Dentists: If you're not using THIS implant, you're using one that's WORSE!

[@amrahmed1205]

One of the best channels addressing implantology , keep going 👏👏

[@Stanleyinstitute]

Thanks, Dr! Grateful for your support!

[@forunonein]

Viewpoint from another engineer: When you talk about the thread profile, a flat thread face on the implant is pushing straight down on the opposing bone; putting the bone thread face in compression. When the insert thread meets the bone at an angle, the contact the load force vector has an angular component. Compression forces will cause the insert thread face to slide down the matching bone face. Friction contact forces will cause the insert thread to pull (tension) on the bone thread face. Compressive loads on tapered threads of the insert will result in radial loading of the bone. Ortho applications are using screws for tension applications, implants threads are dealing with mainly compressive loads. When you mention down in the video, I have to remember down relative to the outside surface of the bone. At the 5:10 minute mark you talk about the advantage of being 40% stronger (140%). 40 almost being 50 (150%), and I think you mean to say something to the effect of “ almost half again stronger (15%) instead of double (200%). That extra 40% of strength can be the difference between success and failure. The work of the screw of the implant seems to get little coverage, I would really enjoy getting an education. It’s role is vital, and appears to be the mechanical fuse in the system.

[@keithratcliff7896]

Fracture toughness is an advantage. Having additional aluminium and Vanadium in your alloy isn't desirable from a precautionary principle perspective. That could be overruled if other implants regularly broke or there weren't alternatives. But grade 4 is strong enough and if you don't trust it there is TiZr alloy Roxolid. Given the known toxicity of Vanadium/aluminium and some unpleasant in vitro research findings for grade 5 and 23 alloys, I wouldn't have this implant material in my head. Small particles of titanium can cause immune reactions - but we get a nice titanium oxide layer and the entire implant remains intact so that avoids small particles of Ti being a bigger issue. Factors affecting the force on an implant - the pitch/thread helix angle, apical face angle or square/reverse buttress/buttress, any counter rotational cutout or sometimes a hole placed at the implant tip of some implants or a flatter apical tip base, the extent of bone to implant contact around the entirety of it's surface area, the microthreaded coronal portion, the width of platform and connection type relative to width of the neck may all play a role in the magnitude of any shear or radial forces. Reverse buttress is nice but only part of the story. The role of the screw is hard to separate out - in an ex-hex design, or shallow internal connection, a screw may have to generate significant clamping forces to keep contact surfaces mating under non-axial loading and so the screw may be wider and torqued to a greater value, then retorqued to allow for its initial deformation a few minutes later. Quite different when compared to a morse taper or deeper conical connection with the friction fit and lower torque requirements. But machining an exterior platform shift bevel and a further deep conical internal space, then tapering the implant towards that could predispose a small 3mm or 3.25mm diameter implant to fracture without these stronger alloys. I'd rather a screw breaks or loosens than an integrated implant snaps partway down, or use a Vanadium/aluminium product. There's always a counter argument and many companies doing their best. No literature reviews conclude there's a perfect or best implant design/company out there.

[@Stanleyinstitute]

great insights. thanks for sharing

[@Stanleyinstitute]

Please keep watching an replying. Many people can benefit from your ideas.

[@broken1965]

How come many DDS hate Zirconia " high failure " is it loading problems 😮

[@Stanleyinstitute]

Ceramics tend to be strong but brittle. If your implant fails it has to be completely removed which is a rather complex situation one would like to avoid. Titanium is strong and tough which means it is less likely to break. For restorative purposes a zirconia crown is excellent! If it fails it is easy to replace. I hope this helps.

[@chevychasedental1]

Thank you Dr Stanley. Been practicing for 25 years but everyday I am learning something new. Your channel is one of the best and very helpfull. Have you ever worked with Hahn tapered implants and what is your opinion. Thank you in advance

[@Stanleyinstitute]

That's so great to hear, Doc! We're always trying our best to provide helpful info to the implant community. I haven't worked with Hahn tapered implants, but I would be very cautious of any implant system with a polished collar! I'm planning a series in which I'll review several popular implant systems in-depth, so please keep an eye out for my deeper dive into materials and design of the Hahn implants in that one!

[@ddsmda1]

@@Stanleyinstitute Thank you very much Doc. You are the best

[@doranpat]

I am losing one one my top front teeth frim a bacterial infection --from grocery store staff wearing masks and getting the bacterial pneumonia infection that they cause and getting that bacteria on their fruit and veggies--I did not know about this and got a sinus infection and cyst--u was able to heal the infection and cyst but now one of my front teeth is hanging down loose a good quarter of an inch and loose--have not figured out how to get it back in place and tightened back up. The snaggle tooth look is just HIDEOUS! I also do not consider putting metal in my mouth an option. I read up on the history of dentistry and it is as bad or worse than the history of mainstream medicine. ANY ADVICE?

[@Stanleyinstitute]

I would encourage you to consider the safety record of all the medical grade titanium used in all the orthopedic surgeries for knee, hip shoulder etc replacements. This is they type of titanium implants I have placed for years and even in my loved ones. It is true that there are discount implants available to doctors that do not use the same titanium and I would not recommend their use. To know what your provide offers Simple ask them. They should reply “grade 23 medical grade titanium alloy ELI”. If they say that you are safe to proceed. If you are not convinced about the safety of the solution presented you could be a candidate for a wide range of dental solutions. Your first step is getting an exam with your dentist. Hope this helps and best of luck.

[@doranpat]

@@Stanleyinstitute It sounds like before you became a dentist you never looked up the HISTORY OF DENTISTRY--well, I did look up the history and it is WORSE than that of mainstream medicine--radiation poisoning FROM XRays AND HEAVY METAL POISONING from ANY metal put in the body-ESPECIALLY the MOUTH only worked when the average lifespan was 30-40 years. EVEN GEORGE WASHINGTON knew not to put metal in his mouth if he wanted a long life--HE CUT DOWN A CHERRY TREE AND HAD DENTURES MADE FROM THE WOOD from the cherry tree.....that is REAL history.

[@russelljekina6416]

Very down to the point I’m Having these implants and you make it easy understanding for patient I love your channel. Thank you.

[@Stanleyinstitute]

Thank you for your kind words.

[@keithratcliff7896]

Laserlok directs the orientation of collagen fibres but is there any proof that it actually gains a true attachment akin to connective tissue or is it really just a more oriented long junctional epithelium? Does it confer any greater strength of tissue attachment at the implant neck region? There is no cementum for the collagen fibres to grow into, as a Sharpey's collagen fibre would around a natural tooth. And what about other alloys - grade 5 is a controversial alloy but TiZr has the alloy benefits of strength, without the same biocompatibility concerns of adding vanadium and aluminium.

[@keithratcliff7896]

looks like a nice implant though. I'm torn as Southern is used by colleagues and their inverta, co-axis and MAX implants look ideal for avoiding encroaching on bone volume at neck, aiding axial loading and avoiding lollipop emergence profiles, respectively. But a grade 4 titanium - tried and tested on a solid ex hex platform. But trained in Straumann, where Roxolid TiZr and brand prominence makes them an easy choice. Claiming all others are worse is a big leap.

[@Stanleyinstitute]

Yes. There is a ton of literature supporting the effectiveness of laserlok. Remember, cementum is rough which allows for the sharpey’s fibers to attach similar to laser lok. There is no credible evidence that medical grade 23 titanium is not biocompatible. The key work here is credible. Just a lot of supposition.

[@DrDremelchausen]

Hey Dr Stanley. Thank you for your fantastic videos. Could you please tell me if Anthogyr Axiom implants are regarded as good? My dentist wants to put them in my jaw :) Thanks.

[@Stanleyinstitute]

Sorry for the delayed response. I just took a look at the Axiom implant. It looks like it checks most of the boxes for a good implant and is backed by one of the biggest manufactures of dental implants. You should be good to go. Best of luck.

[@nausheerpagarkar490]

What do you think of the Camlog conelog system that Biohorizons is promoting these days ?

[@Stanleyinstitute]

I think it is a cleaver merger of the two technologies. Deep reverse buttress threads, tapered macro geometry, no micro threads (this is a good thing), platform switched, deep conical connection. Current limitations (maybe an upgrade is on the way?) are it is grade 4 titanium, no laser lok, no spiral lok, only three cams for timing, and not as many sizing options as the Biohorizons Pro lineup.

[@danieljones4218]

Hello Dr. Stanley, love watching your great videos. Thank you. What do you think about Dentium SuperLine dental implant doc? Love to hearing your opinions

[@Stanleyinstitute]

I’d love the opportunity to discuss this over the phone. Please send me an email through the website, and we can set up a time to chat.

[@floweriepot]

Thoughts about the 45 deg hex causing more bone loss due to micromovements compared to conical connective?

[@Stanleyinstitute]

That is a great question and the answer is there is no data to support a difference in mechanical stability of a shallow vs deep conical seal. There is a fair amount of supposition commonly referenced. Ask your self this question, have you seen a head to head comparison between two identical implants where the only parameter that is different is the depth of the conical seal? If so, please share it with everyone. Additionally, I would argue that micro movement is only a theory. We all inherit a few cases a year in our practices where it is clearly evident the wrong abutment was used to restore the implant and yet in my clinical experience the clinical observations are unremarkable normal. I’ve seen two cases of tri-lobe abutments placed 180 degree off. Meaning the abutment is on top of the implant platform acting like a butt interface with clear paths for bacteria to enter the inside of the implant. In both cases the patient was unaware, had no issues and clinically they were WNL! If we can get that many things wrong with a case and still be okay it makes me rethink the weighting coefficient of micro movement as an important cause of CBL.

[@drhamidimplants5186]

What are your thoughts about the neodent system Doc ? I’ve used a lot of bioH and recently conelog too, but neodent seems to be very popular especially for full arch immediate loading

[@Stanleyinstitute]

Neodent has captured market share but potential at the risk to the patient. The grade 4 titanium is 36% weaker that grade 23. The threads have the flat on the coronal side which is great for getting a good “bite” on the bone but places the bone at a ten times increase in shear load during use. The single abutment for all implant sizes clearly makes the dentist life easier. But, by placing a 3mm abutment in a molar site one takes on a significant increase in abutment failure due to cyclic fatigue when compared to using a large abutment, with a large implant, in the location of the mouth with the highest bite forces. The single size abutment conveys no advantage to the patient. Great question and I hope this helps.

[@robtheram8120]

@@StanleyinstituteWhat about platform switching?

[@ekumsuz]

can you confirn at 1:45 that the biohorizon is actually a buttress design and not a reverse buttress ??

[@Stanleyinstitute]

BioHorizons uses a REVERSE buttress thread, with the flatter edge of the thread pattern facing the bone for better force distribution without risking further penetration by the implant!

[@MdRipon-jc3xy]

😂😂😂❤❤

[@Stanleyinstitute]

Glad you liked it

[@staszatolosnii4408]

Saw your replies to others so maybe I'll get one too. What's your thoughts on B&B implant and JD icon implant systems?

[@Stanleyinstitute]

I haven’t come across those brands. Do you know what grade titanium they use?

[@staszatolosnii4408]

@@Stanleyinstitute they both use grade 4 titanium

[@drkevinharland]

Any experience with ditron implants?

[@Stanleyinstitute]

Hey doc, unfortunately I don't have any experience with Ditron. However, after a brief look at their website, I would advise heavy caution if you're thinking about choosing them. First, one of their main claims is "Designed by doctors, for doctors..." I don't want a doctor designing my airplane, so I certainly don't want one designing a screw! Second, they emphasize microthreading and design features to reduce "risks of peri-implantitis." Only Laser-Lok has been clinically shown to attract a true, physical connective tissue attachment, and I've NEVER had peri-implantitis occur on one of my cases. It's not a concern when you get the fundamentals right. Finally, they reference the aerospace industry, but their entire board is composed of dentists. This casts doubt on the role engineers played in the design of these implants. I'd need to do more research to say definitively, but after a brief look, I can't recommend Ditron. I hope this helps!

[@redefinedentistry4187]

So basically whole idea of ur lecture is that in long term scenario grade 23 is better in terms of cyclic fatigue. I have few questions, mostly in multiple implant cases we uses multiunits, and total load of prosthesis is transferring in screws only, so the weakest link is screws. So can we give more emphasis on grade of screws. 2. Recent studies shows that hydrophillicity of implant also tend to orient fibroblast towards implant surface, that give better attachment and orientation. so implants with better hydrophillicity are equivalent to laser lock or there are some difference 3. After osseointegration do thread design matter, for example if we fill a cylinder with iron rods and cements, once cement sets whatever will be design of iron rod it doesnt matter, iron rods are for reinforcement. Does same apply to bone as u apply same five thread rule for iron and bone

[@Stanleyinstitute]

1. Grade 23 titanium is not only 36% stronger than Grade 4 but it is medical grade. This means that the levels of contaminate metals are held to a higher standard. 2. Laser lok works by creating directionally oriented collagen fibers. Random rough surfaces, regardless of hydrophilicity will create attachment but not in an organized way. 3. Bone is significantly stronger in compression than in tension or shear. Therefore, a prudent approach would be to ensure that when the implant prosthesis is loaded the forces transfer to compressive forces on the bone. So, yes the implant threads are important for primary stability but after integration, properly designed threads would create favorable compressive forces on the bone. Thanks for the insightful questions!

[@michaelkurbah4325]

Implant do have long term complication ,so prefer denture

[@Stanleyinstitute]

I have never seen an implant failure that didn’t break one or more of the four cornerstones of implant success. Properly done they will likely last a lifetime.

[@user-rw718]

I had 10 bio horizon implants done 4 years ago and never had any problems

[@Stanleyinstitute]

That is great to hear. When done properly it is my belief that dental implant solutions can last a lifetime. Congratulations!

[@wendellplett2852]

How long would you say implants normally take to integrate enough to tighten enough? Upper rear ones .

[@Stanleyinstitute]

3 months usually does the trick

[@wendellplett2852]

@@Stanleyinstitute upper front were fine already back ones still hurt ?

[@wendellplett2852]

We’re done dec 1st

[@Stanleyinstitute]

There should not be any pain associated with normal dental implant healing past the first few weeks of wound healing. If it has been a few months then please seek professional guidance.

[@yazeedaljohani4059]

This is a great class 🙏 I have checked Biohorizon implant line and they seem to have many! Which line are you using Doc? Thank You So Much Yazeed

[@Stanleyinstitute]

They're the best! I used BioHorizons Plus for a long time, but have used BioHorizons Pro since they came onto the market. I highly recommend the Pro line!

[@asaventurasdepedroemariana1193]

Fantastic video Doc. 👏

[@Stanleyinstitute]

Thank you, Doc!