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Don, a general practitioner, asks:
I started placing dental implants this past year using Noble Tapered Groovy and have run into issues placing them in my last two cases.
Case #1: #11 extracted and placement of Alvelogrove’s bone graft material and waiting the time recommended; approx 4mo. At placement the graft did not take and was removed. I called Alveologrove, makers of the bone graft and they told me to use their “Flow” material after placing a longer and if possible a larger one and the implant must not be like “sticking it oatmeal”, duh????
A call to Noble advised me to do the same and have similar results. I placed a longer one after syringing the “flow graft” into the socket, but was only able to get about 20 Newton’s of torque.
Case #2: Last week, a similar situation happened to a very similar case (extraction with graft, wait over four months then place #8 and 9) but this time the bone graft that I placed seemed to have taken better, however, I was only able to get “finger tightness” on the implant.
A call to a local periodontist I have used for over a decade advised me to remove the dental implant and graft again if I could not go longer/larger diameter and get the 35 newton’s torque. Due to anatomy, a larger diameter dental implant was not viable, but I did try a longer one without luck.
However, this one was not like being stuck in “oatmeal” as Alvelogrove and NobleBiocare said to avoid, obviously. It was not floating in the socket. It did have threads and could not be just pulled out However, I did what the periodontist I use recommended; I removed the dental implant and regrafted.
Any thoughts? The problem I have is a difference of what is considered “initial stability”. Will you always be able to get 35-40 newton’s of torque and what is considered adequate initial stability?
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6 Responses to “ Noble Tapered Groovy Issues ”
you do not always need 30 or more Newton as initial stability .
finger tight can be good enough if you can leave the implant totally unloaded for six to nine months .be very carefull with ‘indirect’ load from overlying removable prostesis.
for single tooth replacement you should be carefull with this concept . if it turns out not to osseointegrate you may have lost almost a year treatment ,I would suggest extraction with very carefull curretage ( provoque bleeding ! ) and than induce bonegrowth with the Biocoll concept . mixing your graft with patients own bone cells will help getting result . do not believe in ‘miracle’ grafts that grow bone ‘out of the bleu ‘ . bring in patients own living bone cells .
Dear Don,
you are showing the profession exactly what a company like Nobel Biocare want….selling Implants!
Oral biology my dear colleague will answer you your questions and not any salesman……
Dear Don,
Your posting illustrates exactly what the implant companies want you to believe: “Who needs an implant surgeon? Theyr’e so easy to place that a five year old can do it. Why send it out? You can do it yourself & keep the big fees”. Knowing what you can do successfully & what you can’t is no easy thing. My grad students & residents get in over their heads all the time. My best advice: Stop listening to salespeople & take a good, hands-on, 20-100 hour implant course that is university-based, not company-based.
Try using a different hard graft material like hone chips 1-2mm and leave for 6 months (do NOT condense hard in socket). Works!
3I SALESMAN: 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’S RESPONSE:Retrospective reports from a few paid opinion leaders are hardly credible research. I have yet to talk to a clinician using 3i implants who ever claimed that kind of success nor would I expect that kind of success given that the Osseotite surface is the smoothest of any other implant on the market. Acid etching is a chemical polishing process. The VA study compared HA coated implants to acid etched implants in the 1990’s and reported 95% -97% success with HA with the lower number being in type 4 bone, compared to 71%-91% for acid etched surfaces. That is why I abandoned acid etched for blasted surfaces 15 years ago. Also, 3i has no 5-10 year studies on acid etched titanium alloy implants. It had to change to alloy from pure titanium a few years ago when Zimmer licensed it on my internal connection patent. Acid etching does not pit an alloy the way it does CP Titanium so your claim of long term studies are just more salesman’s talk.
3I SALESMAN: 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 their door.
NIZNICK’S RESPONSE: Your restorative doctors will not thank you when they have to make custom cast abutments or cad milled abutments on every case, rather than stock abutments, because 3i does not index the direction of their angled abutments, or the scallop of their contoured abutments to the flat of the hex or one of the tri-lobes. The more stock abutments a dentist can use, the lower his/her component costs. It is even better when the abutment is included free with the implant, especially when the implant itself sells for less than half the price of 3i’s implant.
I want to thank this board for being here, and the dental professional that gave me the clues to get here. He WANTS me to be informed beyond the office handouts and to participate in the restoration of my oral health. This is a great site towards that end and the fact that my Dr. wants me to know about the good, the bad and the ugly gives me great confidence that he is concerned more about my health.
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