DEEP or SHALLOW Conical Seal: Which Dental Implant is BEST?

[@lcl1127]

Hi Doc. What are the actual measurements of the titanium thicknesses in these areas? Also are all Biohorizons internal hex connections made with a different alloy than the new conical alloys?

[@elievictorwarde]

Biohorizon was slow to adopt the long cone Morse deep conical seal. Other implant companies have adopted it for a long time

[@elvislokmic963]

Hellou dr.Stanley, I appreciate your work and approach very much. can you process the topic PRF Best regards from Bosnien&Herzegovina

[@abhuma4198]

Why is it better to place implant sub crestally? Instead of not doing that.

[@DailyMeditation365]

Thank you for the explanation. You mentioned that the BioHorizons grade 23 titanium implants are 36% stronger. Stronger compared to a 100% titanium implant? How would it compare to an alloy like the Straumann Roxolid line made up of 85% titanium and 15% zirconia? For single tooth implants, does the deep conical connection matter at all?

[@Stanleyinstitute]

Medical Grade 23 titanium alloy is 36% stronger that grade 4 titanium. Roxolid is 27% stronger than grade 4 titanium. For single implants with straight paths of insertion the easy of insertion really doesn't differ much. It does make a difference with angled implants and MUA placement.

[@SP94395]

Hi Dr Stanley I havr recently been reading the Southern implant catalogue as we are introducing pterygoid and zygomatic implants into our armamentarium for maxillectomy Oncology patients. I recently came across the CoAxis implant they make which has an angulated abutment incorporated into the fixture which has an external hex to allow you to essentially connect the crown to the fixture directly. They say the stress on the prosthetic screw for a CoAxis implant is less concentrated compared to conventional screw-retained crown and prosthetic abutment. Is this something you have come across before, or what are your thoughts if you have any please?

[@noechaparro8824]

Is the deep conical connection similar to Camlog/Conelog? I think biohorizon's has 6 cams and conelog only has 3 cams.

[@Stanleyinstitute]

Yes. Biohorizons added the extra cams to move from 3 to 6 for easy of use. It is the same concept.

[@geraldniznick5125]

😮​​⁠ BH may have 6 cans in the internal shaft of the implant but only 3 cans on the abutment. I don’t see how this adds to”ease of use” but it could add to more rotational play between the mating surfaces. The implant’s many other shortcomings supersede any perceived benefits with the biggest shortcoming being micro- and macro irregularities on the neck of the implant. Don’t take my word for it. Listen to Dr. Buser’s 2022 lecture at AO.

[@geraldniznick5125]

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[@geraldniznick5125]

I checked BioHorizons catalog and the shortest implant with the conical connection is 9mm. That is not even the worse thing wrong with this implant. As your prior video pointed out, ridges are seldom flat. This means that if you place the implant level with the lingual, which is usually the higher point, the blasted surface and laser lines will be exposed on the labial to the soft tissue and that can contribute to peri-implantitis. If you drop the implant subcrestal to avoid exposure of the rough surface, this will encourage bone loss because bone will recede to below the implant-abutment junction. If the implant is placed in an extraction socket, requiring grafting to cover the exposed rough surface, subsequent remodeling will eventually expose the rough surface. Research shows that exposed rough surfaces contribute to the formation of biofilm which contributes to peri-implantitis.

[@Stanleyinstitute]

The literature clearly states that having rough implant surfaces is superior to smooth ones when it comes to oseointegration. A smooth emergence in the sulcus region of the mucosal tunnel makes sense because it mimics the smooth nature of enamel in that area. However, it doesn’t make sense to have a smooth metal or zirconia abutment in the deeper portion of the mucosal tunnel, where the body attempts to seal off the mucosa penetration with connective tissue and junctional epithelium. These tissues attach to teeth on the cementum, which is not smooth. Laser Lok is designed to enhance CT attachment in the region 2-3mm below the FGM. With proper technique, this region will never be exposed to the oral environment. If an implant is exposed to the oral environment, having a smooth surface would help keep it clean, but the real question is why is the implant exposed in the first place? Properly executed dental implantology does not present with peri-implantitis. Anyone not convinced, take my class, and I’ll prove it to you with my money-back guarantee.

[@lionstilllion]

Sponsor me to your class. Will love to learn .

[@geraldniznick5125]

In the ideal situation with 2mm of buccal or labial bone, the chance of more than 1mm of bone loss is slim BUT as you point out, ridges are seldom level and implant placement into extraction sockets will inevitably result in bone loss and grafted sites will resorb. The answer is an implant with a 2mm to 2.5mm smooth neck to allow vertical flexibility in placement. Ideally, the top of the implant is not at the bottom off a deep tunnel - that only occurred if you place the implan which is often done to assure the blasted surface is not exposed or if the internal shaft diameter is small and you need running room for your abutment to reach a restorable diameter. The ideal placement is with the top of the implant 1mm Supra-crestal so that the junction is away from the bone and the soft tissue can attach to the 1mm exposed neck and will not be disturbed from prosthetic component, healing collars and transfer exchanges. This is a perusing change in thinking for some but it is exactly how a Straumann tissue level implants have been used by Dr. Buser for decades. A. number of studies that support this concept are available at www.paragon-implant.com

[@geraldniznick5125]

In the ideal situation with 2mm of buccal or labial bone, the chance of more than 1mm of bone loss is slim BUT as you point out, ridges are seldom level and implant placement into extraction sockets will inevitably result in bone loss and grafted sites will resorb. The answer is an implant with a 2mm to 2.5mm smooth neck to allow vertical flexibility in placement. Ideally, the top of the implant is not at the bottom off a deep tunnel - that only occurred if you place the implan which is often done to assure the blasted surface is not exposed or if the internal shaft diameter is small and you need running room for your abutment to reach a restorable diameter. The ideal placement is with the top of the implant 1mm Supra-crestal so that the junction is away from the bone and the soft tissue can attach to the 1mm exposed neck and will not be disturbed from prosthetic component, healing collars and transfer exchanges. This is a perusing change in thinking for some but it is exactly how a Straumann tissue level implants have been used by Dr. Buser for decades. A. number of studies that support this concept are available at www.paragon-implant.com in this document: paragon-implant.com/publications/a-paradigm-shift-in-implant-design/

[@geraldniznick5125]

Here is the document with the research reports supporting this Paradigm Shift in implant design and surgical protocol.

[@raednoureddine4401]

If the component material make the implant more resistant,than why not to use these components in all the implants industrie

[@Stanleyinstitute]

That’s an excellent question! The answer lies in cost. Fabricating medical-grade 23 titanium is more expensive, and machining it is even more costly due to its harder nature, which strains the tools used to cut the metal. If you’re selling a cheap implant to dentists who lack knowledge or understanding of the difference, opt for a weaker metal. Now, you understand that implants aren’t a commodity, and implant design can make all the difference between success and failure for our patients. Choose wisely.

[@geraldniznick5125]

Actually, titanium alloy is easier to machine because it does not gum up the drills. I started with alloy in 1982 with the Core-Vent implant and when I introduced the Screw-Vent in 1986 in pure titanium to match the Branemark implant. By 1990 and since, everything I make in implants and abutments has been Grade 23 alloy. I don’t even know if there is a cost difference because there is only about $0.40 of titanium in an implant. The real difference in implants that effects cost is the quality control and the sales/marketing budget. The premium priced companies can sell an implant for $535 to one customer and $100 to a DSO. My go to market strategy had always been pick a fair price and charge everyone, regardless of volume, the same.

[@bayhappy3992]

Just trying to justify one company over another. besides this I have learned a lot from this channel.

[@Stanleyinstitute]

The conical designs illustrated in this video, both shallow and deep, are offered by the same company. My goal is to assist doctors in making the most scientifically sound product selections for their patients, rather than relying solely on marketing. Thank you for watching.

[@geraldniznick5125]

Nice big models but I am not persuaded by your drop test - if the cams align that easily, it just means that it is a sloppy fit. Anyone who has used implants with😢 The 45 degree bevel probably never even noticed the time it took to align the flats of the hex because it takes a couple of seconds at most, not the 1 to 2 minutes you stated. Yes Titanium alloy is 34% stronger than Grade 4 titanium, but small diameter implants made from alloy have also fractured so preserving the wall thickness for greater strength is far nor important than saving a few seconds seating the abutment. The striking difference in your models that you failed to mention is the greater depth of the steep conical connection. In many systems, that precludes making 6mm short implants..

[@geraldniznick5125]

I just checked BioHorizons catalog and the shortest deep conical connection implant they make is 9mm - that, and the thinner walls are game ball on the comparison. A hex is made by broaching (forcing) a hex tool into the round internal shaft creating sharp grooves. Cam slots are made by machining with a cutting tool which rounds the edges of the projections. This is why it - self centers on insertion as evidenced by your drop test. The sloppier the fit, the easier to seat the components but the more likely micro-movement under function will result in a loose screw. Remember your video demonstrating that ridges are seldom flat. The industry is waking up to the increased incidence of peri-implantitis and the importance of having a smooth neck on the implant to minimize exposure of a rough surface to the soft tissue. BH laser lines with blasting to the top of the implant condems that implant regardless of the connection.

[@Stanleyinstitute]

Hey Gerald, as you mentioned, the deep conical design does have some limitations. This video was created to demonstrate the benefit of the deep conical design-its ease of use. The deep conical region enables an off-axis insertion, which is physically impossible with the shallow conical design. (The fact the cams indexed in this video was just a coincidence.) This insertion advantage wouldn’t be clinically relevant in most single implant deliveries. However, when placing angled implants with all-on-x type solutions, inserting the MUA with proper timing and indexing can be challenging with the shallow conical design. The deep conical design allows the surgeon to blindly initiate insertion of the MUA and, with a slight rotation of the MUA seat it into the correct index. In my opinion, this is the single most significant advantage of the deep conical design as illustrated by the drop test in the video.

[@TtownLarry]

@@geraldniznick5125 7.5mm is the shortest .

[@geraldniznick5125]

You said that the ease of seating the abutment is “the single most important thing”. I would think that the stability of the implant abutment junction and reducing the risk of fracture, both of which you acknowledge are better with the short conical seal, are more important. Your perceived advantage in seating is only a factor on distal angled implants which is a small fraction of your cases. In addition, the deep lead-in bevel has two other drawbacks. 1. The shortest implant BH makes with that connection is 9mm vs 7.5mm for its short bevel implant, and 2. Abutments can get stuck in a steep bevel because the mating bevels can cold weld from torquing in the fixation screw. Companies that understand this, like Straumann, include internal threads in the abutment’s shaft so that a retrieval screw can be used to separate the parts, something BH overlooked. If ease of seating the abutment is high up on your wish list, you will love my new GEN5+ which comes with the abutment base friction fit to the implant.

[@geraldniznick5125]

Another disadvantage to very steep conical connections *BH is 82.5 degrees) is that the mating tapers are approaching that of a Morse Taper and can form a bond that requires a retrieval screw to disengage. Straumann recognized that with its 82 degree Torqfit connection on the BLX and included threads in the internal shaft of the abutment so that a retrievel tool can jack the abutment out of the implant. This only works for 2-piece abutments. 1-piece healing collars can get locked in and require cutting out to remove.

[@Stanleyinstitute]

Hopefully, anyone reading these comments will come to the simple realization that implant design plays a pivotal role in the overall success of tooth replacement therapy. Anyone who asserts that all implants are identical is operating from a position of ignorance. Such a claim serves as a strong indicator of the need for further education.