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.

Thanks, Dr! Grateful for your support!

Thank you for your kind words.

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!

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

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.

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.

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!

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.

@@StanleyinstituteWhat about platform switching?

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.

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

@@Stanleyinstitute they both use grade 4 titanium

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.

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!

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.

@@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.

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!

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.

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.

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!

3 months usually does the trick

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

We’re done dec 1st

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.

Thank you, Doc!

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

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.

Glad you liked it