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One Piece Dental Implant
Have any of you started using one-piece dental implant/abutments where there is no dental implant-abutment interface?
The design feature here is to eliminate the junction between the dental implant and the abutment since this connection has a microgap which may become a breeding ground for bacteria. Dental implant placement into the appropriate site and desired angulation are critical since the only way to modify the abutment portion is with a diamond bur. What has been your experience with this new dental implant design?
December 27, 2005 in Abutments | Permalink
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Comments
One piece implants will not succeed. They will be a niche market for those doctors that do not understand that implant dentistry does not have to be 'dentistry'. It is a far better service to patients and doctors to take fixture level impressions and do eveything out of the mouth. Why would you prepare titanium in the mouth if you don't have to? Besides, the interface is not the problem. It is the motion of the interface that is the problem. And the better systems have overcome that. Think like a machinist, not like a dentist.
Posted by: Mark P. Miller, DDS | Dec 27, 2005 3:31:23 PM
I can not think about how to get the angle correct so I do not have to over prep the implant and I am concerned about the heat......But many are successful
Posted by: Jeffrey Hoos | Dec 27, 2005 6:22:31 PM
This implant design, such as the NobelBiocare NobelDirect, is very useful in sites with limited interdental dimension. The typical site is the maxillary laterals. Two piece narrow implants were used before one piece implants were available, but the inherent weakened walls of the two-piece narrow implants presents a structural problem. I have seem two two-piece narrow implants fractured. My restorative team has not have particular problems with this design; but of course angulation, depth, and placement position are critical factors that need to be controlled well.
Posted by: | Dec 27, 2005 8:28:14 PM
Two good postings. Thanks to Jeffrey Hoos for angled comments. If we encounter a space so small that a one-piece implant is required, then it is imperative that the surgeon place the implant so that no angled abutment is needed...EVER. If a house built on a hill collapses because the pilings were not engineered correctly, the fault lies with the person placing the pilings. It's not the fault of the house or the slope. So it is with implants. Because something works does not validate the belief that it should always be used in similar situations.
Furthermore, there is some evidence that the bony response to a one-piece implant is not the panacea that we might think. We must keep open minds. The 'theory' of biologic width is being called into question also. We have assumed that implants respond like teeth, when in fact, that may or may not be the case. Time will tell. I direct your thought processes to the Strauman model vs. the Astra model, vs. the 3i 'platform switching' model. There are still teeth in my practice that cannot be successfully restored with anything BUT amalgam.
Posted by: Mark P. Miller, DDS, MAGD | Dec 27, 2005 9:27:55 PM
Those implant designs, such as the NobelBiocare NobelDirect are under question right now by two professors from Gothenburg University, Nobel don't accept that claim as they publish in their home page, but seems convenient to wait and see. To preserve crestal bone avoiding the micro gap, 'platform switching' concept, seems more promising, and allow to use a broad range of prosthesis options to the patient...
Posted by: | Dec 28, 2005 12:21:45 AM
I agree with you Mark on your first comment. The one-piece may sound like a great idea in theory, however, there are problems such as those noted in other posts. In addition to those issues, one of the particular one piece implants noted above has also been experiencing greater than normal bone loss in certain cases and is currently under investigation. Do your research, gang.
Posted by: | Dec 28, 2005 4:23:26 AM
We should open a thread about implant fixtures and 3i's concept of the set back abutment. The biological width comment has real merrit because of the lack of bone loss seen with implants that the abutment is "back" from the edge of the implant and the microgap is not a problem. I have a case in which I used the "wrong" abutments because of a time factor with every intention of replacing them at a later date......no bone loss down to the first thread. Now we see what 3i is promoting a "step" back abutment. The one piece concept may make no sense at all if the implant systems, Astra, ITI, Bicon, and others have a "transmucosal" abutment...an old name that shows no bone loss. Sorry for the long post.
I am a Nobel fan and teach their system but just because a manufacturer promotes something does not make it good for private practice.
Happy New Year to all....
Posted by: Jeffrey Hoos | Dec 28, 2005 9:19:29 AM
I would just like to point out that although 3i is takeing credit for "accidentally discovering" Platform Switching in 1991, it has been an intentional design feature of the Bicon System since 1985. It has been referred to as Sensible Biological Width.
If you were to look at the trends of the changes in the implant designs over the past 30 years or so, you might be suprised that Bicon has been a pioneer in many design features that others later took credit for or later quitely adopted.
The designer of the Bicon system and its predecessors, Tom Driskell, was and still is a brilliant engineer in the field of implant dentistry and bone regeneration. It is a shame that he may not receve the recognition that, in my opinion, he truly deserves.
(I am a Bicon and Astra customer with no financial interest in either of the companies)
Posted by: | Dec 28, 2005 1:49:03 PM
Having a non segmented implant such as a Nobel Direct very well may be putting the bone to implant interface at risk. Even more so with a high strength ceramo ceramic restoration.
Posted by: Steven Silberg | Dec 28, 2005 7:12:50 PM
Some of the implant manufacturers are now simulating Bicon's design with abutments narrower than the implant fixture platform. Platform switching has become one of the new recommendations for reducing bone loss. Nobel Biocare has two new one-piece implant designs that are not marketed yet and encorporate the Bicon style of narrowed platform neck.
What is the experience with Bicon?
Posted by: | Dec 29, 2005 3:16:47 AM
Well, I think the one-piece dentla implant is useful when indicated, and when we are able to get over 35 N toruqe, and we are able to prevent lateral movements, and when there are no angulation problems, the biggest advantage of this system is to preserve the dental papila using the flapless surgery, as almost no gengival retraction is noticed and eliminating the micro gap which have been proven to be a nice place for bacteria to grow, plus no edema pain and reducing the work time are of big benifit to patient as well as dentist.
I have been using the system for about three years now, and I am quite satisfied with it.
Should the dentist choose cases carefully and decide best system to be used.
Posted by: | Dec 29, 2005 8:29:10 AM
has anyone seen the NobelBiocare designs that copy Bicon?
Posted by: | Dec 29, 2005 2:52:09 PM
A one piece design requires immediate tempoization and no matter how much out ofocclusion you make it, there is still too much risk of micro movement. Does not the literature show greater risk?
Posted by: JML | Dec 29, 2005 3:27:18 PM
Think like a mechanic.... that is the most ridiculous thing I have ever heard..... in implantology you better think like a scientist, dentist and engineer and combine proper and true knowledge and not manufacturer driven crap.WE REALLY DO NEED TO MAKE IMPLANTOLOGY A SPECIALTY.
Posted by: | Jan 2, 2006 5:22:04 PM
I agree with that last comment, I have been using 1 piece implants for 10 years... actually I have helped develope the one I use, we are in its 3rd generation and when used in the appropriate bone densityand case selection they ARE SUPERB.But you cannot blanket 1 piece immediate function we need both 2 piece and 1 piece.... whenyou truly understand the parameters of the 1 peice concept they are as successful and have no more morbidity than our successful classical 2 piece....and that is the truth. One of the best courses and articles written on this topic are by Dr. Bill Locante.
Posted by: | Jan 2, 2006 5:41:34 PM
Thank you whoever wrote that 'thinking like a mechanic' was the most ridiculous thing he or she had ever heard. If that is truly the most ridiculous, then you need to get out more. My comments are based on my lecturing for a major implant company for six years and seeing the angst that many dentists have about torquing abutments and implants in general. Perhaps your further elaboration on thinking like a dentist, scientist, engineer is well stated. However, I think you got my drift. Implants will never, in my opinion, be a specialty...nor should it be. I don't see that 'cosmetic dentistry' has gone too far in becoming a recognized 'specialty'. Implants are another tool in the hands of any dentist qualified to restore and/or place them. One of my favorite sayings in life is 'If it's being done, it's probably possible'. The fact is that many of us G.P.s are restoring and placing implants successfully. The last time I checked, Michaelangelo did not have a degree in art history. Your passion, doctor, should be directed at improving the profession and not finding fault with some brief e-mail from a colleague. I wish you all the best in 2006.
Posted by: Mark P. Miller, DDS< MAGD | Jan 2, 2006 9:52:44 PM
If your experience is based on your lecturing for a manufacturer you proved my point, since you are almost compelled to regurgitate what they want you to say so 1, you will be asked to speak again,2, to help sell implants.... free thought usually is no allowed. I have lectured for over 20 years...I base my comments on experience My practice has been limited to implants for a long time. The angst that you speak of comes from all the misinformation that has been propageted over the years mainly from manufacturers. common sense has gone out the window.... Oh and as far as getting out is concerned I have lectured and taught in both hemispheres of this earth.Maybe its you who needs to get out more.
Posted by: | Jan 3, 2006 4:15:58 AM
Great conversation here. Let´s try to refrain from ad hominem attacks, and focus on the issues. Thanks.
Posted by: OsseoNews.com | Jan 3, 2006 6:59:48 AM
To do it in only one piece i think is a "dirty" work. To spent a litle less money, but those money is more important, is like the all on four and all on six, it is all about money. Some inovations are good others only sells because you always think like the implants seller. i Think,...
Posted by: rui pinto cardoso | Jan 4, 2006 7:29:14 AM
In the case of the bacterias, they live and allways live in implants. There many implants in two pieces that have already more than 20 years in mouth (branemark). Is the gap juntion that important? If we do it in good materials with good impressions and good fit it realy doesn´t matter.
Posted by: rui pinto cardoso | Jan 4, 2006 7:33:23 AM
Dear Dr Cardoso,
Have you ever read artciles about the micro gap claiming that bacteria in this gap and two stage surgery cause bone resorption up to the level of the first thread of the dental implant? If not I would rather advice you to do so.
I do not think any of the threads above have mentioned the low cost(which is not true, as one peice implant is more expensive than conventional implant) as an advantage for one-peice dental implant!
Finally, if you have a patient that is not willing to undergo bone graft procedure for what ever reason, would you refuse to provide treatment if you are able to make the same case with all on six or all on four?
Posted by: | Jan 8, 2006 8:08:46 AM
Is there any logical reason why NobelBiocare's NobelDirect implant should result in greater than normal bone loss? Doing my best to think like a mechanic and dentist at the same time and my head hurts!
Posted by: | Jan 10, 2006 9:25:33 AM
I must admit I drew the ire of at least one dentist when I said we should think like mechanics and not like dentists. My apologies for my passion. Please understand where we have come from and why and where we are today with implant dentistry. No company has bought…or developed…an external hex in years. Nobel purchased Steri-Oss, BioHorizons has introduced an internal hex, Straumann, Astra and the likes have had an internal hex for some time. All these systems, including any of the orthopedic models, are based on the Morse taper, invented by Stephen A. Morse in 1864, who also invented the twist drill. His concept was a taper of 5/8” per foot for easy insertion and removal of machined parts. A web search of orthopedic technology will lead you to many references to the Morse taper and its use in hip replacement surgery. Prof. Branemark was a genius in what he accidentally discovered…the ‘osseointegration’ of titanium and bone. The hex fit was, and still is, an excellent method of placing fixtures into rabbit tibias as well as head bolts in all automobiles. The likening of implant dentistry to machinists is not demeaning…it is in fact a recognition of mechanical principles applied to dentistry that have been in place for quite some time. The external hex implant is dead. May it rest in peace. It has been dead for some time, and declared dead by greater minds than mine for some time. And yet we as dentists continue to use it…albeit less and less world wide each year. Old habits and paradigms are hard to let go of, and so it seems with the restorative platform of dental implants. So when you are deciding on an implant restorative platform to restore, ask yourself as simple question…’I am using an external hexed implant over an internally connected Morse taper/cone fit implant because ________.’
Posted by: Mark P. Miller, DDS | Jan 15, 2006 3:09:02 PM
The microgap should not be an issue in the posterior, non-esthetic areas with the availability of segmented systems designed with transmucosal polished collars for one stage protocols (like zimmer's Swiss Plus and Advent).
Posted by: bm | Jan 17, 2006 6:17:56 PM
In situations where eldery patients with an overdenture are no longer able to maintain good oral hygiene, caused by physical or mental retardation, peri-implantitis and pain may occur. In case of a two-piece implant, dismanteling the implants by removing the abutments and superstructure is a simple treatment. A one-piece implant needs a very complicated treatment since it has to be removed completely or reduced to bone level. Besides I do not see any advantages of a one-piece implant exept financial ones.
Posted by: Leo Visch | Jan 18, 2006 2:38:35 AM
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