Nobel Groovy Implants: Higher Rate of Failure and Increase in Peri-Implantitis?

I place alot of groovy's in my practice and dont seem to have that problem. I have some almost 3 years out.

I called the nobel company and they have not seen this.

I'm not surprised. It's question of lot of money.

See the link below: Two-Year Outcome with Nobel Direct(R) Implants: A Retrospective Radiographic and Microbiologic Study in 10 Patients. Conclusion: Radiographic evidence and 25% implant failures are indications of a low success rate. High counts and prevalence of significant pathogens were found at surviving implants. Although extensive bone loss had occurred in the coronal part, the apical portion of the implant showed some bone to implant integration.

Those statements cannot actually even be made. I'm the Director of the Perio/Implant program at the Faculty of Dentistry and there are no prospective or retrospective studies on Peri-implantitis and Nobel Groovy implants. So to make that statement without any literature of facts supporting is speaks volumes of the literature support this prominent speaker is using in his lectures. You can't just "state" things like that without any support. In any case, my personal experience is that Nobel Groovy works great (extremely high success rates)but so do many other systems that have the "rough" surface all the way up to the collar. And THAT i can easily support with a plethora of literature. Thank you for your time. T.I.

The article linked above by Tommie Van de Velde is about the Nobel Direct which indeed has a known higher failure rate. This is NOT true for the "groovy". Perhaps that is what the "expert" meant to say. I agree entirely with Dr. Irinakis that someone stating something in a lecture does not make it a fact, and that we need to rely on evidence based data. In summation, the groovy system works fine, the Nobel Direct does not always perform as promised and probaly should be avoided.

You cannot cite a poor article with no power to support or argue against a specific fixture. Having placed thousands of Groovy implants I can tell you that my failure rate is

it is literature.... also see Tord Berglundh's study: there must be something... Spontaneous progression of peri-implantitis at different types of implants. An experimental study in dogs. I: clinical and radiographic observations. Conclusion: Spontaneous progression of experimentally induced peri-implantitis occurred at implants with different geometry and surface characteristics. Progression was most pronounced at implants of type D (TiUnite surface).

If you were a Replace Select user who enjoyed all of the Noble Biocare lectures from Dr. Whorle, you always placed the implants supracrestal or at least with the idea in mind that implant abutment interface was subject to causing bone loss or perimplantitis. Doesn't really matter if you believe in microgap colinization, microstress movement or the lack of "platform switching". Everyone agreed that placing the replace select needed some respect for those issues and I enjoyed the polished collar as a way to manage that issue. Then, without explanation, they just removed the polished collar and completely changed the thinking behind their system overnight. That is what caused me to loss confidence in Noble Biocare. I have since switched to Astra or any other system that has a tapered abutment connection. That has been much better in my hands and I have found much less bone loss and much healthier tissues. But don't take my word.......... Noble Biocare's new modern Active implant has a tapered connection proving that they needed to change the connection from the trilob to taper. Why they didn't can only be explained by some European rock video presentation.... or maybe they don't care what is best for the patient.

Read the entire article and not just the abstract. It is about changing implant gear without having sustained scientific evidence. Can we say this makes our patients being the genuia pigs...?

I think the problem may no t be with the groovy macro geometry, Tord Berghlund's paper demonstrate in the dog model that de Ti-Unite surface shows significantly more marginal bone loss than the other implant surface used ( Straumann,Astra,3i) Although its not clear why but it is not definitely the geometry

PS - Not that I don't enjoy picking on Noble Biocare.... I think they sold us out and they are getting what they deserve. But, the new active implant is pretty sweet. I have place 11 of them so far.... And for soft maxillary bone in the 10mm range and immediate loads.... they seem excellent.

Having restored thousand of fixtures over twenty plus years the Nobel Select or Groovy exhibit no higher failure rate than any other implant. I have a success rate over 98% and have used a many different companies fixtures and find the Nobel ones equal to the others when you follow the rules and restore them correctly. There are no large studies showing any problems with groovy or select. By the way the tri channel not being on the Active implant has nothing to due with bone levels I has to due with the design that was there prior to any relationship with Nobel by the design group in Israel. All implants work at a high 97%+++ rate if you do your homework, plan the case and do not compromise anything. Do it right and read good literature.

Yet, Coincidentally, Many of the major implant manufacturers seem to be progressing towards an indexed and tapered connection. Abandoning previous designs without uttering a word of explanation. I agree that most implant systems work very well and are very predictable. But now, we are splitting hairs attempting to get even better results..... I have successfully placed thousands of trilobe connection implants making many happy patients, however.... they simply get more bone resorption, soft tissue inflammation and screw loosening. Since switching to a tapered connection.... the tissues are simply healthier. I make this point because the initial post suggested the problems stem from the surface coating. I would submit it stems from the connection.

Berglund and Lang is not a "good literature"?

Cosyn J, Sabzevar MM, De Wilde P, De Rouck T. Two-piece implants with turned versus microtextured collars. J Periodontol. 2007 Sep;78(9):1657-63. Implant companies have been promoting two-piece implants with microtextured collars in the interest of hard tissue preservation and/or soft tissue integration. However, this rationale may not be justified. Based on comparative studies currently available, it is unclear whether microroughened implant necks reduce crestal bone loss. A possible effect may be overruled by the establishment of a biologic width or by other factors influencing crestal bone remodeling. In addition, the orientation and attachment of the collagen fibers in the peri-implant mucosa are a little different because the surface roughness varies at the level of the implant neck. The clinician should be cautious when using these modified implants because the impact of microtextured collars on the initiation and progression of peri-implant pathology is currently unknown. Sure makes sense - I am avoiding implant designs that have changed from a machined collar to microtexture WITHOUT RESEARCH!

Dr Krastev, what do you read?

The Ti-Unite surface has been around a very long time and there is plenty of evidence to show that it is biologically a very good and effective surface. Prior to "Groovy" there existed a polished collar zone on the "Replace" which if used according to protocol, this polished collar would be placed above the bone level. With the introduction of "Groovy" the protocol became to place the implant top at bone crest level. This significant change resulted in positioning the microgap at bone level rather than 1 mm. above as before. The jury is still out on whether this creates a problem with crestal bone loss and possibly peri-implantitis. The current prevailing evidence seems be gaining support for the notion that indeed it very well may do so in some cases. That is why there is a gaining movement to having a stepped down platform as well as a conex connector.

I started placing implants 6 years ago. I started with the Nobel Replace Select (TiUnite, machined collar). At the World Tour in Las Vegas Nobel Biocare relesed the Groovy implant. I bought 200 Groovys and brought home to Sweden. So did many of my collegues. After I had placed 100 implants I noticed that some of my patients did not respond well in regards of soft tissue healing around the implants ( I know it´s to few to draw any conclusions). My collegues reported the same observations. We then returned the rest of the Groovys to Nobel and got the Replace Select in return. I now place over 2000 Replace Selects / year and it works well. However, this issue regarding the TiUnite concernes me. Since I have such a large numbers of implant surgeries I can not afford a large number of late "problems". On the other hand the patients treated 6 Years ago(with the Replace Select system)look just fine both on the exray and when checked for mucositis and periimplantitis.

The small number of implant patients cited is a problem.The sample size is to small to make any conclusions.

Emperical Medicine, who told you they took the polished collar Replace Select away? You can still purchase them from Nobel, that's what I use every day in my practice!

No, No I realize that Replace select is still available. I was just offended when the changed the entire theory of how to place their implants without any justification. It seemed that they were attempting to match the trends in the industry towards a roughed surface to the top of the implant without changing the design of the implant or the connection. All without justifying why suddenly everything they had been teaching was no longer valid. That and some other marketing issues caused me to loss faith in their company and switch after 7 years. Now I use a tapered indexed connection implant system and I get much better results than I did with the "looser" trilobe connection.

I agree with Emperical Medicine. I also have placed thousands of Replace Select and many Replace Groovy over the past 10 years and have now switched almost entirely to Astra Tech which also has a micro texture surface to the top. Bone loss occurs to a much greater extent around a Replace of either variety than around an Astra and this seems to be related to the medialized abutment connection(platform switching) and to the secure fit of the abutment into the implant via the internal tapered interface. When I use a Nobel implant these days, I've returned to the Replace Select with the polished collar and I attempt to leave the collar 1mm suprabony. This keeps the microgap some distance from bone and I'm more comfortable with the tissue response around the polished collar.

I am one of the clinicians in the Nobel Direct study. There were 38 patients in the study. Presently there are 36 patients remaining. Two are deceased. 48 implants were placed in the patients that were enrolled in the study. 2 implants were lost within the first four weeks. One due to lack of primary stability at the time of insertion and the second one due to overload caused by the provisional restoration. 42 implants are six years in function on the 36 patients remaining in the study. Radiographs were taken for the first three years at six months intervals, and at present, one year intervals. The radiographs exhibit no measurable bone loss. The peri-implant soft tissue is pink and firm, exhibiting no inflamation. I have been extremely pleased with the clinical result using Nobel Direct. Like with any implant device or modality, surgical and prothetic principals must be carefully followed. On another issue, I have placed and restored hundreds of Replace Tapered Groovy implants without any consequences when compared to other systems and surfaces.

I don't believe anyone here is challenging one piece implants. They clearly don't suffer from connection design as there is no connection. Much like the Scallops, Directs are very technique sensitive to place and patient selection becomes a significant impediment. As for the Groovy/Replace Select... I disagree if compared to a tapered connection. Funny that the companies don't often make those relivant comparisons?

I have placed hundreds of Nobel groovys and I have been fairly satisfied with the healing. I have had a few unexplained failures including one after 5 years. I feel that the implant and the tiunite surface is not the best option in Type 3/4 bone or in smokers. This is only my personal opinion and not based on any studies.

Have you ever looked for the ReplaceSelect and the NobelReplace Groovy side by side? Take a look next time you have the opportunity. Check for the color, and question if that's the same surface?????

I am trying to make a decision on implants and am completely overwhelmed with the different treatments being offered for my lower jaw which has only 6 teeth in the front, nothing but a temporary bridge for molars My jaw will need bone grafts - one dentist said both sides, another said left side only, a third said maybe not at all I am trying to find out the best kind of implant for a thin jaw with bone disease, how many implants are optimal One dentist says 6, another 4. Can anyone PLEASE help me?

More long term studies need to be done on this type of dental implant. I have placed a few of these implants and have never had a problem.

All attempts to be different will lead into peri-implantitis, except AstraTech, all other companies are trying to copy the micro texture portion at the neck, but we as dentists only will have some eyes for that because we pay too much attention on sales rep!

This is actually quite a surpise to me. I have been using nobel groovy dental implants and have always gotten predictable results.

The issue with the groovy is purely biological. Why would I want to place a rough surface implant at the bone crest without platform switching, since I know there is going to be 1.5-2mm crestal bone loss from the microgap to make up for the biologic width formation? That means that the first 1.5-2mm around my platform are not going to be in bone after 1 year in any case, so why do I need the roughened surface there instead of a polished collar which is more resistant to periimplantitis? I think Nobel just wanted to market a bone level implant using the very popular design of replace select.

I have placed probably close to a thousand Nobel Tapered Groovy implants. I have seen a total of five failures. In every one of those cases it was a problem with a compromised surgical site or a medical compromised patient. In those cases, I replaced (with another Nobel implant) and they integrated just fine. So you understand I am not a Nobel plant or employee. I also use Straumann a good deal and have placed many 3I and Zimmer implants as well. All integrate and perform about the same in my opinion. The clinical significance of the various nuances of each system is small. It is more about the surgical technique of the doctor rather than the system you use. I have heard of the problems with the Nobel Direct implants, but I have never used them and can't comment on that. I CAN say though that anyone that would use and publish a study that had only 10 patients in it, needs to learn a little bit about statistics. That is not nearly enough statsitical power to prove or disprove anything. Just because something is published, doesn't mean it is proof of fact. There is a LOT of horrible research out there that gets quoted from all the time. Unfortunate.

It is just a clinical comment, not a scientist one: it can be in optimal oral hygiene conditions with a good cheratinized tissue around the implant with the threated neck, we have excellent results. In different clinical situations ( which often happened)the implant exposition with smooth surface neck ( as enamel), seems me to be better than a rought surface where bacteria and calculus are more prone to adhere. in consideration of this, maybe a vintage ( ! ) smooth neck, can be helpfull in case of bone loss and implant exposition. Best regards