Implants In The Esthetic Zone

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I am seeking suggestions regarding a high failure rate of Nobel Groovey Implants that my patients are experiencing. In addition to the high failure rate , the damage when they fail is very significant to dramatic. Substantial facial plate loss to B-L thru and thru defects with verticle loss. I quit placing Nobel implants about 3 years ago after hearing one of our thought leaders suggest that we avoid using these systems along with my hygienists frequently bring to my attention that these fixtures exhibited BOP at perio cleaning appointments. Many of these inflamed fixtures have progressed to where I am forced to remove the implants and repair the sites. The costs do to the severe damage is considerable. I have asked Nobel to help with costs and they surprisingly have made offers but not adequate.
I am very happy I quit placing these but they are frequently returning to haunt me. Anyone else experiencing this problem and any suggestions regarding covering these costs?
Thank you in advance.
Mark

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Hi,

Over 5 years ago I was placing them for a prosthodontist who insisted on the Nobel hex top (Branewashed) and I too had problems with the Groovy. So we parted. I was then transitioning from Zimmer TSV to the Implant Direct Legacy HA coated. My results can be seen on YouTube Channel: periEau and on DentalTown. I had lunch with the Niz when ID was just coming out and he said: “see our logo? It says Simply Smarter. What you are doing John is Simply Dumber” You know he was right…

I make more money placing implants and I haven’t changed my fees. Simply Smarter. Prosth parts are so much cheaper as well. You may not like the Niz so now you can “like” Sybron.

All the best,

John

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John;

Wow. HA coated and Niz. You sure you you want to make that statement.

Speak to us in 5 years.

I could not disagree more.
But as you have your opinions I have mine too.

Regards

Maurice

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Wow, yeah. There’s a reason teeth, bones and enamel are HA. There’s a reason many companies are looking for “active” surfaces. There’s a reason HA has worked for me since 1988. Thanks for letting me contribute to this forum! I can see that things are different here in Berkeley. Things are great though and I’m lovin’ it!

Food for thought…

All the best,

John

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John-
I would like to get your thoughts on the HA coating. I know (somewhere) in the literature there were problems with the HA coating flaking off and the success rates after 5 years or so decreased significantly. Granted the study describing this is probably 10+ yrs old now, but I am guessing this is what Maurice is thinking too(I don’t know him well enough to call him “Mo”).

Nathan

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Hi,

Back in the day (late 80’s, early 90’s) HA coating was very inconsistent. Not the case now. HA is a bioactive coating that results in a chemical bond between the implant surface and bone. That said it is a very quick and substantial bond. In good bone it probably does not matter. In poor bone there is more bone to implant contact. At 2 weeks these implants twist solid and we go for restorations at 2 months, 3 months on immediate implants with grafting. I have used HA coated implants since 1988, even through the HA Wars and the Hype/Hysteria days.

All the best,

John

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I never had a Calcitek implant (mid-late 80s) not integrate. Problems later, for sure, but they always integrated. Not the same for Titanium at that time.

Tony

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I have used the BioHorizons System for some 4 1/2 years now. Very pleased with the tapered int aggressive thread design and most impressed with the relative lack of bone loss across the board in all bone qualities. This has been especially true with all of my bone graft cases including ridge expansion, autogenous block, sinus graft, mesh particulate and composite grafts. I have found little if any none loss as validated w CBCT. The microchannels are remarkably effective with both hard and soft tissue interfaces.
I very much like the thread design that allows tactile feedback on placement and the simplicity of minimal drills needed to place the implants. The go to implant for most cases is the 3.8 diameter. I also use the 4.6 and 5.8 for bi’s and molars as per site allowance. The 3.0 two piece is a real gem for max laterals and mand incisors.
Of course every system has it’s strengths and weaknesses and it’s up to us to play to the strengths of the system. Having placed some 14k implants and comparing a number of systems over 28 years I have been very pleased overall
For those interested I am speaking on Sat pm @ AAP corporate forum for BH. I will be showing a variety of cases including Ti mesh, resorbable and non resorbable mesh particulate graft cases along w extr site and block cases — all with BH tapered int Laser Lock implants.
Hope this helps.

Best regards

Michael

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Michael,

What type of attachment are you seeing at the soft tissue / restorative interphase? Also what linear distance of soft tissue?

Chuck

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Chuck,

The attachment is a very tenacious one clinically speaking when the microchannels are supra gingival I have minimal probing depth. This is unlike anything I have experienced with other implant surfaces. With regard to bone once again I rarely see any detectable bone loss ie. comparing time of placement with up to 3.5 year functional load no change to speak of. Again, many of my cases are verified with cone beam. I hope this helps. Also, my restorative referral base have been extremely happy with the esthetic results in the esthetic zone.

Michael

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Michael,

Do you attention to the linear distance between the “first thread” attached to the implant ( at bone crest) and the height of soft tissue above the ooseous crest.
For example a lineal distance of 2.5mm for a platform switch implant would be 2mm vertical plus .5mm horizontal as a “regular one piece” implant being 2.5mm all vertical.
I have observed if you have between 2.5 and 3mm there is little crestal resorption.
Do you have any comment on this concept of biologic width/ height?

Chuck

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Chuck,

With regard to the linear distance between the first thread attached to the implant (at bone crest) and the height of the soft tissue above the osseous crest – in essence, I am seeing zero bone loss especially with my esthetic zone cases. In other words and especially with my alveolar crest graft cases, when I am contouring these sites I am seeing no bone loss that I can detect either clinically or radiographically 3D such that all my sulcular probings are physiologic with supra crestal placement which is only in the posterior segments of each arch and not too commonly, I might add. I see this attachment and thus 1 – 2 mm sulcular depths. I hope I have answered this to your satisfaction. With regard to BW I think there may be a bit of a paradigm shift going on with these micro channels and the attachment of soft tissue. I’ve had this dialog with Ron Nevins and we seem to agree on it.

Mike

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Mike,
I think You answered my question, but to be more clear: Do you have additional soft tissue attaching to your implant between sulcus depth and the crestal bone or is that 1-2mm of sulcus the total amount of soft tissue that is supra crestal.
My 2.5-3mm number includes all attached and non attached soft tissue supra crestal.

Chuck

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I’ve been struggling recently with some older implant cases in the upper anterior. More often than not, these are young adults, congenitly missing laterals, with implant replacement three to five years post restorative. The problem seems to be deficient hard and/ or soft tissue on the buccal and up into the vestibule causing a “greying appearance” or darkened area. I’ve tried subepithelial grafts to try to bulk the area out and create a convexity but with little esthetic benefit.
Lately I’ve been more careful with presurgical diagnosis. I’ve been taking a scan, using the Prexion CBCT but trying to delineate the incisal edge of the “tooth” to be replaced as well as the soft tissue. I found that a mixture of cavity varnish and PulpDent endo sealant ( which is 10% barium sulfate) shows up nicely on the scan. For the radiograhic guide, I paint a barium sulfate mixture and dry it with a hair dryer. The process seems to help idealize implant placement and determine the need for presurg grafting.

Chuck

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Great method to get valuable info.
Mark

Check out our website at: http://www.pittsburghimplantsandperio.com

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Thanks Mark. I still struggle trying to get the tissue tone and convexity correct over the implant. It seems that at least 1 to 1.5 mm of crestal bone bucal to the platform is essential. Not so easy to get, especially with the case of the congenitally missing laterals.

Ed

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Me also. I may be too conservative and worried about the added expense that an additional bone graft and or layered bone + a CTG would entail.
I watch Maurice’s lectures and realize I am not doing as much Tx. Unless I have to add bone for the implant to be housed or the emergence would be wrong, I have not been bone grafting to achieve > than 1+ mm of bone facial. I am having a dilemma here. It could be that I need to augment much more frequently.

Mark

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That’s because with “conventional” treatment of the immediate socket implant, neither the bone height nor width are preserved, even in the short term.
Those who are adding a bone graft, barrier and CT graft are adding 2+ mm of thickness which helps to compensate for the loss of bucco-lingual ridge diameter that has been shown in EVERY immediate socket implant study in humans or animals.

Bob

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