Endopore Implants in the Posterior Maxilla?

Dr. F--I've done 3 of the endopore implants in the maxilla[longest 3 years in place] and so far so good. The sinus was 'lifted' through the osteotomy. I've also used them in the posterior mandible[10 of them so far] with 5 mm of bone or more. I've had one failure so far[a 5mm by 5mm] and the rest have held up. I'm keeping my fingers crossed but the patients love it because they don't have to have a sinus lift or some of the patients have been told that they couldn't have implants in the posterior mandible but the endopore works.

Dear Dr F Placing short Implants in the posterior region such as 7mm elevates the potential of failure.Usually in these areas there is severe bone loss and therefore crown to root ratio is unfavorable.Pushing the limit with short Implants is not the recommended solution.I prefer doing a sinus lift and not as one of our colleagues stated "chicken Implants"...

I use them for those cases specially, they work like a charm and the indirect sinus lift is a really easy technique and has very predictable results luck

well.. to start, I am not an advocate for endopore, nor any other company. I am not using these Midget implants as my routine implant cases, but as everyone said (except Mr. "God" who thinks treating patients should always accompany pain & permanent paresthesia, just to prove he's not a "CHICKEN"..) these implants have their own limited indications, but within those limitations fall several patients who do not want to, can not afford paying for, or are scared of sinus manipulation, or as other colleagues said, have been turned down the gift of implants, due to lack of posterior mandible bone quantity. I have placed about 20 of these implants exactly in those cases, and i have up to 4 years of post ops from surgical all the way to my referrals' photos & xrays...and except one... all are fine. and ALL of those cases from bridge to single units have naturally UNFAVORABLE crown-root ratio! the key is to stick to the rule...do not leave the rough part supracrestal...and by the way.. it would be nice if people who talk about Crown-root ratio would understand that they can not apply the natural tooth mechanics with PDL, to the implants .

I have recently added the Endopore fixtures in my practice when a past mandibular implant patient requested fixture placement in the #14 area and refused traditional sinus floor augmentation. I have placed 10 fixtures thus far within the last year; all within the posterior maxillae. Ostetomes were used to both condense the surrounding osseous support and elevate the sinus floor. I allow additonal healing time, 6 to 8 months and have been extremely pleased with the results thus far. I do a thorough informed consent and review several treatment options with benefits, risks and alternatives discussed. I agree, for those patients that cannot afford or refuse traditional sinus floor augmentation for any reason, these fixtures offer a viable alternative. Additionally, I have patients with both mandibular and maxillary endore fixtures placed by other practitioners 5 plus years out functioning fine and look extremely good on radiographic and clinical exam. Good Luck

I have placed and restored over 50 Endopore in the posterior maxilla and mandible by 2004. I have had two fail in posterior maxilla with very limited bone(less than 4 mm with a socket lift to place a 7mm implant with a 2mm smooth collar region) I was chicken to do a normal sinus lift at the time(over 4 years ago--2003) These were the second type of implants I learned to place (first was Sterioss). Most all of these implants have held up without bone loss past the ball surface for 3 plus years. Most all have a 1:1 crown root ratio with no implants being longer than 9mm. After continued training(Misch) I began to become anxious about these implants and went to another system (Biohoizons). I have had success with this more normal type of implant but also more failures (9%)than I ever would have expected or had reasons for failure. Endopore certainly seems to work but I'm still cautious about them. Best of luck and skill to you!

Dear Dr. F: Perhaps it is unfair for me to respond as I teach a residency for Innova on Implant Placement for the Restorative Dentist and my statements could be construed as biased. However, as a wet fingered clinician who has placed thousands of these mini marvels called Endopores (in addition to just about every other implant on the market today and some no longer on the market) in my General/ Implant practice and as one who intimately knows the realities of this implant’s abilities, technique related intricacies, science backed claims and pitfalls, I feel compelled to “set the record straight”. In the first place, proper training in the placement of these implants is the most important key to long-term success with these implants (more than any other implant) as they are truly unique in design and function. Without going into a long dissertation better suited for my two hour PowerPoint presentation on the science of these implants, let’s just say that they “love porous bone”, have a higher success rate in shorter lengths and are best restored individually in a tooth by tooth fashion. These implants display an uncanny ability to support full contour restorations which throws the inapplicable theory of “crown to root ratio” out the proverbial window! As far as results, just listen to some of your colleagues…Dr. P, Dr. Wenk and Samuel M. seem to be getting the hang of it and Dr. Berg is right on. I’m sorry that Dr. Pat C was momentarily redirected but seems to be coming back around…just remember don’t do these on immediate extraction cases unless you can obliterate the socket completely as the precision fit of the implant into the osteotomy is the key to success. My personal success rate with these implants is the same as with any properly planned and restored dental implant and the “Google-able” 12-year studies for these 7mm implants show an average success rate in the mid 90’s! No one’s “Chicken” here…just offering our patients a less invasive option with less surgery, favorably comparative results (to conventional Caldwell Luc sinus lifts and implants…double check your statistics! there’s no elevation of failure potential here…just a less voluminous elevation of the Schneiderian membrane!), and a shorter overall healing time! I sincerely hope this clears up any confusion or concerns you may have had concerning Innova Endopore Implants…If not, you may contact me directly! Terry

I have been associated with Innova for more than 9 years as a distributor in India. Recently, Millenium Research Group did a study on the Dental Implants market and informed me that it is one of the Top 3 selling implants in India. I can tell you why: 1. Endopore is simple to place surgically than a screw implant 2. With their Trial Fit Gage you can ensure the perfect osteotomy (no other system offers this accuracy) 3. With short implants, you save healthy bone tissue 4. Great success rates 5. Takes far less time to place surgically than screw implants, thereby saving time and enhancing the long term prognosis. 6. The company offers a life-time "no-questions asked" guarantee. Would they offer it if the implants had a high failure rate? Especially in USA? I agree with Terry in all he says; and would add that if there is any doubt in anyone's mind, they should hear Dr. Nick Elian, Chief-Dept of Implantology, NYU; and also Dr. Deporter. Especially Dr. Nick Elian shows success with real extreme cases. Dr. Deporter uses 4.1x7mm lengths in most of his cases. I think very sensible. It reduces all the huge inventory costs to stock different diameters and lengths. This size fits all. We also use Endopore in extra-oral cases with great success. Once you understand how to use it properly and its limitations, you will have great success.

Afte using Innova for several years I stopped for one reason. Unlike threaded implants once the bead becomes exposed the implant fails very quickly. After removing and replacing multiple infected implants and replacing them with threaded moved away from these beaded implants except in special cases. If you have great buccal bone and can get the bead subcrestal 1mm ok but any thing short of that will prove failure. there is a place and time to use with minimal bone heighth but for anything else i would stay with threaded. just my personal experience after seeing major failures when the bead becomes exposed. don't believe its my technique as the threaded don't do this

We have used Endopore in our practice for about 10 years and have had outstanding results throughout the oral cavity. The success rate is well into the high ninety percentile, with either shorter or longer fixtures. This is as good or better than any other implant system we have used in our OMFS practice. It's niche is definitely in the posterior maxilla and mandible where there is limited bone available to the sinus or the mandibular nerve, and I agree crown/root ratio is not a factor. It is not a matter of being "chicken", just a matter of doing what is best for the patient. When all you have is a hammer, everything looks like a nail, but when you have a complete tool box you can choose the treatment that fits the clinical situation. We do formal sinus lift surgery when indicated, however we have been able to avoid more extensive surgery in many cases using the Endopore implant.

its really very confusing. the one who does endopore are really not confident about it . i say this because then why is the need to do a surgical sinus lift procedure when we have a better, simple and less traumatic technique ? then why not just do endopore in all situations and save hassel of the patient in all aspect ( financially and mentally too ).

Dr. S.P. No you are not confused. Endopore should be AN OPTION for those patients who do not want to undergo sinus lift in post maxillary or vertical ridge augmentation in in post. mandi. region. REASON FOR DOING SINUS LIFT AND RIDGE AUGMENTATION IS TO HAVE A BETTER OPTION. PERIOD.

dr.satish, there is nothing like good or better. we have to deliver the best for the patient both surgically and financially ( regardless of patients affordability ).we either do it or we dont.So either we do a sinus lift and give a better implant or put an endopore implant. thats the reason i am confused. if we are inserting an endopore ---- we are not doign it only because the patient doesnt want to get a sinus lift ( anyways who would love to get an additional surgery done )or a ridge augmentation. hope you got my point.

I have placed 15 innova implants over the last 3 years. All in the posterior maxilla with a minimum of 3mm available and a max of 7mm. All are in place still and healthy. It appears that placement in conjunction with a summer's technique they are doing well. Some people in the discussion above stated that they do not care for shorter implants and talk negatively regarding these implants. Please feel free to continue what you are doing but don't be so simple minded as to not read the studies available or try cutting edge techniques with a lot of positive short term studies. Sinus lifts work well in good hands. They create two surgeries, usually, two and a lot of time. They may not be necessary. Good luck. Erik Belinfante

I am an experienced periodontist, and place about 500 implant annually, and I will NEVER again place an endopore implant. I placed around 10 of them in the posterior maxilla and the mandible, and ALL lost significant crestal bone during the first year of function and 3 had disastrous failures (the facial and lingual plates were lost). Once the beads become exposed to the oral bacteria it is impossible to maintain these implants; a fact that the company founder conceded to as well. There are a lot of other implants with proven designs that can be used when bone height is scarce, so my advice is to stay away from Endopore (All of the surgeons that I respect concur with me on this point).

Dr. m , could y ou suggest some other alternative to a 3mm bone without sinus lifts or your suggestion would be sinus lift first and then implant placement.

Dear Dr.F and Dr. S.P.: Don’t Be Confused! Just do what is right for the patient! Global Statistics compiled by University based research that continues to this day, show that both approaches work equally as well in the correct hands with correct technique, good patient selection, sound restorative techniques, consistent recall and hygiene etc…All with considerably less surgery, reduced healing time and the ability to restore individually (do not splint!). It is an University Research proven implant system…the same University that introduced Branemark to North America! What more can you ask for! Reserve grafting for those situations when prosthetically, cosmetically or structurally (i.e. less than 3mm bone) necessary to accomplish the desired result! As you see from the numerous other docs who have had great results, it is not just some advertising hype! In the right hands, the system works like a charm! There are few options except a conventional Caldwell Luc sinus lift, Osteotome (Summer’s) sinus lift or subantral graft or possibly a Balloon Lift through an osteotomy via the crest of the ridge approach for the posterior maxilla when you have less than the ideal 13mm of bone height as is conventionally recommended for a singly restored maxillary tooth in type 2 bone! The only caution I have for you is to get good training in technique! It is not like other implants! The technique is no more difficult than any other sequencential drilling technique for a screw…just different! If you do not take a course, there will be a slight learning curve…even for the most experienced of surgeons! So I do not advocate just buying a kit and some implants and learning via perusing a product catalogue! Is an Endopore infallible? Absolutely not! No implant is! Do I get repeatably successful results averaging in the high 90’s? ABSOLUTELY!!! A screw is not a panacea! They loose bone with as much frequency as an Endopore! In fact, allow me to let you in on an interesting observation (and any of you seasoned professionals can chime in and tell me I am way off base if you think so): After having performed the conventional Caldwell Luc sinus lift for the last 20 years, I have noticed crestal bone loss around my 13 - 16mm long implants occurring to the level of the original sinus floor then stopping when the “un-natural bone” is reached…interesting huh! This appears to happen because the native type 3 and 4 bone in that region is more prone to resorption! This doesn’t happen with a correctly placed Endopore due to the osteo-compressive technique used in placement in this region transforming the type 3 and 4 bone to a more resorption resistant type 2 bone!…Really interesting…huh? So, evaluate all you options carefully and do the right thing for the patient!

i do prefer 3I FULL OSSEOTITTE BETTHER THIT 98 % OF SUCCESS

Remember, we're talking about research based success rates with regards to lifted sinuses.

Could Dr M share with us what in his experience is the best implant system he has used when bone height is scarce?

We started using the Endopore system when it was first cleared and brought it to our research clinic where it was one of the featured systems. Most of the co-chairmen were using it and it seemed lke a great solution for compromised ridge height. However, as soon as all of started to experience a high ailing/falure rate, one by one each of us stopped using it. We have subsequently withdrawn the system from our residency program. There seems to be a common thread here. If the polished collar is at or slightly above crest, the failure rate goes up DRAMATICALLY. The key to success with this implant is to sink the implant 1-2mm sub-crestal. This "ramping" of the bone to the implant collar prevents significant crestal bone remodeling. The problem with this technique is that most of us were using it in a compromised site that often did not lend itself to deeper placement. If you have the bone to place a threaded implant with desirable length, use it. This implant is to be considered a "niche system", used carefully and judiciously.

I can't help commenting on Dr M, the Periodontist, comments about his experience with Endopore implants. Unfortunately it reinforces my belief that Periodontists should stick to Periodontal treatment and leave implant placement to those with a much broader understanding of implants. I have been placing Endopore implants for about 14 years, so have probably had as much experience as most in this area. When I commenced placing them they were new and the understanding of their use was limited. With more experience we now know their benefits and their limitations much better. Like any implant system currently on the market there is no such thing as perfection, and there are a few important dtails to note when placing Endopore implants. Although they are simple to place they can't be placed in a sloppy manner. The porous coating has to be fully submerged on placement and there has to be an adequate width of bone at the crestal margin. Knife edge bone around the crestal porous surface places the implant at risk as any resorption of the knife edge will result in exposure of the porous coating and implant failure, and we know that following surgery a knife edge tends to resorb, irrespective of the implant. Our Periodontist colleague probably didn't understand that if you are sloppy with their placement you will get failure. He may get away with sloppy placement with screws generally, although with the newer surface enhancements I would expect he will start to experience failures with these also if placed sloppily. What the Endopore gives is the ability to place implants in areas otherwise unuseable,with a degree of success on par with any other system.The longterm bone stability of these properly placed style of implants is impressive-14+ years with no sign of crestal bone loss. I'm sorry, but none of the screws I have placed show this degree of bone stability.

I've done 10 endopores with green stick fracture technique. All in place, looking gorgeous. A great implant to have in the armamentarium. K Herring DDS

I was one of the original FDA investigator in USA for Innova. Together with 5 other collagues we did the FDA study for the Endopore company. If the implant is buried 2 mm. of smooth colar they can work if the bone does not resorb. IF IMPLANT GETS BONE RESORPTION INTO BEADS, THE IMPLANT CAN NOT BE SAVED. I have tried to save over 200 of these mirospheroidal implants with 0 success of saving a single implant with bead exposure. The beads can be trimed but detoriation of bone continues. I personally placed 905 of these implants and feel the implant has limited use.

I am a maxillofacial prosthodontist based in Bangalore, India. We have used the endopore 5mm x 5mm implants for three implant supported auricular prostheses, and have not lost any over a three year period. Have used a few intraorally as well.

this is addressed to ruumi could you please fwd all the specs and the details of what you just mentioned about the implants through your rep in delhi. i would be interested in including the endopore as part of our armamentarium

It seems the literature is mixed. I have read several studies with results comparable to success rates of traditional implants, but have also read too many articles with less than ideal success rates. I would not feel comfortable experimenting on my paients with these implants. Especially since sinus augmentation procedures are so easy and predictable. But if you have ventured out and had good success with them, all the power to you.

If you want to use short implants to avoid damaging vital structures and bone grafting take a look at Bicon. All the benefits of Endopore but with none of the associated bone-loss problems, quite the contary in fact. Take a look at bicon.com/shortimplants

I am not a fan of Endopore implants (at least the original version. I've placed well over 200 and while most are still functioning well, the failure rate for me is significantly higher than other implants. Endopore has their new design that tells me that the original concept was in need of improvement. The increased surface area is not really significantly more than most traditional screw type implants. If the beads become exposed, the implant will fail. There can be no repair. If not removed promptly, you'll find much larger defects than with failing traditional screw implants. If you really need a short implant, look into the Bicon. I do not do Bicon, but I have done a few hundred of the Stryker implants (the implant's original marketer). I have a very good success rate with these implants. I have been using Implant Direct's 8mm implants when indicated with great success (so far). Anything shorter should probably be grafted anyway.

There is clearly controversy based on submissions above regarding the Endopore implant. I am an oral surgeon and I have worked with two prosthodontists who have collaborated with me over 5 years in the restoration of 134 of these implants to date. As others have stated , it has its place in what we call our "bad bone cases". We have lost 2 implants. We believe this system has a place in treatment planning some of our "bone-challenged" cases. By our numbers , it should be obvious that we use more conventional systems in the majority of cases. We have found it useful in medically compromised patients for whom grafting is not an option. Though I have not used Bicon (4.5 x 6), I suspect it has its place , too. One of the prosthodontists and I do presentations on this implant system and we never present it as the gold standard, BUT we believe it should be an arrow in your treatment planning quiver.

Well at least there is some years of literature about these implants. Something we cannot say about the latest surface modifications by the screw implants!!! Placing such an implant is also keeping your fingers cross.Although the experts in this field seems to be very confinced about these implants. Everyone about the one he/ she gets the fee from, even an university! Where are the 10 years results of these implants? With the endopore if one have a failure the bone loss seems to be limited arround the implant surface and maybe the implant has failed, but the damage for the patient is at least lower then a failing screw with 16 mm length. I use both endopore and screws with both their own limitations, because that's what it is all about.

Dear Docs, I have followed with interest the debate on short

Over the last twelve years I have placed many different systems, i.e., 3i, nobel biocare, biohorizon, astra, etc... I think they all worked very well as long as we stick to the basic. If we do not have enough bone, we graft. It is so easy to graft the bone given all the new developments available, i.e., osteotome lift, sinus lift with the balloon technique or with the conventional antral window, platelet rich plasma harvesting, chin and ramus onlay graft, split ridge graft, growth factor,etc... Now with the cone beam x-ray we can visualize the surgical site much more precise. If you are a patient and you have a choice between a long and a short implant, you would want a long one. Why are we keep wanting to avoid grafting when GBR is much more predictable now? Sometimes I wish I would have a short implant, but then I am glad that I manage to place a long one with no complication. Crown and root ratio may not apply to implant, however, better crown and root ratio will allow for more force distribution down the central axis and less torque or tip movement. This is pure physics. I will not say that Endopore does not work, but let use it when we absolutely cannot do anything else. I guaranteed my implant success life time, and up to date, my failure rate is .04%, with all the fail implants have been replaced successfully at the second time. We are scientists, therefore we should not try to go around our problem by quickly jumping into short implant. Have some pride and graft the site. It only help us to become a better surgeon.

There is much talk about crown root ratio not being significant in Implants particularly endopore I dont accept this at all A)Vertical levers are a law of physics ,the longer the lever the greater the applied force to a moment around the point of rotation B)Endopore to not osseointegrate better than any other contempory surface treated implant The long term results are thae same It is as good as, but I do not beleive better than all others To say that the forte of Endopore is in soft bone isa silly hype suggestion No implant by very definition is "better"in soft bone These days it is down to proper surgical protocol using expansion techniques regardless of system press fit or screw...and well designed biomechanics ..period

I followed this discussion with great interest particular in the fact that if the beeds of the endopore implantis exposed the implant will rapidly fail, but a screw don't. So with a screw we are satisfied with just survival??? I think with losing bone with a screw implant we cannot talk about a succes as well, just about survival. But the srew implant survives even when it is stuck with its last two treats into the bone. But I see some people believe this is a succes as well, because the screw implant still survives???!!! Maybe you lose the endopore implant once the beeds are exposed, but in my experience the bone loss is just arround the implant and a little more. So less damage at the end then the srew implant which stays in fo years killing more and more bone, but it survives!

I have placed a number of implant systems over the past 15 years. I started placing Endopore implants in situations where I did not have enough bone - in the mandible - I was doing sinus lifts routinely in the maxilla. The implants were going so well that I started placing them in all sites. They were all buried well below the ridge crest so the beads were not exposed, exactly according to protocol. I was also placing other systems concurently as I have a practice dedicated to surgery. All went well until about 3 years after the first ones were placed and then they started to fail. To date the failure rate is running at about 20%. I looked at 385 Endopore implants and compared them to 425 3i implants (ext hex) all placed during the same time period and restored by the same group of prosthodontists. The 3i failure rate was about 2%. What is heart breaking is the huge amount of bone destruction that occurs - the additional surgical procedures and pain patients have to go through and the massive financial loss that has to be borne. In my opinion there are enough good implant systems on the market that it is completely unecesary to use this system that carries such a huge risk of failure. No other implant system I have used: Astra 3i ITI Bicon Ankyloss Osteo-Ti has such a dramatic failure rate or is so destructive when it fails. Patients are still coming in with failing Endopore implants 5-6 years after placement. There are no long term multicenter studies on this implant. Many colleagues I have spoken to have the same experience. I would never use this system again. If you still want to use them warn your patients of the high risk. One final hint if you place three together do not link them prosthetically the middle one will almost always fail - no-one mentions this officially but it kept happening and other colleagues confirmed it - almost inevitably one of the other implants in the row fails afterwards and sometimes both.

I have used endopre system in differnt locations, different quality of bone in human model. This is my reseach topic too. I personaly feel, the system is good to use but little bit technic sensitive. I would feel great if RUMI can help me in RFA /quantitative bone formation , to categoricaly differentiate IL/DL for clinical usage.

Any experience with endopore 5mm diameter implants and platform switching anybody?

Is there any way to find out if there is any dental professional in my area who actually DOES endopore implants? I have been unsuccessful with internet searches of finding providers who use the technique. Is it still experimental??