3i did the same with Osseotite, although maybe not with as much attention to publishing. Machined surfaces gave way to HA coated surfaces or roughened additive surfaces which gave way to subtractive surfaces. Each time improvement regarding healing times occurred. Giving that once all implants recommended 6 months prior to final prosthesis. Once again you bring up the rather simplistic Immediates arguement, which as I stated in another post is like saying if your car works you should drive it. What happens when you do not have the bone quality for an immediate is a far better question? That is in keeping with the reality of the situation that implants are being placed into. If it doesn’t matter then why not go back to machined surfaces and make everybody wait 6 months for a prosthesis?

  The same Buser study you qoute shows new bone replacing old bone in the first week of implant placement. Their is no statisitcal difference of bone to implant contact in the 8th week. But their is a huge difference in week 4 when you consider that we are talking about secondary stability and not primary stability. I also notice on your website you did not post all the comments from the SLActive Blog from this site. Why is that?

• Jerry Niznick June 20th, 2006

  
  

  “ANONYMOUS” POSTED QUESTION:
  What happens when you do not have the bone quality for an immediate is a far better question? That is in keeping with the reality of the situation that implants are being placed into.

  NIZNICK RESPONSE:
  Now you have asked the right question, not that you or Straumann will like the answer. In type 1 and 2 bone, where the density requires 35Ncm of torque or more to insert the implant, then any rough surface implant can be immediately loaded. In Type 4 bone, which is so porous that the implant can be inserted using finger force alone, it is best to wait the full 8 weeks it takes for maximum bone attachment. At 8 weeks, the Buser Study I cited and Straumann relies on for its claims of faster healing with SLActive, show that SLA has a higher bone contact than SLActive, although not significantly so. That leaves type 3 bone that may or may not require 35Nc of torque because it is subjective as to what you call type 3 bone. On Straumann’s web site, under the histology picture of the bone at 4 weeks healing with SLActive surface, it states: “Woven bone is mainly recognized by the numerous large osteocytic laculae.” This hardly sounds like bone well suited to loading at that time and Straumann has no side-by-side clinical studies showing success with SLActive loaded at 4 weeks with failure of SLA surface implants in the same quality bone when loaded at 4 weeks.

  THE ANSWER TO YOUR QUESTION ABOUT WHAT TO DO IF YOU DO NOT HAVE GOOD QUALITY BONE, SUITABLE FOR IMMEDIATE LOADING (i.e. can not achieve 35Ncm of torque) IS FOUND IN TWO ARTICLES. One was written by me in 2000 and is posted on www.implantdirect.com under Research on the home page. It is entitled “Achieving Osseointegration in Soft Bone: The Search for Improved Results.” That describes the technique I developed and even patented of placing a tapered implant into an undersized socket to increase the initial stability. The Tapered Screw-Vent and the straight step-drills I developed for inserting that implant (also used for my new Spectra-System Implants with the same body dimensions and taper), were used in that study and show a doubling of the torque required to insert an implant in soft bone. So if the bone is too soft to achieve 35Ncm using a straight implant like the ITI, or a tapered implant inserted using tapered drills like Nobel’s Tapered Replace Implant, the threshold stability for immediate load may be achieved by varying the surgical technique. If by using my surgical technique of inserting a tapered implant into an undersized straight socket, one could achieve the 35Ncm minimum initial stability and therefore allow immediate load, that would be 4 weeks shorter than with the ITI implant with its $50 premium SLActive surface.
  My study and surgical technique are backed up by a recent study by Shalabi et al. COIR Vol17. #2, April 2006. Pg 172-178. In that study, Shalabi compared Tapered implants with a machined surface to the same implants with a “grit-blasting and additional acid etching”… sound familiar? The researchers looked at Bone to Implant Contact (BIC), Peak insertion and removal torque, and SEM of bone morphology.

  “RESULTS: Insertion and removal torque values were significantly higher for etched implants inserted with the undersized technique… Also the average BIC value was higher for the etched implants placed with the undersized technique, which was statistically significant, compared with machined and etched implants inserted by conventional technique.
  CONCLUSION: This study shows that the surgical technique has a decisive effect on implant fixation (represented in this study by installation torque values/removal torque values and histomorphometric evaluation) in trabecular bone.”

  Straumann would have been better advised to taper the ITI implant, develop a set of drills to allow inserting it into an undersized socket, and than drinking the saline.

• Anonymous June 20th, 2006

  
  

  Dr. Niznick,

  The word is paradigm, not paradym

• Jerry Niznick June 20th, 2006

  
  

  It use to be paradigm but the Shift changed the spelling to paradym. “Para” means around, and “dym” is an acronym for “Defect and Yield Management.” So a Paradym Shift in the Dental Implant Industry means we can go round and round discussing defects with the products and pricing of dental implants but in the end, the consumer will ultimately yield to the company most capable of managing design, quality, simplicity and price.

• Anonymous September 10th, 2006

  
  

  Keep it up Jerry! You do recognise dental implants is a growing market. So a 5% share today is significantly less to a 5% share 5 years down the road.
  Give those big players a run for their money and I hope you can force some positive changes.
  regards,
  kfchow.msia

• Dr. Emil Shiri March 28th, 2007

  
  

  I have been inserting dental implants since the late 80’s. I started with the original corevents because as a G.P. I was not “invited” to the Nobelpharma courses. I took courses whenever I could and slowly advanced my expertise in the implant field. The introduction of implants in Dentistry is one of the most significant advancements in this century for our profession and for the public. In their hast to bring these products to market many manufacturers did not do proper research and developpment and left many dentitsts to develop their own skills at “problem solving”. I took on these early problems as a challenge, not a chore in an attempt to further my ability to give my patients an alternative to removeable prosthetics.
  I believe that any company who spends millions of dollars doing research should be compensated by having implants at a premium price like that being charged by the big four implant companies. However, like the pharmaceutical industry, there are many companies who have made “generic” products at a substancial discount to prices that are being charged. It is up to the dentist to decide when and where these products are to be used. They certainly have their place and I welcome them.

• Dr. Spinner June 19th, 2007

  
  

  To Anonymous: who is very passionate about supporting the big companies and even more passionate about knocking Dr. Niznik. All implant manufacturers quote better than 97 percent success rates. Implant Direct will likely achieve the same. If you are happy to pay Nobel and Straumann prices thats great. You may even truly believe you are getting a better product. Maybe you really will get a half percent better integration - or, maybe you won’t. What I don’t understand is how strong your objection is to an implant provider who has a history of quality and innovation that provides a highly competitive implant at half the price. I am sure Implant Direct will significantly alter the mindset of what Dentists are willing to pay for implant products on the basis of questionable claims.

• dprizut December 23rd, 2008

  
  

  Dr. Niznik said:

  “As for your “hope that I can convince (my) new customers,” I do not know exactly what it is you expect me to convince them of. The design innovations, significant price advantages and on-line ordering system for my new products will appeal to some and be of no interest to others. Given the size and growth in the implant industry, I have already bet $20,000,000 before selling a single product that I will appeal to enough dentists to make a good return on my investment. There will be no salesperson, training courses, international symposia, paid oppinion leaders or free products used to persuade dentists to buy my new products. I am only targeting the knowledable, experienced and open minded clinicians who already realize that Nobel, Straumann, 3i and others have failed to adequately address all their clincial needs at prices that allow the benefits of implant dentistry to be enjoyed by the majority of their patients.”

  How many sales reps do you have now? Why did you state that you would not hire sales reps when you have approximately 15 nation-wide and are in the process of doubling that?

• R. Hughes December 24th, 2008

  
  

  It’s a free market! There are a number of decent and reasonable implants on the market.

• Dr. Robert Sicurelli Jr. February 21st, 2009

  
  

  Dr. Niznick
  My dad and I have been using your products since the 1980’s when they were packaged by hand and sold at AAID meetings. They have always demonstrated the highest standards in bio and mechanico engineering. Thank you for all that you’ve done for our field. Dad sends regards.

  Bob Jr.

• R. Hughes February 22nd, 2009

  
  

  We GP’s owe Dr. Niznick a big thank you! If it were not for him. Not as many or any GP’s woulg be placing implants…….R. Hughes, DDS, FAAID, FAAIP, DABOI

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