Failing 3i Nanotite Implant: Anyone Experience This?

It seems like a regular case of implants failure. This is a part of the statistics of our daily practice as implantologists

Dr. Have you ever considered the Xive 3.0?

What gives you 100% success anyway? If your overall success rate in your practice is above 95%, you must be doing things right!...

I had a case just like this, but with the difference I didn't put on the crown, because of some luck. The patent didn't tell me he had osteoporosis. The oral surgeon had put in two sla actives. one intergrated and one didn't. I always ask the patient if he has experience problems during the healing and he told me one of the implant had been painfull after placement and for two till three months after the placement. This is why I did a double check alltough everything smees to be gooed: good gingiva health, etc. One was intergrated and one I could screw out of the bone. I think your case is similar in the thing that the implant has never been intergrated. Some stability duing second fase can be mimiced by the srew action.

Did you do an immediate placement? Did you graft the area? Have you ever looked into the PerioSeal implant? That is what I am using and having wonderful success.

Nanotite is still acid etched which makes it about 10 times smoother than SLA, TiUnite and all the HA blasted implants. Smooth is bad, rough is good where surfaces are concerned about. If you want HA use an HA coated implant to get the roughenss and the bioactive surface. I was against Osseotite and dipping it in a solution of Calcium phosphate to put a couple of nanometers of HA crystals in the bottom of the pits is just window dressing.

Dear NL, I carried out an "in vitro study" about the mechanical stability of different surface treatments: I have found that the Nanotite Surface, after contact of Osteoblasts SaOs2 cell colture loosed about the 50% of CaP after only two months. This is a clear sign of an unstable surface in which the link betwenn the nanoparticles and the titanium in not so strong as explained by several authors. The surface unstability could explain the failure of several fixtures. Sincerely, Enrico (Italy)

have you checked any bruxism or any concern in the medical Hx. Isn't better to place 5mm or 6mm diameter implant {instead of 4.1mm) in the molar area.

Interesting, I recently placed 4 nanotite coated implants from another manufacturer in 4 different patients and all 4 did note integrate, the fourth appeared as your second and later was removed. All 4 have been replaced with either HA or Plasma sprayed Ti implants and have intergrated without incendent. At this time I no longer place the nanotite coated implants but either HA or plasma sprayed Ti.

Might be worth looking into the new Active by Nobel. self-condensing, self drilling ability of this implant seems to make it advantageous in all types of bone, specifically in compromised situations like softer bone.

The implants that were placed, went into areas that had natural teeth that had to be removed. NL did not state the reason for the failed natural teeth. What was the pathology around the natural teeth that led to the extractions? Under the best circumstances, under the care of the finest surgeons, and using any number of the most proven implant systems regardless of the surface treatment, we see failures occurring for reasons unexplained. It is my firm belief that pathogens and destructive cells may remain and lie dormant until the bone in these edentulous areas is desturbed by drilling or pounding to recieve a dental implant. We need more research into the histology and patholgy of bone in edentulous sites, which may one day give us answers to these unexplainable failures. Gerald Rudick dds Montreal

Implants are only a part of my practice but I place over 300 fixtures per year, in all types of bone in all of the various applications: immediate, delayed, young, old, etc. If you are not geting around 99% success rate, then you need to take a look at what you are placing. I have asked for the long-term research and scientific data on this Nano-HA surface and am still awaiting a reply. We are not just Oral and Maxillofacial Surgeons, or whatever, but also scientists. We need to demand scientific data prior to using anything on our patients. If there is long-term, well-documented research data on this product, then you need to ask the manufacturer why it isn't working as you and your patient would expect.

Since you said the bone quality was type 3 and a year post extraction, and that you allowed 6 months for osseointegration, the time allowed for healing was certainly sufficient and a 4 x 11.5 fixture was also large enough. Assuming you used correct protocol and good surgical technique in placing these implants, one thing I can say is that the failure was not related to the implant system. All systems can have failures, and the failure of a case does not mean the implants were faulty. It sounds as if the most likely problem was a low grade infection which prevented osseointegration from taking place and that the restoration of the remaining implant was the final nail in the coffin as far as its loss is concerned. Overheating of type 3 bone is not very likely cause of failure here. The size of the occlusal table being "premolar sized" is certainly reasonable, but occlusal overloading could have been a problem if the crown was high. The forcefulness of the occlusal contact is much more important than the size of the occlusal table. A big occlusal table only has to resist food between the teeth. A pinpoint premature contact causes extremely high forces to be delivered to the supporting bone (regardless of the size of the occlusal table), especially when there isn't any food in the mouth i.e. parafunctional activity.

I had similar failures with Nanotite. Still keeping within statistical range of failures, the disturbing aspect is the time delay of the failure on bog standard placement situations. Usually implants fail pretty quickly, no later tha stage two, if infections were to blame. The Nanotite cases are all after delivery of prosthesis and some usage, which is terrible, if you are working on a referral basis and something like this happens on simple cases. Your coments , please.

My concern would be what drill diameter was used before final placement of the implant. The outside diameter of a 4mm implant is just that, 4mm's. The inside diameter, body excluding threads, of a 4mm implant would be significantly smaller. That is why most clinicians would suggest the use of a 3.0-3.15mm drill diameter to place a 4mm implant.

All implant systems can have failures and these procedures genrally have a 95% or greater success rate today. In my practice I have found that over the last 5 years I have had an increased number of failures with tapered implants and have stopped placing them. This was especially true in sinus lifts in which I had a previous very high success rate, only to have a series of implant failures in my sinus lift cases with tapered implants. Parallel wall implants have better mechanical stability. Whether the fixtures are Nanotites, or other types of implants, it is clearly the roughened surface that provides better osseointegration. More studies and sharing of clinical experiences will determine scientifically whether the ano surfaces are an improvement. There are certain implant brands in which my success rate is very high which influences my decision on which systems to use.

Sadly we also have been burned with tapered 3i certain implants both at 2nd stage and well after being restored. We went back to the straight wall and have been back in the normal success pattern. I loved their end cutting burs which harvested bone for us to use but that apparently was the problem. I switched to another implant system to rule out our surgical technique being at fault. When the new implants just weren't failing we realized it wasn't our fault

I think that this thread is going the wrong way. We have a case of two implants being placed and it is no big surprise that the one that failed is 18. This site typically has poorer bone and more stress. While I do not utilize nanotite implants I do know that all implant systems can fail sometimes. I doubt that the problem was overheating due to the fact that this site usually has less dense bone and is of higher surgical risk so typically the surgeon is proceeding slower and more cautiously.

To what extent can we blame the implant type or the implant company? I think local factors and case selection play an important role in implant success. and again nothing is a 100%.

There is significant failure of 3I tappered implants. When I first began having failures which were atypical of my normal success rate I spoke to my rep who assured me no one else was having problems. After continued failures (I was not smart enough to stop using right away because I assumed it was opperator error and changed protocol)I spoke to regional rep. Again I was the only one having these problems. Then the company changed the drills!! Since I am the only one having problems why change drills throughout the country? By this point I change implant companies and will not place tappered anymore. 3I cannot understand why I will not try their new products. As clinicians we are scientists but we need full disclosure of manufacturer info. I made changes based on the information at hand.

I have also experienced the same phenomenon of loss of more implants than usual with the 3i implants. I do not know exactly why. Now the company is saying to under drill the osteotomy etc... They will also come out with a "pre-bore implant internal hex configuration because we were having difficulties in removing the carrier. I only do 3i implants for 2 referrals out of over 1500 implants every year. They are good referrals; however I have told them the problem and they are highly considering switching since many of their final restorations are failign as well.

How, as clinicians and scientists, we put up with such blatant disregard for patient safety is beyond me. OK, it's a dental implant, but would orthopedic surgeons be as casual about such poorly performing products? 3i has consistently released products with little or no evidence supporting it. The latest case being the Nanotite surface, released with just one study - in which they removed the worst results to improve the statistics. What are the long term implications of delaminating implant surfaces? In my view, implants with additive surfaces are a step in the wrong direction. In the case of tapered implants, we've known that obliterating a socket with a true-tapered implant is the the way to go. But 3i tells us we're drilling wrong. Or, to cover their design flaw, they release a new type of drill. Talk about a duct-tape approach. When you release a new implant - make sure you have a proven surgical protocol to go with it. Now that knock-off/discount companies are popping up everywhere, I'm afraid things are only going to get worse and clinicians like me, who stick with companies with well researched products, will also suffer because the reputation of our profession will be tarnished.

I have moderate experience placing implants. I have been placing on average 700-800 implant annually for the past 7 years. I have to say that I also have experienced a significantly increased amount of implant non-integration with the new nanotite implants. A snapshot at my numbers of 3I nanotite implants placed in a 8 month period revealed a 13% failure rate...compared to a 1% failure rate with SLA surface, in similar scenarios. I was told by the 3i rep that this is an isolated problem and that I must be doing something wrond, and that no one else was having this problem. By the way, this was the same thing the reps told me when 3I had all the NT implant failures. I no longer place 3i implants and currently I am trying to trade out the remaining 100 nanotite implants that I have left in my practice. I whole-heartedly believe that there is something wrong with the nanotite surface...especially in grafted sites.

what do you think about the progressive loading in D3-D4 bone to arrive in a good osseointegration condition? i observed in my experience that using progressive increasing recovery screws lenght can bring a better quality bone around the implant fixture before to apply the abutment and the temporary restoration. i think that this light and progressive mechanic insult on the D3/D4 bone "osteociti cells"(i don't know this word in english) can help to arrive in a better bone framework to support the occlusal load by osteoblastic activation. "i really trust in the progressive function to reach the implant surrounding bone ipertrofia!" sorry for my english. Flavio Rome Italy

I too have experienced problems with 3i implants. To be fair, not with the Nanotite surface. But I started using them about two years ago and saw a dramatic increase in my failure rate (saw 4 come out in 1 patient). I'm not new to implants and don't seen anything like this when I use Straumann or Zimmer implants. I eventually stopped using 3i altogether because it was casting me money and referrals, not to mention the damage to my reputation. No one from the company has ever proposed a reasonable explanation for the complications I saw, even after showing them the cases. Bottom line, I don't trust their products anymore.

I am scheduled for implant placement (#s 19 & 20) and, having had an extremely unpleasant experience with a (former) dentist, have become proactive. One hopes "a little knowledge" isn`t necessarily a bad thing. I learned today that 3i implants will be used and have spotted all sorts of negative comments about them among your postings. I am not having the procedure done until June, as I will be out of the country for awhile; don`t want to chance problems while away. Any suggestions will be greatly appreciated.

There are comments here about 3i tapered implants. I'm not sure if everyone is aware that 3i introduced changes to their NT implant. They also don’t call it the NT design anymore. They have new drills, depth indicators and the implant itself has a new, less tapered shape. I had some issues with the first generation NT, but have had excellent results with the new design. They should have gone with this from the beginning, but at least they listened to the feedback – I give them credit for that and the new design. If you are using their tapered implant today, it is the new enhanced design.

Dr. L. asks: Some of the dental implant manufacturers have started using a new surface coating called NanoTite. This is supposed to stimulate a more rapid osseointegration. Has anybody started using Nanotite coated dental implants? Is there truly an additional benefit from this new surface? Have you attempted early or immediate loading with these? Any other thoughts? Thanks. Dear Dr. L, I have had an 18% failure with the new Nano, vs 1% failure with zimmers and 3%with straumann SLA and have placed at least 120 of each over the last year. Trust me, you want to stay away from the Nano Nightmare. 3i will probably deny this but check other postings on the site.

This is a very interesting thread of clinical experiences. Osseotite and Nanotite from 3i are about 10 times smoother than blasted, TiUnite or HA coated implants so what else would you expect than higher failures in soft bone? As for tapered vs straight implants, tapered has advantages but the design and dimensions of the drills are critical. I developed the use of straight step drills to insert the tapered Screw-Vent when it was first introduced in 1998, a decade ago, and you do not hear of the type of problems with that implant that you do with the tapered Replace (bone compression with crestal bone lose) or 3i NT (implant loss)that use taped drills. There are three types of tapered implants. The Tapered Screw-Vent and Implant Direct implants are evenly tapered from top to bottom. Implants like Replace, BioHorizons and 3i taper at the bottom only with straight walls above. The NobelActive implant flares out rapidly to a wide diameter than tapers back in at the top. One advantage with all these tapered implants is that in soft bone, you can start the narrow apex in to an undersized hole and expand the bone, increasing initial stability. With the ones that taper only at the bottom, and rapidly flare to their major diameter, this expansion can be too great and too rapid, causing excessive compression. The NobelActive flares out dramatically from the apex to its wider diameters near the top. It has sharp, deep threads so its ability to compress bone is questionable. Unfortunately, it tapers coronally to a narrow platform. This works in soft bone but in dense bone, a wider diameter (4.6mmD) drill is required to insert implants with either a 3.1mmD (External) or 3.9mmD (Internal) platform, leaving a gap between the implant and the platform for downgrowth of soft tissue. An evenly tapered implant like the Screw-Vent, goes in easily since half the length drops into the socket before threads engage. With tapered implants being inserted into a socket prepared with a tapered drill, increased seating just increases the compression near the crest and if you back a tapered implant out of a tapered hole, even a little, it is loose... so straight drills are the answer with a proven relationship between diameters of implant and drill, as determined in torque studies. The NobelActive has very sharp threads at the apex that can cut its way through bone and it is small enough that you can diverge from the path of the socket created by the drills. You want to establish the desired implant trajectory and depth in your treatment planning, and then create the socket using end-cutting drills to the appropriate depth. With the Nobelactive, you can inadvertently get off line (they tell you this is an advantage to change direction during insertion) and you can screw the implant past the established depth. Under the sinus, you could screw this right through the floor and tear up the membrane. As for research, look on Nobel's website under NobelActive and you can be reassured by the fact that there has been one poster presentation and two company studies underway.

I agree with Davids comments from March 5th. Our profession is one of PATIENT CARE. We should be DEMANDING scientific, clinical trials on implants before we start placing them in our patients. Astra Tech is one of the few companies that has INDEPENDANT CLINICAL RESEARCH to support its surfaces, thread pattern, internal deep (long) Conical seal, and Connective tissue seal. Our profession and patients would benefit if we demanded all companies to invest in research PRIOR to selling to the general population.

I feel that you SHOULD ask your representative, whether it is a 3i, Zimmer, Straumann or Nobel rep for studies. I am sure that if they have the independent studies you demand then they should give them to you.

Can someone tell me, if they are so bad why they are still in the business today and as a major player in the industry? thanks

I'm talking about 3i

"Can someone tell me, if they are so bad why they are still in the business today and as a major player in the industry?" Eric: That's because some of our colleagues are still willing to overlook something as fundamental as "sound scientific support" for new medical devices and instead stick with what's familiar and has a good discount.

Anytime there is a specific company mentioned in these threads, more times than not, industry partisans’ jump in to slam the company mentioned. Most posts do not post a name as they probably are not even clinicians. This has happened to Nobel, Straumann, etc. Trust your own experiences. 3i has been and is a solid company – not perfect, but who is?

I rarely post an opinion on internet forums, but feel embarassed by the lack of professionalism demonstrated by many of my dental collegues. I have no issue with mature debate and discussion, but have read so many slanderous and ignorant comments that draw conclusions that are naive and insulting. I am a periodontist with over 15 years of implant surgical experience placing only Biomet-3I dental implants. I have historically used straight walled, expanded platform, and tapering 3I implants with the machined, osseotite and nanotite surfaces with excellent success and predictability. Why have I placed only 3I implants to date? This is because this product has allowed me the opportunity to achieve success outcomes consistent with what is objectively reported in the literature. Everyone feels compelled to defend the system that they use, but why at the expense of another? Easy to blame a company for your failures! I don't care if an implant surgeon is a specialist or a general dentist, however, the problem appears to be with either poor treatment planning or deficient surgical skills. Implant surgery, similar to periodontal plastic surgery is technique sensitive, requires skill and expertise, and the understanding of how to manipulate both hard and soft tissue. Without sounding ignorant, if you are experiencing higher failure rates than reported, there is likely deficiency in your technique or poor case selection. Do not blame any of the reputable companies with good research such as 3I, try being a little humble and mature, and take some personal responsibility for your higher rate of failures. Whichever reputable system you choose to use, learn from experienced surgeons who have success with this particular system. Every system has subtle variations in surgical technique unique to the product design. Jumping from one implant company to another when you experience a pattern of self induced undesirable outcomes, is a diservice to both you and your patients as well as our proffession.

Back to the original question: The issue may be the tapered implant rather than the surface. Problems were noted by 3I shortly after their introduction some time ago which led to the change in drills and protocol. It is my opinion that in an effort to be competitive ALL implant companies release products with minimal field testing which is dramatically different from controlled studies. A product may work well under research conditions but not well in the real world. For this reason, I do not adapt any new implant technology until after it has been on the market for some time. I have been burned enough in 27 years of perio practice so I let others discover the glitches with the new products. As clinicians we have a responsibility to get beyond the marketing. Hope this is useful.

PC....Not only useful but dead on the money Just look at how corporate America works with new releases Vista is a classical example for microsoft (a reputable company) Our Implant companies are no different I disagree with Steve ..if there is a consistent problem lets talk about it on forums like this You can bet your last dollar your rep will NOT tell you There is nothing ignorant about that or immature We lead isolated lives as Dental Surgeons we probably dont get out enough! Sharing experiences and admitting failures is easier done on line than vis a vis at a convention when we brag about our 99% success rates I have no issue with 3I and I use Imtec and ITI as well as others ..all my success rates are the same I would be eager to know if you started having failures with Imtec that seemed unusual . Implants are my tools not my politics or religion.

Steve you probably working for 3I. Yes I will confirm 3I system its not a great system. There is more failure with 3I than with other Titanium implants.

I haven't seen a 3I Implant system, neither is it marketed in my country. But I guess it must be on the lower price bracket with huge discounts. After talking with plenty of implantologists and surfing through Osseo news I have come to the conclusion that only 2 implant systems get into the eye of the storm (1) the cheapest [they are not backed by research],& [if it is cheap, it can't be good] (2) The costliest [ they are over charging, so what if they have the research to back up their claims], [for all the money they are charging us are they giving us our money's worth?], [Even they haven't done enough studies]. In cynicism we dentists attack every one left, right and center. No implant system is good enough for us. Experienced clinicians always state that "any implant system will work in experienced hands." The pro and anti arguments here sound more like the WWF (World Wrestling Fedaration) make believe fights. No matter how hard they hit each other the matured spectator doesn't believe they are REALLY FIGHTING. All the pro and con arguments sound pre-decided by Con artists. Dear Doctors screw in just any implant you like, it seems every thing works!

Thank you OA (March 22) for only reinforcing my comments of March 19th! A little honesty and you suspect that I work for the company. Do you require my credentials????? Dr. S.S (March 19), how can we have productive discussions if there lacks trust and honesty in our professional community? Sad.....