Straumann 6mm Wide Neck for posterior region: What are your thoughts?

Lately patients don’t seem to be open to sinus lift procedures, even if it is summers technique. Therefore, we have to find ways to treat them…I think the Straumann Standard Plus 6mm is a great alternative. What do you all think about it? Below is my most recent case, still haven’t worked on the prosthetic part yet. What do you think?

54 thoughts on “Straumann 6mm Wide Neck for posterior region: What are your thoughts?

    • John says:

      This is the type of comment we do not need. If you don’t agree with it, at least use some argument. What would you have done? Patient does not want any kind of sinus lift procedure and want implant supported restoration.

    • ddsman says:

      @rsdds
      The “looks” of an implant are irrelevant because you won’t see the implant. What is it about the implant that you dislike, and why would you not have that in your mouth?

      my opinion is that a premolar sized crown on that implant may function just fine. The surface area might provide enough osseointegration to withstand chewing forces. I haven’t read any studies on this specific implant but short wide implants have shown to be adequate in the posterior.

      It’s hard to tell from just a single film.

      What was your torque on insertion? How long has it been in the mouth? How long is anticipated crown height going to be? What does the contralateral side look like?

      From this image and your initial post, it seems fine, but there’s a lot more we’d like to know.

      Thanks for posting! 🙂

  1. Dr. M Martinez says:

    wow, nice comment! not. Read the literature and there is more and more studies supporting the use of shorter implants. Less traumatic to patients.

    • Dr. M. Martinez says:

      Occlusion will be very critical. Light centric contact, make sure no interferences. Like others have mentioned , small occlusal table on restoration. Looks like maybe you could have gained maybe 1-1.5 mm apically by selecting slightly longer implant, maybe more stability. Hope works out well.

  2. Robert J Miller says:

    My only problem with this design is that it has minimal threads throughout the body. This dramatically reduces surface area in a high load zone. I have found a higher incidence of late failures with these architectures. Short implants are fine with architectures that have greater surface areas.

  3. Peter Fairbairn says:

    Agree a good friend places many short implants with great results ………….but for me they are the ones I lose so a personal thing .
    Here the main issue is the lack of bone distally as well … no grafting .
    Sinus augmentation with Dask and the other new applications is quick safe and yes … easy .
    With the use of full bio-aborded materials the patients have only their own bone long term.
    I am not critical of the case as I know a lot of things work due the the host healing and the miracle of host healing ..
    I am also not the patient , so do not make the decisions

  4. Neil Zachs says:

    Please ignore negativity…Kudos to you for asking the question.

    Short implants definitely work, but there are definitely times where they can be an issue. I personally will put a shorter implant in when it is between two teeth as the bio mechanical forces can be controlled much easier. A short implant as the most distal tooth in the arch can be a bit dicey based on a severely skewed implant to crown ratio.

    If a patient does not want a conventional sinus lift, consider getting Versah Burs for densafication. You can easily lift the sinus 3 plus mm during implant site prep and the lateral bone becomes more dense which helps implant stabilization.

    Hope this constructive advice helps! Best of Luck

    Neil Zachs
    Periodontist, Scottsdale, AZ

  5. Implant guy says:

    Implant direct has 6mm short implants with greater surface area and buttress threads….more apical engagement and stability. Short implants can work…but dont spend a fortune on Straumann.

  6. Charles Consky DDS FRCDC says:

    As an OMF Surgeon, I have no reservation regarding bone augmentation techniques. They are useful and predictable.

    That being said, I have frequently used the 6mm Straumann tissue level implant. This is especially useful in elderly patients or patients with medical comorbidities. They have been quite successful. The only caveat is to place the implant deep enough to allow for appropriate emergence. This may require mild countersinking.

    In the case shown, the implant could have been placed 2mm apically with the osteotomy stopping at the sinus wall. This then would have prevented the distal exposure of the implant and allowed for an excellent emergent profile. Placing the implant above the sinus floor by letting the implant infracture the sinus during insertion, may gently displace the membrane (due to the blunt nature of this implant) and act as a modified Summers Technique without a graft.

    • ddsman says:

      “In the case shown, the implant could have been placed 2mm apically with the osteotomy stopping at the sinus wall. This then would have prevented the distal exposure of the implant and allowed for an excellent emergent profile. Placing the implant above the sinus floor by letting the implant infracture the sinus during insertion, may gently displace the membrane (due to the blunt nature of this implant) and act as a modified Summers Technique without a graft.”

      My opinion is that you need to have pretty good clinical skills (meaning experience) with this technique to avoid perforation. A skilled surgeon can do this. A General Dentist shouldn’t attempt it unless they can repair a perforated membrane.

      And I’m just a General Dentist…

    • Jimmy D says:

      @John Beckwith “I’ve seen these fail after loading.”

      If it does fail, then the patient may be more open to a sinus lift.

      But on a more serious note, have you been able to determine what the cause of failure was? Parafunction/Bruxism/TFO? Perio?

      Which brings up the all important question… Why did this patient lose the natural tooth?

  7. jose o guillen says:

    I definitely like short implants as long as the crown to implant ratio are appropriate. I think the ratio here is a bit too much. I agree that an 8mm implant could have worked maybe. What’s planned for the distal of this implant? Perhaps another short implant double abutment should work in your favor. It was placed well. I’d just like to see it a little longer. Hope it turns out well.

    I’d check the torque prior to loading.

  8. Implant guy says:

    I agree with Robert Miller look at the X-ray the Straumann implant only has two threads for that short implant. The Implant Direct short six millimeter implant has better apical engagement in more threads and more surface area which would have been a better choice and it would have saved you money. It’s not always about the money I agree but I don’t see any advantage to paying for Straumann implants especially when their design is lackluster and quite frankly antiquated

  9. Dennis Flanagan DDS MSc says:

    This cannot be a stand alone implant. The crown-fixture ratio is too large. Put in 2 more distally and have a nice long term functional result.

  10. Albert St. Germain says:

    Well, not having a CBCT, which would show placement accuracy better, I believe that a longer implant could have been placed without a problem, not impinging on the sinus. Let’s not forget that Keystone has created wide body implants for immediate placement with a similar configuration.

    And BTW, I ceased criticizing others’ work a long time ago when I adopted the mantra: “I wasn’t there, don’t know the patient nor the circumstances”.

    It’s much better to provide constructive criticism in a forum such as this that to throw stones, since there isn’t one of us who’s never made a mistake. And I must also submit that I remember best the examination questions I got wrong, knowing full well that i would not get it wrong again.

    Humbly Submitted

    • John says:

      Thanks for your comment. I did have a CBCT prior to the surgery. I had 7mm to place an Implant. For now I work only with Straumann and Neodent, so my only option here was to use a 6mm implant. This patient use to have the tooth nº 17 (2º molar) and was extracted in the same surgery of the implant placement, I grafted the socket but it didn’t seem to have worked. I read all the comments and now I’m really in doubt of what should I do next. Patient really wants a tooth there. It’s been almost 3 months since the surgery and I’m thinking about placing an healing abutment this week and in 15 days some provisional crown so the patient have his tooth. Wait a couple months and ask for a new CBCT to see if I can add an additional implant on the distal to do a partial fixture. What are your thoughts about next steps?

    • Jawdoc says:

      Retro studies are not level 1 evidence. A well-done systematic review or a meta-analysis would be better.
      Having said that, short implants have their uses; but surface factors will be critical due to unfavourqble crown-height ratios.

  11. mpedds says:

    I agree with Dr Flanagan. We can always work a miracle and place an implant of some type in some way. But lets not forget about the prosthetics. The “crown/root ratio” is poor for this situation whether it is an implant or natural tooth. This will be taking all of the posterior support. Likely the patient will lose this at some point due to occlusal load. Could work well as retention for a removable prosthesis.

  12. WJ Starck DDS says:

    Hi-

    You might get lucky with this one, and you might not. The crown to root ratio is going to be disadvantageous.

    If I had been doing this case (I use Straumann as well) I would have gone with an 8-10 mm Straumann bone level implant. There just isn’t enough thread on those little 6 mm Wide neck implants.

    8-10 mm you say? Heresy!!!! Why you’ll drill right through the sinus floor????!!!!

    Yup. And the stars will not fall from the heavens. What will happen is that the sinus lining will re-form over the exposed portion of the implant, and eventually bone will creep up to cover most (if not all of those threads). But even with an 8 mm Bone level, it looks like you would have been right at the sinus floor, and wouldn’t even have broken through. I can’t remember the last time I’ve needed a sinus lift – it’s been well over 10 years at least, maybe more.

    I’m inclined to advise you to remove it now and redo it. If that thing craters down the road, you will have a real mess on your hands (with a lot of cratering bone loss – no pun intended)

    Good luck, make sure you update us on how it turns out. Thanks for sharing

  13. Ninja says:

    We always accommodate to the patient’s wants and agree to doing magic. Short implants are the same huge compromise as immediate loading that in many cases should not be done. The in by 10:00 out by 12:00 is a common thing with dentists. If one would reflect on the basic physics it should become apparent that the lever principle prohibits placement of a 6 mm implant with a crown above it of 10mm or more. Anyone with any sense would see the absurdity of short implants especially in the molar, primolar area. A loss over time if not initially of 1 mm of bone equates to over 16 percent. How often do we extract teeth that are anchored only 6 mm in bone because of periodontal issues in non/esthetic areas?

    • Mark Bourcier says:

      I doubt that you have any study to back that sentiment up. And the reason I say that is that Bicon has been placing, studying, and documenting the placement of short implants with multiples of crown:root ratio for 2 decades and they work. The reason why is twofold: 1, an implant is ankylosed, not suspended by a PDL like a tooth. And 2, according to Wolfe’s law, bone responds to forces placed on it by becoming stronger and denser. Please check out this article by Dr. Rainier Urdaneta for a good overview. http://support.bicon.com/customer/portal/articles/1240252-are-crown-root-ratios-a-factor-with-bicon-short-implants-

      I agree that the Straumann may not be up to the task due to lack of surface area and aggressive threads. Ankylos and Bicon certainly would be. I would leave the implant in and see how it does.

      Best- Mark

  14. mwjohnson dds, ms says:

    This is a weird post. What does the poster want us to say? What a smart talented surgeon he is? He’s only asking what we think but he “hasn’t figured out the prosthetic part yet”. I thought the latest thinking was prosthetically driven surgery. That means the first thing we should be doing is figuring out patient desires and prosthetic design then deciding if the surgery can meet these prosthetic objectives. So what do I think? I think most posters are correct on this thread including rsdds. There are posters here that think an honest opinion is bad. It’s not. There’s nothing wrong with someone asking “what were you thinking?” Yes, there is literature supporting short implants and their success rates (Int J Oral Maxillofac Implants, 2012;27:1323-1331 with the majority of short implants, 71%, failing before loading) however, a free standing first molar in type 3 or 4 bone might be pushing the envelope a little. Agree with the poster that said there’s not a lot of stabilizing threads and this implant design is a single stage implant so any force on this small implant during integration can cause problems. Also enjoy seeing postings from “implantguy”. Obviously works for implant direct since his only input is “buy my product”. So maybe buy ad space from Osseonews?

    So, would I do this? Depends on the circumstances. A shortened dental arch is not the end of the world. What was the patients motivation? Just because the patient doesn’t want a sinus lift doesnt’ make this an appropriate treatment. As some other posters have stated, there are alternative ways to hopefuly improve the success rate of this challenging treatment plan; densify the bone or use a different implant system with more threads (maybe a two piece system?). So yes, short implants are absolutely a viable option when anatomy gets in the way. Just make sure this is the correct treatment plan for the situation and try to tip the odds in your favor. Also, to the poster, can you please post this again in six months after you figure out how to restore it so we can see if it was successful?

    • implant guy says:

      haha…i enjoyed your post. I’m just also “trying to improve success rates of treatment plans” If you think using straight walled, tissue level implants from 1987 with limited apical engagement and limited threads is the best than great! And if you like paying $400 per implant for that success…than more power to you! Some people enjoy going to Straumann’s paid CE’s at events and drink the koolaid, and love their lavish parties where they buy out doctors. All of this has to be paid for somehow, and the doctors who buy the products end up paying for it!! Straumann came out with a bone level tapered implant finally and thought they did something great. ID has been doing this since corevent and paragon 20 years ago! Hey, nobody ever said dentists were good business men. One day they will understand….all implants work, with the right patient and right clinician. All this different surface treatments and absurd marketing is useless. Get a good price and good rep, good support, and good product variety…..and that is all. Get a company that can help you across the board, not just sell you overpriced screws.

      • mwjohnson dds, ms says:

        I chuckle when you say surface treatments are useless. Have you seen your catalogs lately showing off your implant surfaces? You’re no different than any other company in drinking your own koolaid. I’m not sure where you came up with the idea I like straight walled implants from 1987 (nothing like putting words in my mouth to justify your sarcastic reply) Actually I like using implants that have research behind them. Your implants are knockoffs of Straumann (Swishplant), Nobelreplace select (Replant) and the nobelactive and nobel parallel conical connection (interactive) so your company is a copier not a leader (I do give Dr. Niznick credit for his larger internal hex for anti-rotation in the 80’s with corevent).
        Compare your design of the interactive abutment for the conical connection against the OEM part from Nobel. Your abutment has a longer hex and a shorter conical portion. It is emphasized in your catalog. The implant abutment interface in a conical system is designed to have maximum conical interaction with the internal of the implant to prevent screw loosening, with the hex there only for indexing. Your abutment mimics the longer hex of the original corevent and minimizes the cone so your system introduces more load to the screw since there’s less conical mating surface of the abutment and implant (Nobel literature). So don’t throw stones at the premium brands of implants. They are premium for a reason. I work with many different implant systems including yours and other lesser expensive systems. However I do take exception with lesser priced systems touting their superiority to other systems when there’s little R and D behind them.
        Your main selling point is cost, not quality. Not once have I seen you post about your research and why your system is superior to any other. Your company mostly just denigrates other systems and touts the lower cost and the “aren’t you stupid to pay too much for a screw” mentality. I agree with you that all the hype of the different surface treatments is there to sell implants and I agree with you that most all of the surface treatments work and was a great advance in improving implant success in weaker bone. It is now selecting the correct implant for the site and making sure the all important abutment/implant interface is precise. With the conical connections available today (instead of the old flat top design) precise machining and mating of the connection surfaces are vitally important for the overall stability and longevity of the screw joint. So, get a good price? How much is the price of screw fracture and failure when using aftermarket products?

          • OsseoNews says:

            Please keep comments relevant to the original topic of this post. These particular comments of one implant system vs another are not of value for this particular discussion. Thanks.

          • mwjohnson dds, ms says:

            aftermarket just means a secondary company made the abutments. And, many times changes must be made to the design to get around patent infringements. Also, many secondary companies that mill abutments are not FDA approved and are not 510k compliant (newest regulations regarding medical device manufacturing). With the new conical connections precise mating is an integral part of the overall design of the implant complex and is very important to the overall success of the implant system. Thank you for your question. Also, unfortunately, all screws break at some time or another. Since I’m a prosthodontist, I remove a bunch of broken screws. One of my challenges is that different abutment manufacturers have different screw head sizes. So when a screw breaks, I need to know the abutment manufacturer not the implant system! Ugh. The nobel head size is different from Atlantis which is different than Implant Direct (the star drive is the same) so I need the correct replacement screw for the abutment. Sorry to get off the topic of short implants but I think this is also an important thing to document in your chart notes. What abutment system did your lab use? oh, and yes, I have had to replace implant direct screws I’m sorry to say!

  15. John says:

    Damn, sorry about using Straumann. I heard about their reputation in the USA and Europe…Where I live is isnt really that expensive, that’s why I use it.

  16. Osurg says:

    Would someone explain the reference to crown root ratio when discusssing implants that have no periodontal membrane. Having had to extract short primary teeth that are ankylosed and not being able to move them without recourse to surgery, I feel than a well integrated shirt implant should be evaluated somewhat differently. Attempt to remove a failing 10mm implant which is only one third intergrated and you will realize how strong is compared to a similarity compromised tooth.

  17. Ninja says:

    If we always did what the patients want us to do, we would need a license as a cosmetologist ( a person that does nails). Is there anything wrong to turn away business by saying it cannot be done successfully unless one wants to do something to last for as long as the party lasts. There are appliances on one lab’s menu called snap on smile which is made like a thermoplastic retainer filling in the missing teeth. That is magic. There is nothing wrong wanting to make money but there is also nothing wrong with making money the old fashion way, by earning.
    Just dealing with an oral surgeon after a patient came in with 6 mm implants in the posterior mandible and complaining of food traps. On examination one can see about 2 to 3 mm of resorbed bone around the implants making it a nice place for food to lodge. Implants were placed less than a year ago. Most of the time we see immediate resorption after bone placement. How much resorption can we afford when the entire implant is 6 mm?

  18. Mark Bourcier says:

    You presume that there must be bone loss and historically there is a reason for that. Platform switching and Morse taper address that, and in the Bicon system it is routine to see bone gain over time, particularly with their hemispherical abutment base.

    If you are expecting bone loss, you should be looking for a new implant system because it does not have to be that way. And if you do get peri-implantitis, do you want to trephine out a 15mm implant, or twist out a 7 mm implant, graft, and try again?

  19. John Beckwith says:

    Crown height is a force factor . Stress =force/area
    You will have crestal bone loss w excess stress
    Please refer to Misch
    Regarding force factors.
    I really hate to rehash factual references. This is the basis of treatment planning implantology. Of course there have been improvements w implant design etc. but lets all try to be consistent w treatment planning etc.

  20. Matthew W. DMD says:

    I too think the first response was a little abrasive. Although I would not want that in my mouth , I would’ve allowed for a sinus bump augmentation. Our patients are not dentist and don’t understand the success and ease of augmentation. I think as long as you get good integration then you have helped a patient in need And as long they understand possible compromises. I personally would’ve gone a little bit longer , maybe even got longer implant in that space. I think you might have gotten into the cortical wall of the sinus and maybe could’ve achieved better initial stability. That being said. Good luck and I hope all goes well. Without some experimentation there is never gonna be advances.

  21. Ninja says:

    Since a dental implant is medical device I would like to see a certificate of approval by the FDA of Straumann’s 6mm implant specifying applications. I wonder how rigorous are the tests by the FDA in approving dental implants and how the process compares to other medical devices.
    Various studies that are followed by publications in various journals are often done on samples that are not statistically significant. It is my personal opinion that because of tradition dental devices exist without significant testing by FDA and many shortcuts are taken in the approval process. One colleague writes that there was a study done that provided evidence that bone resists to a greater extend in the opposite direction of applied force. Wood does the same and the screws fall out. There is always magic in dentistry because of extraordinary simplification. If Bicon implants were so successful why are we resorting to sinus lifts in so many instances? Are we over treating people? Is the insurance industry so dumb and indifferent that they approve ridge augmentation, bone grafts rather than suggest Bicon? They do that in many other instances.

  22. kent hamilton says:

    I agree, a very small sinus bump would have allowed a crown to root ratio.
    Straumman is an excellent implant inane length. You can never go wrong using there implants.
    There are millions of edentulous spaces that would allow a more predictable outcome.
    we as doctors are always trying to help the patient. But often times that is truly not what is best for the patient
    Do your patients a favor always provide the very best treatment. If you can then refer to someone who can
    Your patient will thank you for it and respect you more

    with all of that being said , if you manage the occlusion, it should work out fine
    Good luck

  23. rwdds says:

    Many of these comments regarding crown/root ratios with regard to implants are antiquated and not in keeping with present research findings. It was presented at the AO meeting this year with research basis that a 6 mm implant will support up to a 15 mm crown/abutment. 4 mm implants are on the way……..

    • John says:

      Yeah well when I decided to treat this patient and he told me he didn’t want to do sinus lift augmentation, I did lots and lots of research about 6mm wide and short implants and I did see lots of favourable outcomes, that’s why I did it. Anyway, my main ideia still is to place another implant distally to this one and splint the fixtures. I just thought this subject would generate lots of discussion (and I was right).

  24. Kn says:

    I am concerned that this was placed too deep. Aren’t these implants supposed to be tissue level? From the X-ray it looks like it placed at the level of the bony crest. This would 1) make it difficult to restore since the margin will be buried deep making it prone to “cementitis” and 2) cause bone loss (i.e. cratering) that could also compromise the adjacent tooth. Couldn’t you place it more coronal so that the margin is at the gum level and this would allow for a longer implant? I’ve had pts with problems when these types of implants are placed too deep.

  25. John says:

    No…I assure you the treated surface of the implant is at bone level. The neck of the implant is above the bone. Maybe you’re looking at the soft tissue line

  26. Leal says:

    If the implant is 6mm long I mean if there is 6mm from bone crest to the apical portion of the implant, then you are left with approx. 3mm bone that equals 9mm total height. Why not just crack the sinus floor with an osteotome and place a 10mm implant without bone graft? That’s almost double the size. Do you need to charge more for this simple and quick procedure (more then the implant surgery itself without bone graft)? I don’t. I would never use a 6mm implant in the posterior maxilla but my future opinion may change. You never know.

  27. Suresh Variar says:

    To people skeptical about short implants and crown root ratio etc .,kindly look at evidence from Hammerle and colleagues from Switzerland .they have 6-7 years studies which are encouraging .

    But I guess there is a learning curve !

  28. rsdds says:

    I’m sorry If I offended someone but In restoring this case you need to take into account that a maxillary first molar needs to widthstand from 200 psi of bite force under normal function to 800 psi in a bruxer now do you think that this short skinny implant can accomplish this?

  29. Saurabh says:

    According to latest academic research articles, even crown to implant ratio ~2 has a good success rates. What I feel in case of short/ultra short implants what matter is the quality of bone and the design of the implant.
    Yes, In this case the dentist should have pushed the implant little more inside, as I can still see some bone is available.
    Also, one could splint this with another longer implant, which can be placed in this situation.

  30. Gregory Steiner says:

    We are gaining more in site into what repetitive excess load does to bone. In the past the assumption was that repetitive excess load resulted in increased bone density and strength but a recent study says the opposite. A recent presentation at the American Society of Bone and Mineral Research found that repetitive excess load over time causes osteocyte apoptosis and bone resorption and permanently compromises the health and strength of the bone. This implant surly would fit into the category of excess repetitive load. It may take years for the damage to accumulate to the point of failure but the damage may be more permanent than the loss of the implant. Greg Steiner Steiner Biotechnology

  31. Kaveer Ratan says:

    Firstly, lets try and be less offensive to peoples posts. Constructive criticism please.

    I think when it comes to implant treatment I think its important to ask yourself 2 things:

    1) Do you as a clinician want implant treatment?
    2) Do you also want a sinus lift?

    Its all good and well telling patients they need all the implants and sinus lifts in the world, but what do they want?

    I firmly believe that avoiding the sinus is a great idea if its not completely necessary I would go for a shorter implant first before forcing the issue with a sinus lift.

    I don’t think theres anything wrong with this particular clinicians treatment. Im not sure what the clinical scenario is with the occlusion etc but I would leave an implant like this for a minimum of 6 months prior to planning a restoration. Its important to also discuss all pros and cons with the patient prior to going ahead with whatever decision you make.

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