Thinking of Switching from 3i Implants to Ankylos: Any Thoughts?

Dr. MA asks:
I have been using Biomet 3i implants and am thinking about switching to Ankylos implants [Dentsply Friadent] because in the cases I have observed there is minimal die-back [Editor: bone loss around cervical area of implant in crestal bone]. I would like to confirm this with users if they have observed this as well. I also am concerned about retrievability of implant abutments after they are torque down [pre-torqued] to the recommended torque values. Can these abutments be torque out if necessary without damaging the threads of the implant fixture? Anyone else make the switch? What has been your experience?

39 thoughts on “Thinking of Switching from 3i Implants to Ankylos: Any Thoughts?

  1. Ankylos have an excellent implant-abutment connection, ‘the morse taper’ which has minimal to no micromovent which results in stable crestal bone levels due to providing a bacteria proof seal similar to bicon which uses a locking taper. The nature of this connection also allows the abutment to be torqued down at much lower values – 15 Ncmm which can achieved by finger pressure and hence can be torqued out easily in most cases

  2. Here is an interesting study to consider, especially since it wasn’t done under load:

    Clin Oral Implants Res. 2010 Jan 13. [Epub ahead of print]

    Microbial leakage through the implant-abutment interface of morse taper implants in vitro.
    Aloise JP, Curcio R, Laporta MZ, Rossi L, da Silva AM, Rapoport A.

    Department of Head and Neck Surgery and Maxillofacial Surgery, Heliópolis Hospital, São Paulo, SP, Brazil.

    Abstract Objectives: The aim of this study was to determine and compare the frequency of bacterial leakage of Streptococcus sanguinis biotype II along the implant-abutment interface between two systems of morse taper dental implants. Different methods of activation of the taper abutments were used: tapped-in (Bicon((c))) and screwed-in (Ankylos((R))).

    Materials and methods: Twenty sterile assemblies were used and attached, 10 Bicon((c)) and 10 Ankylos((R)) implants, according to manufacturers’ specifications. They were then totally immersed within 20 test tubes containing a sterile nutrient solution brain-heart infusion (BHI). The internal part of the 20 implants was previously inoculated with 0.1 mul of S. sanguinis II (ATCC 10557) and then connected to the respective abutments. The assemblies were incubated under anaerobic conditions for 14 days in an autoclave at 37 degrees C. They were monitored daily for solution cloudiness resultant from microbial leakage on the interface of the assemblies. For statistical analysis, the Fisher test was applied and significance was assigned at the 5% level. Results: There was solution cloudiness, indicating the finding of bacterial growth inside two Bicon((c)) assemblies and two Ankylos((R)) assemblies 48 h after incubation. Microbial leakage was further substantiated by testing the suspension for the presence of Streptococcus sp. None of the sterility controls were contaminated. The frequency of bacterial leakage along the implant-abutment interface, with the two different morse taper implant systems, was 20% of the assemblies of each system. There were no statistical differences between them.

    Conclusion: Irrespective of which of the two morse taper implant connection systems of activation was analyzed, tapped-in (Bicon((c))) or screwed-in (Ankylos((R))), this in vitro experiment showed bacterial leakage along the implant-abutment interface.

  3. Although I am not a 3i User, I would review all the evidence around both systems, and I would not sacrifice the high predictability of a system like 3i, as compared to Ankylos. Both surgically and prosthetically, 3i is by far superior and more reliable. At the end, swithching implant systems in practice alters clinical protocols. Are you willing to pay the price for no real reason. Think about it. By the way, I am a Nobel User, not because is better than others, just because I have very well established and succesful clinical protocolos with it.

  4. There are numerous different systems available and everyone has it’s good points and bad. The champions of each system will show their best cases to support their views while quietly burying the ones that didn’t turn out so well. In the end the system that works best is the one you know. When you understand your tools perfectly then you achieve the best results.
    My experience of chasing the ideal implant system has cost an awfull lot of money and yielded very little. I now use Nobel for most situations which is back where I started because I know it so well.

  5. I’m a long time user of Ankylos platform who play an important role in a whole change in the modern implantology that for a long time accepted the so called saucering or saucer type defect ( Bone Loss ) granted by many experts and many studies that bone loss of 1 mm/first year, was organic and brought by the remodeling of the cervical bone due to biological factors. I got fantastic success with Ankylos, easy to use, with few components in both, surgical and prosthetic procedures, usually companies create tons of parts required to complete a case, the Morse and cervical porous collar is a proven successful combination if not why Straumann created the Bone Level system? which is based in surveys based on Ankylos. There are many papers proven the contrary in the Brazilian study presented by the colleague above. I’m sure Dentsply can offer you all the assistance you need for a in deep presentation of this simple a reliable system.

  6. This is a “no brainer”. Make the switch. Ankylos implants are placed sub-crestal. The importance of this is crucial to their success. Crestal bone can not tolerate lateral stress very well. If early loaded, it breaks down. Loss of crestal bone height leads to loss of support for the papilla. The Ankylos C/X implant has a 6 sided orientation feature making the implant very friendly to work with. It is simply the best implant system on the market today, bar none.Bicon is also sub-crestal, but very unforgiving. All others are “bone level” which means that they transfer stress to the crestal bone. As I said, a “no brainer”.

  7. Be careful. The Ankylos implant is a very nice implant, but can be a restorative nightmare. Have a chat with your Dental lab, they tend not to like this system even with the new indexing system. There are other systems out there that offer the same benefits as Anklos but without the restorative hassels, for example Straumann Bone Level and Astra.

    Hope this helps

  8. I have been using Anlylos for over 3 years. I have found the bone to stay at the preop level and even increase the bone height in some cases. Please review the literature and you will find great bone response to this system and connection. As with any system, there is a learning curve for all involved (including the labs) Anlylos is now setting the standards for bone and tissue stability. I wish I had learned about this system much earlier in my career and not left so many patients with bone loss around the implant that will probably continue. You can use this system with the confidence of over 20 years experience in Europe.

  9. I for the life of me don’t understand why anyone would want to switch to Ankylos from any other implant system. I have restored Ankylos implants from the time they came to the US, before there was an anti-rotation feature. My experiences as a restorative dentist were less than pleasant.
    First, the interface between the implant & abutment is quite narrow and is the same regardless of the implant diameter. This makes restoration of molars difficult from the prosthetic standpoint, since starting out from such a narrow platform makes it difficult to close gingival embrasures when restoring wide teeth. A similar problem is found with the NobelActive implant.
    Secondly, the small diameter of the interface makes it impossible to use an abutment screw of conventional design. The neck of the abutment is so narrow that the threaded part of the screw is pressed on to the shaft after the shaft is inserted into the abutment and then laser welded into place. It is called a “captive” screw. I personally have pulled the threaded portion off of the shaft when hand tightening an abutment screw. This, in my opinion is a weakness and a major design flaw.
    Third, I don’t understand one of the previous posts regarding sub-crestal placement. Any “bone level ” implant can be placed in a sub-crestal location. My understanding of the lack of crestal bone remodeling is due to platform switching, not the location of the implant related to the bone crest.
    Lastly, though a surgeon may look at the limited number of prosthetic components as a plus, a restorative dentist appreciates the flexibility and options that a more robust prosthetic catalog presents.

    I find the Ankylos system to be quite limited prosthetically. Though every implant system has it’s plusses & minuses, I would recommend not leaving what you know until all factors, both surgical and prosthetic, have been considered.

  10. I move from 3i to Bicon 10 yrs ago because 3i was getting over complicated with too many drivers. I moved from bicon to ankylos 5 yrs ago because I had had some unexpected integration failures with Bicon. They do not work well with simultaneous gingival healing caps . Ankylos has similar advantages to bicon in terms of no micro-movement and failures are very rare but I do wish there abutment posts werte a bit better thought out . But I still find it a great system , but previous comment about the labs is correct , Bye the bye , after observing some of my old bicon cases I have gone back to using bicon posteriorly in half my cases . I{and bicon] modified my surgery techniqes to ensure gingival ingress does not occur post-insertion.

  11. Ankylos is a far better system & has got much better results. Its design & easy 2 use make it friendly. I think you better go for an implant system for which you can hav full back-up in ur clinic in all respects. Implant success or failure depends upon dentist’s technique……………….

  12. Some clarification: The Ankylos abutment system does create “problems” for those of us wedded to smooth transitions and appealing visual esthetics on radiographs. Creating natural looking molars with wide gingival bases is not a problem. The positive contact to the gingival tissue is in a plaque free zone. We need to get over “smooth” emergence profiles we desire in crowns cemented to natural roots.

    The welded screw to the captured shaft is an excellent design as long as a 15 Ncm torque wrench is used. Hand tightening is a legacy technique, of unknown force values, carried over from high torque screw design.

    Lastly, even though all implant systems can be placed sub-crestally, they do not enjoy the acid etched surface over the entire bonding surface of the implant, including the gingival platform area. This promotes positive osseous development in a crucial area for gingival support and papilla growth.

    All in all, even though the Ankylos system doesn’t look like a tooth in cross section, they are the best human engineered system on the market. Airplanes don’t look like birds either, yet both fly exceptionally well.

  13. The Ankylos system can be more challenging to restore, but it MAY POSSIBLY have the benefits that out weigh the challenges. I am talking about the reasons why you are considering to switch systems.
    I have used and tried different systems, and I am not as familiar with Ankylos, but do use Nobel Active. The Nobel Active implant has a similar internal hex morse taper, and has the platform switch…but what it has that the ankylos does not…is a deep thread pitch..which provides for more bone to implant contact…therefore increase surface area, as well as being more aggressive i.e. self tapping and increased initial stability.
    In addition, it has a slight reverse taper at the top of the implant, which helps minimize the torque placed on the crestal bone at time of placement….minimizing the amount of bone loss at the crest and implant platform.
    All that being said…I have used Nobel Active since it has came out on the market…along with other systems. When comparing initial stability and evaluating bone die-back at the crest…I can honestly say I have not seen one other implant system that is as good and can compare with respect to these to factors.
    Yes…the restorative side of things are tougher and more technique sensitive….but again…the benefits you gain from this implant…far outweigh the more difficult restorative phase with this implant

    Good luck

    Therefore if you are looking at the Ankylos system…before you make a final decision, you may want to look at the Nobel Active as well.

  14. Here is what is good about Ankylos: very high insertion torque / inital stability, very good bone and tissue response, very good for immediate loading, good to place in esthetic zone, very strong 3.5 fixture that you can use under any crown. It is also very well researched. What is bad is it looks odd as previously noted, and a little learning curve for the prosthetics, no UCLA abutment, dentists in the US dont know much about it so you have to educate your referrals.

  15. Do the switch. But choose C/X components. You will have advantages of Ankylos with the convenience of an ordinary indexed system while restoring.

  16. I am a big fan of Morse taper implants. I do not use Ankylos, but I use Bicon and Quantum, (both Taper lock systems). The benefits of Quantum is the versatilty. It can be used in both external hex and Morse taper applications. There is no other implant system on the market that has that flexibility. It has a deep hex on top with a thread pattern (screw threads below the end of the Morse taper well)down in the well for screw retained. In addition to Quantum pieces and parts, all Bicon Morse taper parts fit the Quantum system. For example an 11 mm Quantum implant can be placed at depths of 9, 10, 11, 12, 13 mm. In a Morse taper application you plant the top the hex 1 to 2 mm below the crest or in a external hex application you plant the implant from flush to 2 mm above the crest. The Quantum is a screw-in implant with an aggressive thread patter similar to Nobel Active. The Bicon is a pushin and does not have the advantage of being used in a screw retained application. I love Morse taper implants for east of paralleling for over dentures. The o-ring abutments come in 0, 15, and 25 degrees. The Morse taper allows 360 degrees of rotation for paralleling. Just get the abutments alinged and tap em in place. The other implant systems I use are Tatum and Implant Direct (Nobel Biocare Tapered Groovy Clones). I am of a fan of Hilt Tatum’s concept of cementing the abutment into the implant and placing the crown margin on the implant body. (no chance of wiggley crown down the road). I like Implant Direct because of the cost because I think Nobel Bicare is over priced. Hilt Tatum’s implants are $110. Hard to beat that cost. I am not trying plug these systemns, but just pointing out my experience with these systems. I am a general dentist and have an implant only practice. I also have an i-CAT classic. I would hate to be limited to only one implant system because that would limit my treatment options for patients.

  17. To ceep the crestal bone, to harvest bone I would defenetly go for bicon. It is really simple and is really bacterial sealed.

  18. whilst all the systems mentioned worked, i have used many!

    in my experience only Ankylos gives consistent, predictable results, which on most occasions go way beyond even my own expectations.

    Dr Best mentions Bicon above, but with Ankylos you get all this and more.

  19. Implantdent, what your expectations has Ankylos gone beyond?
    Small diameter or short implant for big tooth?

    I know Bicon delivers it, but the system is analog: you dont control torque of insertion, of abatment. Just tap and tap. And prostetic component – having to light-cure 3 unit bridge in the mouth… It’s time for something newer.

  20. You may want to try the AB Dental implants, MIS-7 and the Quantum Implant. Also consider Implant Direct. All of these have interesting advantages and at a reasonable price. I am amaizeb that some manufactures are still making implants with machined (steel) threads.

  21. You cannot dent the beautiful results with Ankylos, it does have restorative challenges though. Other conical interface designs with much simpler restorative options that give you the results you’d want in your own mouth would be Straumann Bone Level or Astra restored with Atlantis Abutments. It is very hard to get a better restorative result than you can acheive with Atlantis CAD/CAM abutments. Cost in the scheme of things is really a non issue. Going the cheap route is like buying a Mercedes and saving money by not getting the floor mats.

  22. As for the prosthetic dificulties some collegues faced with Ankylos , those dificulties had been over comed now after invention of new Ankylos CX which has an indexed abutment connection , now you can say that Ankylos is very near the perfect implant system of the near future , we all have to ride this train any how , either you take the front cabin or wait till the end and take the last ones , shifting to Ankylos is a very wise idea.

  23. A final word: Not all “Morse Tapers” are created equal. Only Bicon adheres to the original Morse Taper specification of 1.5* of taper. Ankylos, at 5.7*, still enjoys a removal force greater than the insertion force. Most other systems are 11*+ and require much higher torque values on the retaining screw. Secondly, many of these other taper systems compromise the benefit of the taper by sacrificing the taper to incorporate their index (Nobel Active). The Ankylos system enjoys 2.35 mm of continuous taper depth. If you chill an Ankylos abutment to 0*C (place it in ice water) prior to insertion into the integrated fixture, it will thermally expand and form an hermetic seal of less than 0.25 microns. The abutment/fixture becomes “one” and the screw loses all practical retentive function.

    The Ankylos system has only had 2 design modifications in 22 years. In 2005 they removed the cervical polished collar and replaced it with a continuous, micro blasted and acid etched surface with the body. Then in 2008 they added internal indexing, the C/X line, without sacrificing any of the dimension and benefit from the taper surface. Most other systems have gone through design changes many times over the years, looking for the holy grail. Ankylos found it many, many years ago. Anklylos tracking data on 16,000+ implants placed reports 98% success, maxilla and mandible combined.

    I believe it is time to stop looking for the best implant system and recognize it is right before your eyes.

  24. Thank goodness you are getting away from 3i! Ankylos has issues too, why not look at cam log, astratech, Nobel, or even zimmer?

  25. Bicon dental implants appear to have every advantage of the Ankylos system, since they feature a gradual locking taper (1.5 degrees) which gives it the same tight bacterial seal and prevention of movement. The outer edge is tapered to allow space for bone (harvested during drilling) to grow around the top of the implant, in order to further protect against crestal bone loss.

    Bicon implants also feature larger fins in the base which provides 30% more area for the bone to grip onto, providing better protection against lateral and rotational forces.

    So…Bicon implants for the win?

  26. All implant systems have issues. I use 3i for 6 years and I am very happy with this system. The most important part of dental implant systems is to know how to use them. If you know the technique of using the system then you should have no problem. The only one issue I found with 3i is the price. I do late implantation and immediate implants placement and I have excellent primary stability.

  27. dont go for ankylos.
    the system is very good but the customer service is the worst i ever experienced. here in the uk the people in sales are really stupid. sending bills several times with urgend and last notice reminders for articles that have been paid 2 months ago.
    the people in sales dont know about the products.
    i got wrong items delivered and so on.
    very very poor customer service.

  28. I have to agree with many of the messages. As a GP who works with many surgeons with many systems, long term success to me is all about bone and tissue stability. NO system for 20 plus years of data has shown me what Ankylos has. Stability means fewer black triangles 5years later, stability to me is almost a virtual elimination of the saucer effect that I have seen on other systems. NO doubt many good systems out there but for 6 years now, Ankylos has shown me incredible stability.

    Yes, restorative has been an issue. NO internal hex, equates to jigs and for mulitiple unit casework, far more difficult for sure. Their new CX has now an indexing which will make this system far more user friendly for restorative docs and labs. WELL overdue for sure but enjoy the long term success.

  29. hello dear colleagues,
    swiching from a brand to another one?why?of course there might be some advantages in newer brands ,but do any one thinks that the most important point in implantology(as other branches of human surgery )is te knowlege and skill of practitioner?
    i have a casr done in 1986 for a lady with no sufficient bone in maxilla and only 2 first molars one on each side,and only by inserting of 2 long fixtures(45mmeach)throu maxilla to the zygoma and doing a complete upper rehab with only 2 molars and these 2 fixturers,with no coating and only pure titanium and it is still working properly in this old lady,and the point is i do not remember the brand!!!i only know that i,ve done this without thinking about the brand or the prizes they provide or the package tours…etc

  30. The study submitted by Dr. Peter B is not valid to evaluate Ankylos, as the implants were completely submerged in a liquid solution. The authors (and Dr. B) failed to understand that any liquid (or bacteria) found inside the Ankylos implant may have entered from the top of the abutment and through the retention screw.

  31. The reference posted by Dr. Peter B is incorrect. The correct reference is;

    Clinical Oral Implants Research
    Issue: Volume 20(9), September 2009, p 1026–1027
    Copyright: Copyright © 2009 Blackwell Publishing Ltd.
    Publication Type: [Posters (Abstracts 40 to 425)]
    ISSN: 0905-7161
    Accession: 00001698-200909000-00380

    Please note that this is a poster and not a peer-reviewed paper.

    Kind Regards,

    Bill Schaeffer

  32. About Ankylos with index (cx) you have to consider problems that can occur in the prosthetic phase. Ask someone about it and you will understand what I’m speaking about.

  33. I wonder what is the difference between ANKYLOS C/X and any other system with indexing capabilities (internal/exernal hex, octagon, etc).I can only think of the perfect seal that Ankylos provides at the implant abutment interface and the platform switching feature…

  34. I have a quite long experience in Ankylos, old and new design implants. I believe it is a very flexible system for use in any bone site, especially the narrow ones.The very clever anterior abutment design is very helpful for nice aesthetics.

  35. What about the an implant that has the lot Axiom made in France without the prosthetic headache.Internal hex true cone morse taper and trilobe abutments?

  36. Does anyone screw retain their crowns on Ankylos fixtures? I have been using Strauman, 3i or Nonle Biocare but am about to start restoring Ankylos. The implantologist and the rep both say it is not necessary but I am trying to avoid cementing crowns to prevent cement remaining under gingiva but more importantly because screw retained crowns are always easier to retrieve. Anyone any thoughts on this?

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