Legacy 2 Implant System from Implant Direct: Discussion

Legacy2 or 3 are implants are easy to use implants without Hocus Pocus. SBM is the same surface as RBM (Resorbable Blast Medium) or MTX (Zimmer) and used since the 90's in millions of implants. Nothing special RBM is the ideal surface for (stronger) titanium alloy implants cause etching is avoid (etching will lower the pure titanium components of the alloy on the surface).

This is Implant Direct's most aggressively threaded implant I have used. I use it mostly in the posterior maxilla - Type 3/4 bone. Using the same drilling protocol that I did with Zimmer (undersize the osteotomy) I achieve increased primamry stability and increase bone to implant contact. The surface is the same as Zimmer surface. I recently tried their newest size (7.0) in the molar region and felt very comfortable immediately loading.

I've been using this system for a while now, with no complications...other than operator error at times,the system offers great versatility, such as transfer copin,abutment,healing or extention cap, cover screw at an unbeatable price...It gives great flexibility in todays economy,and practices with modest patients...hopefully, this new company won't skyrocket the prices.....

This is a great dental implant. I have used Implant direct products for the last 3 years and have found their products to be precise, high quality dental implants. The legacy 2 implant has 3 cutting grooves and it really works very well in all areas. I have also used the 7mm wide implant and found this to be an exciting new alternative for post extraction immediate placement.

I like the Legacy system too, but have run into a problem that I would like some input on. I recently placed a Legacy 2 in a severely resorbed mandible with very little trabecular bone. Since their system is set up solely for oversized implants in undersized osteotomies (ie no bone taps available), I ended up with a binding problem in the portion of the osteotomy apical to the crestal portion prepped by the crestal bone drill. I tried to solve the problem by stepping up to the next drill size, but ended up with a loose fit since the osteotomy was now .1 mm larger diameter than the implant. I ended up drilling my osteotomy deeper and stepping up to the next implant size, but would rather not get stuck doing that again. I have talked with two tech advisors at ID and neither one had a solution. Any ideas? Thanks.

Correction to above post: it was a Legacy 1, not Legacy 2 implant.

Hi jc dmd I use drills from three different companies.I also use drill stops from different companies,saves a lot of time and prevents overdrilling,especially when you are near the IAN,it a big stress reducer. As you know drills differ in widths and lengths by a couple of tenths of mms from company to company,which I find helpful if I want to undersize an osteotomy. In your case,I would measure the smaller step on the ImplantDirect drill with a dial caliper that measures tenths and find a straight drill a tenth or so larger,and drill into the osteotomy by a mm or two until the the implant seats,that way the crestal bone is left intact.

Get a piezo with implant tips to fine tune your osteotomies

I would like to see some immediate post-op radiographs and then at 1 year on this system. With the microgap so close to the bone level, I just don't see how you will prevent significant crestal bone remodeling with this design as there is no medialization of the implant platform. One more point; a high torque value when this drilling protocol is followed is NOT synonymous with greater initial stability. By definition, initial stability is resistance to displacement when shear forces are applied at time of implant placement. As torque value increases, there is actually increased microfracture of bone at the implant interface. This will ramp UP the catabolic phase of bone leading to pronounced reduction of intial stability for the first few weeks. We will be publishing a paper that shows torque values in the 45-55 Ncm range, accomplished using an implant design with cutting threads rather than compression threads, leads to greater initial stability in the critical early healing phase for implants. This is especially valid when implants are immediately loaded. This implant design is simply a modified tapered screwvent with all of it's attendant problems. RJM

I started using this system just a few months ago and I didn't put this kind of implant for more than 6 fixtures yet; therefore it may seem too early to look to my own experiment as scientific. I felt this system easy to use, combined with a very user-friendly surgical kit. The "fixtuer mount" delivery of this system makes it relieving, ie. you won't have the concern about lack of components. One of my fixtures failed, I mean it lost its stability and came out of its "socket", which I presume was because of operator's fault.

You just made my point better than I could. Stop blaming yourself for your failure. This is a common problem for compressive implant designs. As the torque value goes up, so does the compression remodeling of bone. High compression leads to interuption of angiogenesis and fibrous encapsulation. The implant then simply lifts out of the osteotomy. Move on to a biologically driven implant design. RJM

I have been using Legacy implants since they first came out. In the last three years I have place about one hundred. I have been very satified with the results and have not see a problem with the implant / abutment connection with regard to bone loss. I have used in the past: Endopore, ITI Straunnam, Steri-Oss, Life Core and BioHorizons. Legacy has become my implant of choice.

Likewise, I have used Implant Direct since its inception first with their lead product "Screwplant" and now "Legacy" since its beginning and have not seen any problem at all including bone loss. My understanding is that the Legacy3 implants have a very agressive type of cutting apex which I would think would fit the bill with being more acceptable to Dr Miller since I would think it should have less compression of osseous tissue doing placement.

A cutting or self-tapping feature at the apex of an all tapered implant has nothing to do with bone compression. The drilling sequence, as proscribed by Dr. Niznick, is to prepare a parallel walled osteotomy into which you place a tapered implant. The entire concept of the tapered screwplant, and it's progeny, is a high torque value at final seating. Torque values above 55 Ncm have deleterious effects on bone and actually reduce initial stability for the first few weeks, also known as the catabolic phase of bone. It's nice for all of the "clinicans" who have just posted, without a link to their websites or contact information, to suggest how wonderful these implant designs are without any shred of clinical outcomes or statistics. Let's post some immediate post-op radiographs and then one year post-ops so that we can judge for ourselves what the clincial outcomes are. It is, simply, the right thing to do. RJM

Sounds good, lets see what you got Dr Miller. I think we are all here to learn.

Bob: Good points, I never subscribed to the high torque principles.

The Legacy 2 implant design is a modification of the Legacy Implant which is a copy of the Zimmer Tapered ScrewVent. It deviates in two principle ways. Firstly,instead of tapering almost immediately from the interface to the apex it has a 4.5 mm parallel wall before it starts to taper. This induces less bone compression nearest the crest compared to the Legacy when a parallel walled drill is used as specified in the protocol. Secondly, the thread design is different having spiral threads which more closely resemble buttress threads than the typical V thread of the Legacy or the Zimmer or other brands or designs. This more aggressive thread design allows for better insertion cutting efficiency and produces superior shear force resistance to loading. All in all, the Legacy 2 is quite a good design. It is one which creates good primary insertion stability without creating an excessive amount of bone compression. Further, I personally believe that no one implant design or insertion protocol is suitable for universal use. I believe each implant design and the way it is put to place should be site specific.

Still waiting to see all of the 1 year post-op radiographs so we can judge for ourselves. How many times throuhout the history of our discipline have we heard about the virtues of a new implant design, only to be disappointed with the clinical results. If the original tapered screwvent was so good, why has it been redesigned two more times? It is still a tapered body placed in a parallel walled osteotomy with the implant abutment interface right at the bone margin. Hardly a recipe for long term success. RJM

I am using Reactive Implant Direct Implants which have the same thread design as Legacy 3. My results are excellent, better than the Replace implants that I have placed before for more than 12 years! Legacy 2 has a more aggressive thread pattern which allow the clinician to place it easily in an undersized osteotomy (1 drill less as it is showed in the Implant Direct drilling protocol). After 22 years placing implants I am experienced enough to know if an implant is better/equal or worst compared with what I have been using for years. This is a top quality product with an excellent clinical performance!

I uploaded some x-rays of ImplantDirect Implants to Picasa: http://picasaweb.google.com/implantdirectbenelux/XFotos In contrary what Dr. Miller says it can be very beneficial to screw in an implant in an undersized socket. There is a tremendous amount of research about this topic and from this it can be concluded that scraping of the boneparticles when torquing the implant will coat your implant with autogenous bone and has more influence than the type of surface of the implant. Read for example this article about it 'Bone Particles and the Undersized Surgical Technique from A. Tabassum and J.A. Jansen in the J DENT RES 2010 581-6' Of course it's very important to avoid to much compression in the crestal cortical portion and that's why ImplantDirect has tools to widen this area. (Astra has the same approach)

I have reviewed your photos and, I must say, I am not impressed. First, you did not provide immediate post-op and then one year post-op photos of any of these cases. So where is your baseleine measurement? Second, you must be wearing rose-colored glasses. In at least 50% of the cases you show, there has been measureable crestal bone remodeling (look at the angulation defects from the crest of bone. Third, I see you have placed some implants supracrestally, some at crest, and the rest subcrestally. What is the placement protocol for a system like this? Hardly a post that one can debate critically. RJM

And last, the more you microfracture bone, the more severe and longer the catabolic phase lasts. There is an inflammatory phase while this microfractured bone is turned over. There is NO osteoblastic activity during this phase, hence the higher percentage of early failures is compressive implant designs during the first few weeks. In the next few years, watch how the evolution of macro-, micro-, and nano-design changes in light of this reality. RJM

The principle of catabolic degradation as a given occurrence in implant placement may not actually be so. There is evidence to show that bone can be laid down on implant surfaces without necessarily being proceeded by a resorptive phase. While material surface substrate may play a role the phenomenon of uninterrupted cellular growth and bone development, strain related forces of less than 50 nm on the implant have been shown to induce a rapid and uninterrupted osteoblastic activity into immediate bone formation creating what is virtually an immediate osseointegrated state. Minimizing implant movement below the the 50 nm threshold requires that there be a very high bone to implant contact of about 90%. Creating this intimate contact will require fairly high dental implant insertion compressive forces as well as a suitable implant macro-design. Strain related bone modeling may in fact be the elusive pandoras box for bypassing a resorptive phase and in fact be more relevant than so called bioactive surfacing. Immediate loading under these circumstances may then be routinely feasible.

Dennis; What you are referring to is the piezo effect on bone cells. Strain on the collagen fiber network (NOT the inorganic matrix) is stimulative to osteoblasts. The oldest reference to this effect, without understanding the biology of bone, was Wolf's Law. But we must appreciate that bone growth is a multifactorial and highly complex process; the ratio of tissue cytokines, pH, hormones, availability of free ionic Ca+2, presence of pathogens, the inflammatory cascade, early angiogenesis, to name a few. Yes, it IS possible to subvert the catabolic phase of bone. One of those is to use a bioactive CaPO4 nanoimpregnated implant surface (i.e. Ossean). The presence of Ca+2 will help to keep bone at physiologic neutral by buffering pH, ramp up production of mitogen activated proteins resulting in early type I collagen synthesis, and inhibit osteoclastic resorption resulting much earlier bone bonding (the mechanism behind early HA implants). But one other thing we have found in implant design (in our previously published papers)is that LESS implant contact to bone the BETTER. The primary reason for higher implant failures/complications in compressive implant design is precisely because of bone microfracture and the inability to control the aspects of bone biology I just mentioned. We showed that a design that incorporates stabilizing threads WITH bone chambers gives a better quality, and faster growth, of bone that can be loaded earlier. These are not compressive designs, they are cutting macroarchitectures. You then layer all of the other aspects of implant design (macro, micro, nanotechnology) and you end up with a true "biologically engineered" implant system. I am amused by the slow refinements of many of the older systems that attempt to address their shortcomings, but ultimately get left behind by new upstart implant companies who are not bound by their marketing investments and architectures. One thing I am sure of, the implant company that builds a better "mousetrap" will be rewarded in this marketplace. RJM

I agree with dr Miller that the company that builds a better mousetrap will be rewarded in the marketplace. Implant Direct did that trough taking a proven connection (Niznick 1986), a proven surface (SBM 1992) and a proven body design and surgical protocol (Tapered Screw-Vent Niznick 1999) and updating the design with Micro-threads that don't cross-thread (Niznick Patent) and progressively deeper threads with longer cutting grooves for increased stability in soft bone and self-tapping insertion in dense bone. Add to this all-in-1 packaging, options that offer surgical and prosthetic compatibility with 3 of the top implant systems at 1/3rd their price and online ordering/tech support. Then you have only some of the reasons why Implant Direct commanded a $300,000,000 valuation in just 4 years. You can keep looking for your idea of a "true biologically engineered implant system" but what the market found in Implant Direct was what was needed - simplicity, versatility, value and customer support.

Gerry; I thought we had this debate back in 2006? I direct the readers of Osseonews to the section "Surface Topography for Implants: Where is This Trend Headed?". You have gone back to the same argument you haved used for years. I have copied one of my responses from that blog: "Miller: So the true measure of the worth of an implant system is cost, packaging, and internet ordering? Spoken like a true marketer. “Fact” is that it is still about the biological response. Any implant can integrate, but the “issue is the soft tissue response”. When we pay more attention to crestal bone changes, papillary support, apical migration of tissue margins, bone to implant contact, speed to loading, degree of loading to deleterious bone breakdown, rate of bone turnover in the steady state, relationship to bone levels of adjacent natural teeth, then we will be addressing true biological parameters. 20 year old implant designs no longer meet my criteria. RJM" Read the rest of the blog so that everything is in context. Oh, one more thing...I thought that links to company websites were verboten on this site. But I guess that none of these rules applies to you. RJM

You. brough up that the market would reward a better System - I just agreed and gave you an example of hoe this has now been proven. I forgot that on this commercial blog site, only links to paid advertisers get published.

No outside links are permitted in the Q&A comments. This has been our policy for 7 years already. However, as you might imagine, we do not have a human being 24/7 every single day monitoring the posts, as this is physically impossible. Comments are scanned by software. We stop 1,000's of links every day and keep the forums civil, interesting, and valuable to the implant industry worldwide. Unfortunately sometimes links do get thru the software. A human editor tries to remove those where appropriate and possible. We apologize if a certain tiny percentage of links are not caught. This is simply an impossible task when you have a certain level of traffic. As mentioned on a previous post, OsseoNews.com is a third-party website that is not affiliated with any implant manufacturer, dental "guru", or dental association. Of course we accept advertising, as any business publication or directory does. But, there is no advertising in our Q&A posts and comments, nor do advertisers have any influence whatsoever on the Q&A topics, posts, or any questions. Advertising is restricted to banners, course listings, product listings, and other featured text ads which are visible throughout the site on the margins. This is similar to any other commerical website on the Internet. Content is user-generated by website visitors and under zero influence from advertisers. Advertisers promote via banners and text ads on the margins. Thanks for your understanding.

Dr. Niznick sells his company for $300 million and yet still feels the need to comment on websites in his free time, and on New Years day nonetheless. Too funny...Let's stick to science and facts here fellow readers, and not get sucked into Niznick's marketing whirlwind, which predictably tends to ruin what are otherwise enjoyable discussions and debates on this site.

i have not read or blogged on this list for a few years that I can recall but Dennis sent me the link which prompted my response. Interesting that the one posting critical of Implant Direct is from an anonymous blogger who sa;ys he is going back to Zimmer or Nobel because of failures, There was a comparative study by 5 Spanish dentists placing Replae ane RePlant side b;y side in the same patients jaws and had 13% more failure with the Replace. Dr. Cavallero has an article accepted for publication showing 99%f success with Implant Direct implants with bone loss matcing that reported for Astra - less than 1mm.. I suspect that the poting critical of the success was from a competitor salesperson. Contrary to Miller, there is no silver bullet for implant success other than acheiving high initial stabilit or to crestal bone preservation other than starting out with 2mm of bone labial and lingu;al to the implant.

As the comments here appear to be veering off topic, we have closed the comments on this post.

90% of implant direct Legacy Implants sold to me by the swiss branch are failing!! Late failures - catastrophe! At the same time the Screw plant versions place before Legacy came out are working as they should as well as most of other brands used by me. Question: why did ID shut down their Europe branch coinciding with the Legacy 2 disaster? Who knows. I have SOO MUCH trouble because of that shit - unbelievable. And yes- I know what I am doing - placing implants since 1997! I believe the Legacy surface was contaminated leading to late immune response and SEVERE bone loss. Nightmare.