Dentaltown December 2019 - 51

I'd like to ask if anyone of us can tell if there are design or feature differences between a
Legacy 3 implant by Implant Direct and the BioHorizons internal that would make the Legacy 3
better suited for an immediate-load scenario?
I couldn't figure it out, but I'm definitely having a lot of problems with early failures with the
BioHorizons that I did not have before. I am wondering if it is just that I got too overconfident,
or if there are detectable differences that some of us could tell me about that I don't know of. ■

eeznogood
Member Since: 02/23/06
Post: 38 of 68

9/30/2019

I wish dentists can throw away the ideas of, "This caused this, so I do it this way." When
you're treating a person, whether it's a nagging constant local infection or dental implants, it's a
combination of everything. And you still have the person, who is different than everyone else.
Implant surface is usually rougher when the manufacturer uses additive method. The examples are TPS, HA and TiUnite. They do very good in a poor bone quality because they provide
the most amount of surface areas. The other type of implant surface is the reduction type. SLA
and double-etched 3i/Biomet are the examples. They do very well in both types of bone and are
more resilient if there is any exposure of the surface in the future. This is roughly the idea on
implant surface, so that's that.
When the implant is placed, it is almost always the failure of the initial stability. This is the
tricky part. You want lots of stability so there is minimal micromovement. At the same time, you
don't want too much fi xation force, which creates osteoclast activities within the next few weeks,
which doesn't happen right away. This initial osteoclast activity creates the gap where epithelium
can migrate into, which causes the future failure of the implant.
I was just about to start talking about why immediate implant placement might have the
reason of failure in your case, but ended up talking about implant surface instead.
The initial stability of the implant comes from friction grip of the implant, whether it is
delayed or immediate. This does not change. In one to three weeks, again depending on studies
you are citing, osteoclast cells populate the area to start the bone remodeling. What it means
is that the implants are in their most vulnerable stage during this time. Delayed implants will
tolerate better here because it is stable through the surface. In an immediate implant, especially
if it only has apical grip (which is frictional-only at this point), you will temporarily lose that
grip during this time. If you did not have any coronal fi xation, your implant is a goner now.
Remember that micromovement is everything to ensure implants survive.
Let's assume your immediate implants survived this period. Are we absolutely certain there
was no epithelial infiltration around the neck of the implant platform? Depending on the surface
type of the implant (which is why I briefly talked about implant surface), it can be very damaging
for survival of the implant. Generally speaking, the rougher the surface, the faster the epithelial
invasion will be. This is why implant companies are trying hard to prove (at least in some lecture
setting for the OMS and periodontists who are more academic than we are) that their implant
surfaces are more resilient than other types of implant surfaces. By the way, this is why ailing
implants are treated differently-and should be-depending on what type of surface they have.
Now, back to the initial fi xation of the implants in immediate placement. Anecdotally
speaking, the more pressure you placed (I mean initial torqueing), the more severe your osteoclastic activities there will be. This is why I like my implant placement to be "effortless." I don't
struggle around doing reosteotomy, or torqueing it to 70ncm or whatever it is. My machine says
35ncm and whatever the RPM/torque setting is, and it puts it right at the crest of the bone. I
don't do hand-torqueing of the implants, if ever. ■

CheckRaise
Member Since: 09/01/14
Posts: 39 and 41 of 68

9/30/2019

Read more advice online!
It seems as if "eeznogood" is dealing with something that is all too common.
To see what other Townies had to say or to share what you've done in a situation
like this, go to dentaltown.com/magazine to find a link for this message board.

dentaltown.com \\ DECEMBER 2019

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Dentaltown December 2019

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