ID Featured in Articles Editorial

Implant Direct Featured in Articles and Interviews

Editorial on - Dental Implant Industry and Product Development

issn 2161-6531

the international C.E. magazine of

3

North America Edition • Vol. 2

•

Interview with Dr. Niznick on Value Segment Market

Issue 3/2012

oral implantology

2012

_c.e. article Graftless solutions in implant dentistry

_events AAIP and AAID gear up for annual meetings

_industry The InterActive evolution of conical connection implants

Article on InterActive Evolution

Article on - GPS Attachment and GoDirect Implants

Article on Implant-Abutment Connection

www.implantdirect.com Innovation.

Quality.

Service.

Value.

Reprint from: Dental Tribune, May 2013

IICCO CO I SSY YPPM M PO SISSIIIIUU M

Breaking News!

DENTAL TRIBUNE The World’s Dental Newspaper · U.S. Edition

MAY M AY 2013 — V Vol. ol . 8 8,, N No. o. 5

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Implant Direct, the company that revolutionized the implant industry by creating the value-priced segment in 2006, introduces a new online store that will dramatically simplify how implants and auxiliary items are ordered.

This new online store, with advanced technological capabilities, represents the latest progression in the web-based business strategy Implant Direct was originally founded upon. The company Available at www.implantdirect.com, the has long strived to augment the service new online store introduces visitors to and support available to dental the latest products, resources and events professionals from the customer service with an ever-changing homepage display and field teams with online assistance, (Figure 1). Visual selection charts lead such as an extensive library of 3D graphic clinicians or office staff through the videos detailing technical procedures and implant selection process, first by product features. identifying the implant system (Figure 2) and then the correct diameter and Implant Direct’s implant systems offer prosthetic platform (Figure 3). Once surgical and prosthetic compatibility with on the implant product page, the premium-priced systems as well as compatible components, abutments, significant design improvements for instruments, biologics and literature are enhanced clinical performance. Unlike just a click away! There’s no need to jump other companies, Implant Direct offers a through different product categories or non-negotiable list price for each item in pages – with All-in-1 Shopping, its broad product range. everything can be found all in one spot.

All-in-1 Packaging includes components The simply smarter system even identifies such as cover screw, healing collar, the related items. transfer and final or temporary abutment with the implant for added value.

In addition, Implant Direct’s new online store allows visitors to: About Implant Direct • Watch related 3D graphic videos Implant Direct is a joint venture between without interrupting shopping implantology pioneer Dr. Gerald Niznick • Easily switch between different and Sybron Dental Specialties (SDS). The product images or zoom-in for a venture combines SDS’ 100-year history close-up view of providing service, quality and • Compare the features and benefits innovation to dental professionals, the between different products of expansive expertise of its Fortune 500 interest parent company, Danaher Corporation,

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NEWS N EWS

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and Dr. Niznick’s 33-year history of innovation in the implant industry, with over 30 patents including the internal, conical connection in 1986 – the cornerstone of modern dental design.

Today, Implant Direct continues those traditions through its commitment to provide high quality products at value-added prices with simplified surgical procedures and versatile prosthetic options. The company releases numerous new product lines and line extensions each year while also continually improving its existing product designs, manufacturing processes and online support.

PRSRT STD U.S. Postage PAID San Antonio, TX Permit #1396

Fig 1. Implant Direct’s new online store at www.implantdirect.com

HY YGIENE GIEN E T R RIBUNE IBU N E

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• Move to different categories when desired via the global, top navigation bar • Find Attachments International products and Education opportunities easily in their new, dedicated sections • Look for products quickly with improved search capabilities and new advanced search option • Quickly preview cart contents • Keep track of potential future purchases with the Wish List • Manage your account and view all recent activity easily from the Account Dashboard

www.dental-tribune.com www .dental-tr

A TTIMELY, IMELY, DETAILED DETAILED LOOK LOOK AT AT INFECTION INFECTION CCONTROL ONTROL STRATEGIES STRATEGIES

Dental Tribune America 116 West 23rd Street Suite #500 New York, N.Y. 10011

New Implant Direct Online Store with All-in-1 Shopping

Fig 2. Implant System Selection. Shown here: Legacy™ System with Dr. Niznick’s orginal, internal conical connection interface

Fig 3. Implant Diameter Selection. Shown here: Legacy3 implants packaged on a carrier that is transfer and final abutment.

Fig 4. Implant Product Page with All-in-1 Shopping

AD

Implant Prosthodontics: Past, Present, and Future

Dr. Niznick graduated from the University of Manitoba Dental School in 1966 and earned a Master’s degree in prosthodontics from Indiana University in 1968. He has been awarded 36 U.S. Patents and has received honorary doctorates from the University of Manitoba and Tel Aviv University. Dr. Niznick can be reached at drniznick@implantdirect.com.

Disclosure: Dr. Niznick is founder and president of Implant Direct. He developed the Core-Vent system discussed in this editorial.

Research published in 1983 documenting the long-term success of titanium screw implants which, by a process called Osseointegration, became firmly attached to bone, changed the course of implant dentistry.1,2 The Brånemark external hex implants used in that study offered a single abutment option for a screw-retained attachment of a hybrid prosthesis for restoring edentulous jaws.

Reprint from: Journal of Cosmetic Dentistry, Summer 2012

In 1986, Core-Vent introduced the Screw-Vent implant, featuring an internal lead-in bevel, hex, and threaded connection.5 This became the cornerstone of modern implant design and is today referred to as a “conical connection.” This advance paved the way for greater use of cemented restorations, which resulted in acceptance by general practitioners of fixed prosthetics on implants, as the procedures more closely paralleled the restoration of natural teeth. The internal connection provided a greater tactile sense when seating an abutment, thus eliminating the need for x-rays to determine whether transfers and abutments were fully seated. It also allowed for smallerdiameter implants with adequate strength to be designed, thereby expanding clinical applications.

difficult task has been to overcome the stereotypical thinking that there is a direct relationship between an implant’s cost and clinical success.

Many implant companies use paid opinion leaders in private practice and academia, along with large sales forces, to perpetuate this myth.

Today, however, the Internet has leveled the playing field, making it possible to educate more dentists to the benefits and features of “appropriately priced” products— some with cross-compatibility to the surgical protocols and prosthetic connections with which dentists are familiar. Offering application-specific implants with All-in-1 Packaging simplifies implant selection, eliminates confusion with ordering ancillary products, and provides unprecedented value, thus allowing more patients to Implant dentistry is a prosthetic benefit from implant dentistry. discipline with a surgical component; Additionally, online education—aided thus, Core-Vent’s system was designed by live surgical videos, lectures, for simplified surgical procedures, product comparisons, and, especially, allowing general practitioners to online ordering—is changing the learn implant placement. implant industry’s dynamics.

The key to proper training was to establish educational courses that focused on case selection and treatment planning.

In the three decades since the Core-Vent and Brånemark systems were introduced, the number and The Core-Vent hollow basket implant diversity of implant designs, surface had been introduced in 1982.3 Unlike treatments, and abutment options Brånemark’s 0.7-mm short external have proliferated. I believe this has hex implant, the Core-Vent had an been spurred primarily by implant 8-mm deep internal hex for ratcheting companies, in an attempt to justify insertion and to receive a variety of price increases. Unfortunately, this cemented abutments. This system has compounded the confusion was the first to document the use associated with selecting the implant of freestanding implants to retain system that best suits an individual an overdenture, screw-retained bar dentist’s practice and budget. overdentures, and single tooth replacements with bendable and In the 30 years I have been involved castable abutments.4 with the implant industry, my most

Today, most patients know about the benefits of implant solutions for their missing teeth, resulting in more restorative dentists making the investment in education to be able to offer these services in their practices.

References 1. Zarb GA. Introduction to osseointegration in clinical dentistry. J Prosth Dent. 1983;49(6)824.

2. Kasemo B. Biocompatibility of titanium implants: surface science aspects. J Prosth Dent. 1983; 49(6)832837.

3. Niznick G, inventor. Endosseous dental implant system for overdenture retention, crown and bridge support. United States patent US 4431416. 1984 Feb 14.

4. Niznick GA. The Core-Vent implant system. J Oral Implantol. 1982;10(3):379-418.

5. Niznick G, inventor. Screw-type dental implant ancho.

United States patent US 4960381. 1990 Oct 2. jCD

The Implant-Abutment Connection: The Key to Prosthetic Success In 1991, Compendium published an article by Dr. Gerald Niznick (Vol. XII, No. 12) with the same title as the heading above. The principles Niznick expounded 20 years ago are even more valid today with Implant Direct’s broad line of application-specific and industry-compatible implants shown by the company’s one- and two-piece implants below.

Dr. Gerald Niznick, a prosthodontist, revolutionized the implant industry with the introduction of the ScrewVent® implant (now sold by Zimmer Dental) with its patented internal connection platform that featured a lead-in bevel for lateral stability and an internal hex for insertion and accurate transfer capabilities (Niznick U.S. Patent #4,960,381). This implantabutment connection has become the cornerstone of modern implant design, licensed to eight implant companies and copied by many others following the expiration of the patent in 2007.

One such replication is the lead-in bevel/internal hex of Nobel Biocare’s NobelActive™ implant. Whether the lead-in bevel is 45 degrees, as in the original Screw-Vent implant, or 8 degrees (Straumann®), 11 degrees (Astra™) or 12 degrees (NobelActive), a “conical” interface provides lateral stability, reducing the occurrence of

screw loosening in comparison to butt joint connections (tri-lobe and external hex implants). The original 45-degree bevel, present in Implant Direct’s Legacy™ System, has the added advantages of increased strength and improved tactile sense for seating an abutment without the need to take an X-ray as recommended by Nobel Biocare for NobelActive.

Dating back to the early 1980s, Niznick’s focus has been to provide high-quality products at value added prices with simplified surgical procedures and versatile prosthetic options. Following this strategy and with a strong focus on use of the Internet for education, sales and marketing, Implant Direct has been credited with bringing about a pricepoint shift in the implant industry in just four years. The industry changes and recent economic factors have prompted many dentists to have a “reality check” on the best options for their practices and patients.

United States Patent Niznick Patent Number: Date of Patent:

4,960,381 Oct. 2, 1990

Reprint from: Implants, January 2011

Today Implant Direct offers the broadest line of implants and abutments in the industry, many incorporating Niznick’s patented innovations including double-lead body threads for faster insertion with coronal quadruple-lead microthreads for reduced stress and increased stability (Niznick U.S. Patent #7,677,891).

The company philosophy has been to combine clinically proven implant design concepts with “All-in-1 Packaging” for maximum value and convenience. While the items included vary by product, All-in-1 Packaging reduces or even eliminates the need to purchase additional items at the restorative phase of treatment (Niznick U.S. Patents #7,396,231 and #7,785,107).

The application-specific SpectraSystem® includes ScrewPlant® bonelevel and ScrewPlus® tissue-level implants with the same internal hex/external bevel connection as well as several unique one-piece implants.

The one-piece implants provide increased strength, allow use of smaller (3 mm) diameters while shortening chair time and reducing both cost and inventory requirements.

The GoDirect™ one-piece implant features a platform that is compatible with Zest Anchor’s LOCATOR® Fig. 1: Implant Direct’s expansive product offering. Clockwise from top right: ScrewIndirect, RePlant, ScrewPlant, InterActive, SwishPlus, GoDirect, (center) Legacy3.

(Images/Provided by Implant Direct)

Fig. 2: Dr. Gerald A. Niznick’s patent for the internal hex connection that became the foundation for modern implant design.

Fig 1

Fig 2

to Nobel Biocare’s NobelActive implant plus surgical compatibility with Nobel Biocare’s Replace, Zimmer Dental’s Screw-Vent and Implant Direct’s Legacy implants. Implant Direct will also launch a full line of 3i Certain™ compatible abutments.

With 60 outside sales representatives and 40 inside customer support representatives in the United States, plus the industry’s most intuitive online support and shopping cart, it’s no wonder that Implant Direct received the highest customer satisfaction rating among seven implant companies in an independent study by Millennium Research Group.2 Implant Direct is truly transforming the implant industry and allowing implant treatment to become an affordable part of conventional dentistry.

Fig 3 abutments1 for overdenture attachments. GoDirect’s innovative design also allows for conversion to screw-receiving, multi-unit abutments should the treatment plan change over the years. Implant Direct has recently launched a complete line of GPS™ abutments that are compatible with the LOCATOR system. Another Spectra-System one-piece implant, ScrewIndirect™, provides a multi-unit abutment platform for bar overdentures and fixed-detachable, hybrid prostheses — making Teeth-in-1Day™ a practical and cost-effective procedure.

In addition, Implant Direct offers implant solutions with industrycompatible internal hex, tri-lobe and octagon connections. The Legacy System offers surgical and prosthetic compatibility with Zimmer Dental’s Tapered Screw-Vent developed by Niznick in 1999. Legacy abutments are compatible with several other internalhex implant systems, such as BioHorizons®, BlueSky and MIS®.

Implant Direct’s RePlant®, RePlus® and ReActive™ Tri-lobe system provide prosthetic compatibility with for Nobel Biocare’s Replace implants and Implant Direct’s SwishPlus™ and SwishPlant™ internal octagon tissue-level implants provide prosthetic and surgical compatibility for Straumann customers.

Implant Direct does not make clones.

It designs updated versions of these popular competitors’ products by adding features to improve self-tapping insertion as well as increase strength and surface area.

Implant Direct is in the process of increasing its manufacturing capacity from 40 CNC machines to 68 to keep up with the demand for its products.

The additional manufacturing space will allow Implant Direct to offer CAD-milled titanium bars, custom abutments and surgical guides.

In addition to an already broad product line, Implant Direct will be launching the InterActive implant system with prosthetic compatibility

1. LOCATOR is a registered trademark of Zest Anchors Company. The GoDirect and GPS Systems are neither authorized, endorsed, nor sponsored by Zest Anchors Company.

2. Satisfaction among current and former users, US, Q211. Global Dental Implant Perception Pulse Study, Millennium Research Group.

Fig. 3: GPS and Zirconia abutments, the latest in a line of simply smarter prosthetic solutions.

Dr. Gerald A. Niznick President and CEO of Implant Direct

A Legacy of Innovation Legacy4 implant combines the popular Legacy2 implant body with a revolutionary two-piece fixture-mount for precision transfers and prosthetic simplicity.

New

Legacy™4 Implant All-in-1 Packaging includes implant, fixturemount, abutment, transfer, cover screw & healing collar — $225

Square top detaches with impression for

metal to metal transfer accuracy

Two-Piece fixture-mount (patent pending) with

Torque- safety feature prevents damage to implant interface

preparable abutment

Concave transgingival profile

1982 Core-Vent® Implant & Abutment System Pat. #4,431,416, #4,645,453, #4,488,875, #4,758,161

1986 Screw-Vent® – First Internal Connection Pat. #4,960,381

1987 Micro-Vent® – First Small Diameter Implant Pat. #5,061,181

1990 Sterile Fixture-Mount Packaging Pat. #5,062,800

Quadruple-lead micro-threads

1994 Friction-Fit Internal Connection Pat. #5,334,024 Friction-Fit External Connection Pat. #5,433,606

1995 Tapered Implant with Surgical Protocol for Stability Pat. #5,427,527

1996 Selective Surface & Dual Transition Surface Treatments Pat. #5,571,017, #5,885,079

Progressively deeper buttress threads

1999 Advent® One-Piece Implant for Edentulous Jaws Pat. #5,989,028

2006 Application-Specific Spectra-System® of Implants Micro-threads Pat. #7,677,891, Healing Collar Packaging Pat. #7,396,231, One-Piece Multi-unit Implant and Abutment Pat. #7,699,613, #8,118,596 Multi-Functional Fixture-Mount Pat. #7,785,107

2007 RePlant® System with Tri-lobe Compatibility Pat #7,108,510 2008 SwishPlant™ with Octagon/Square Connection Patent Pending

2009 GoDirect® One-Piece Implant for Overdenture Attachment

Over 30 Years of Implant Innovation

Patent Pending

Gerald A. Niznick, DMD, MSD President & CEO Implant Direct Int’l

Screw-Vent and Advent are now implant trademarks and products sold by Zimmer Dental Implant Company 1900 Aston Avenue, Carlsbad, CA 92008.

2010 GPS™ Abutment with Internal Resilient Overdenture Attachment Patent Pending

2012 Legacy4 Implant with Two-Piece Fixture-Mount Packaging Patent Pending

Three long cutting grooves

Must Have Implants From Single Tooth Restoration To Overdentures and Teeth-in-1Day™

Single Tooth Restoration with Legacy3 & Zirconia Abutment

Immediate Molar Replacement with Legacy2 and Titanium Abutment

Legacy™3

Legacy™2

3.2mmD

7.0mmD

Legacy™3 6mmL1 3.7mm diameter

GoDirect™ 3.0mmD

4.2mm diameter

4.7mm diameter

Implant-Retained Overdenture with GoDirect 1-Piece Implants

5.2mm diameter

5.7mm diameter

Implant-Supported Fixed Prosthesis with ScrewIndirect 1-Piece Implants

ScrewIndirect® 3.0mmD

Intro Offer: Make the switch & receive three FREE implants.2 1Coming soon.

2Terms and conditions apply.

www.implantdirect.com | 888-649-6425

An Interview with Implant Direct Gerald A. Niznick, DMD, MSD, President and CEO

INSIDE DENTISTRY (ID): How much

has really changed about the implant industry since you started Core-Vent Corporation in 1982, Paragon in 1997, and Implant Direct in 2004?

targets the established Premium-priced product lines with systems that offer surgical and prosthetic compatibility for a non-negotiable list price of $150 to $200.

We provide added value with All-in-1 Packaging that typically includes a cover screw, healing collar, transfer, and either final or temporary abutment. Quality and a broad line of products are essential for Implant Direct’s “Value Strategy” to succeed.

This is made possible, even at relatively low prices, by operating the industry’s only “lights-out” 24/7 manufacturing facilities that can be viewed on five online cameras on our website. This strategy has forced many of the premium-priced companies to aggressively discount to volume purchasers to maintain their best customers.

(ID): You have been widely recognized and honored for your contributions to the dental implant market. Which of these contributions GERALD A. NIZNICK (GN): The success do you think made the biggest impact on of a broad range of implant designs, surfaces, how implant dentistry is practiced today? and materials is now well established in the dental literature. What has changed, (GN): The original Core-Vent (1982) twoespecially in the last decade, is that implant stage implant had a hex hole into which a companies have segmented into three variety of application-specific prosthetic categories in order to find their USP (unique abutments could be cemented. This was in selling proposition). Premium Priced Players contrast to the Brånemark implant which did differentiate their products based on claims not come on the US market until a year later of research and the support of paid opinion with only one multi-unit abutment for leaders. This research is designed to create edentulous screw-retained bridges. That sound bites for marketing, comparing a concept of versatile prosthetic applications company’s new and improved products to contributed to making implant dentistry part their old ones without providing any clinical of conventional fixed prosthetics with studies to show a significant improvement in cemented crowns and bridges. The internal success. Each new version is accompanied hex connection (Niznick US Pat. #4,960,381) with a price increase, now reaching an and all the screw-retained abutments that I average of about $350 to $450 per implant. developed thereafter accomplished the same Discount Priced Players sell on price alone, prosthetic versatility while offering offering a limited range of implant designs retrievability. When these types of two-piece and dimensions. These companies vary their abutments were developed for the external implant prices and volume discounts based hex implants, it became apparent that the on the market and the negotiating skills of internal connection offered greater stability the dentists. With an average list price of and esthetics. The industry was slow to $100 to $150 and substantial discounts for change over because the internal connection volume purchases, the dentists purchasing was patent-protected, whereas any company these products are prepared to accept could make an external hex. In 1999, I solved possible compromises in quality, precision, the problem of achieving high initial stability packaging, and limitations in implant or in soft bone with the development of a softabutment options in order to get what they bone/hard-bone surgical protocol, inserting perceive as a bargain. Value Priced Players the newly designed tapered Screw-Vent in is a segment of the market that Implant undersized sockets prepared with straight Direct created in 2006. Implant Direct step drills. Inserting a tapered implant into an

Reprint from: Inside Dentistry, June 2012 undersized socket created with a straight step drill led the way for immediate loading of implants.

When dense bone was encountered, the size of the socket would be enlarged, eliminating the need for bone taps and allowing selftapping insertion in both soft and dense bone. In addition, I am especially proud of the 5-year clinical study conducted at 32 Veteran’s Affairs centers that included 900 patients receiving over 2,800 implants. This was the largest dental implant study conducted worldwide and special issues of Journal of Periodontology and Journal of Oral and Maxillofacial Surgery were dedicated to publishing the results, which added significantly to dental implant knowledge.

(ID): You’ve built Implant Direct into an international company with hundreds of employees and distributors in more than 30 countries. How would you define your approach to launching and successfully running a business?

(GN): Building and running a successful business in a relatively short time takes production capacity, an innovative product line, the right “go-to-market” strategy and a dedicated team of knowledgeable people.

After selling Core-Vent/Paragon Implant Company to what is now Zimmer Dental in 2001, I retired for a few years. In 2004, Zimmer chose not to renew the lease on my Los Angeles factory and moved their manufacturing closer to their corporate headquarters near San Diego. This presented an opportunity to re-occupy the factory I had built in 1994 for producing implants and re-hire 80 of Zimmer’s top machinists and QA specialists, many of whom had worked for me for years before the sale to Zimmer.

In the next 3 years, my team developed the lights-out manufacturing processes that assured efficiency and quality. Together with my design engineering team, I developed the Spectra-System® of six 1 and 2-piece implants, all with the same body and, therefore, surgical protocol, but with different platforms and packaging for different clinical applications. This created the industry’s first application-specific implant system with each implant appropriately priced — low enough that the premium- priced implant companies could not routinely discount

(GN): We will be launching a new implant system, the InterActive™. This system will provide prosthetic compatibility with (ID): Implant companies continue to face NobelActive™ and the NobelReplace™ some challenges with the economy. Have conical connection plus surgical compatibility you done anything differently over the last with Legacy™, Zimmer Dental Tapered few years to better position Implant Direct Screw-Vent®, and NobelReplace drills. It for growth? Did the recession alter your offers the first implant with both microbusiness model? grooves and micro-threads plus unique packaging that provides a patented cover (GN): The recession has only further proven screw/healing collar assembly and a new the Implant Direct business model. Patients two-piece (patent pending) fixture-mount need and deserve affordable implant care. that can be modified for use as an abutment While other implant companies may be and serves as a transfer that provides the contracting, we are consistently expanding accuracy of an open-tray impression with not only with personnel but with new the simplicity of a closed-tray impression.

We also will be launching our own image(ID): How do you separate—if you do at all— facilities. We just underwent an expansion guided software, surgical guide, and CADyour roles as clinician, inventor, entrepreneur, of our manufacturing capacity by adding educator, and researcher?

18,000 square feet that provide room for 28 milled titanium bars as well as custommilled titanium and zirconia abutments machines in addition to the 40 we already by the end of this year. Our pricing for these (GN): I am first and foremost a clinician, had operating 24/7. We also have a new ancillary services will be commensurate with having practiced the specialty of state-of-the-art educational center in Las our value-added philosophy, making Implant prosthodontics for 14 years before starting Vegas with computers at each desk for Direct a full service company. my implant business in 1982. Throughout image-guided surgical training, the 1970s, I used the implants available at models/mannequins for hands-on (ID): If you could look into the future, what that time to help my patients. The Core-Vent training, and a four-chair dental office would your prediction be for dental was developed primarily to function freefor live surgical demonstrations. implantology in the next 10 years? standing to stabilize a lower overdenture.

I published the first article showing the (ID): It’s been over a year since Sybron (GN): My predictions 30 years ago, that efficacy of this application, which has now Dental Specialties acquired a 75% interest implants would become an integral part of become the minimum standard of care by in Implant Direct International. What impact conventional dentistry, have come to pass. the American College of Prosthodontists. My has that had? What has changed in the My gamble in 2004, with the start of Implant inventions were needed to implement my scope and mission of Implant Direct since Direct, that dentists would look beyond the treatment philosophies of simplicity, the acquisition? marketing hype of the premium-priced versatility, and economy. I needed to become products and place a greater appreciation on an educator and entrepreneur to have the (GN): The new joint venture between value, has paid off for me as an entrepreneur. financial resources to see my inventions, now Implant Direct and Sybron Dental Specialties It will also continue to pay off for dentists numbering 35 US Patents, become clinical has created many new and exciting who take the time to learn what is important realities and to advance the field of implant opportunities. We merged Implant Direct for implant success and trust in their own dentistry. There is an invaluable symbiosis with Attachments International, a Sybron good judgment. The day is fast approaching between these roles and I would not Company, and absorbed the sales force when patients, missing some or all their choose to separate them even if I could. and distribution responsibilities for Sybron teeth, or needing an extraction, will seek Implant Solutions primarily keeping their out dentists capable of replacing the missing (ID): When you’re not inventing an implant biologics products. Danaher owns such teeth with implants. While implants have product, you’re flying an airplane. What well-known brands as KaVo, Kerr, Image become a major part of every oral surgery lessons have you learned from being a Sciences, Sybron, and Pelton & Crane, and and periodontal practice, every general pilot that you can correlate to your life’s we plan to integrate our efforts with our dentist removing a tooth should have the work in dentistry?

Danaher and Sybron Dental Specialties sister knowledge and confidence to either companies to bring full digital solutions for immediately place an implant into a resized (GN): To fly an airplane you need to be implant dentistry. I remain Implant Direct’s socket or have the skills to perform the site committed to education and you need to be president and CEO. I have been able to preparation procedures needed to preserve extremely focused. I acquired a commercial, broaden the management team in sales bone for future implant placement. Good multi-engine, instrument rating with type and operations, leaving me even more dentistry, as well as the patients, demands ratings in two jets. Flying a plane is like time to focus on product development. such services in ever-increasing number. playing the ultimate video game with all the Implant Direct’s goal has been, and continues avionics now available in the glass cockpits. to be, to make that option accessible and (ID): Can you share anything with us that You’re going at 500 miles an hour, monitoring you might have in the pipeline right now? affordable to a greater number of patients all sorts of electronics on the control panel. without any compromise in the quality or You have to be aware of everything that’s longevity of the treatment. to match that price. This formula of offering innovations, quality, and value was just what the industry was waiting for and the 2008 economic recession made the need for “appropriate” priced implants even more compelling. To keep the selling expenses low, I focused on the internet for education and sales. Demand grew globally for the products and, today, Implant Direct has almost 150 people in North America providing sales, customer service, and technical support. We opened an office in Zurich to support our direct sales forces in Germany and Italy, as well as shipping to our distributors throughout Europe.

going on around you. It definitely sharpened my abilities to multitask and respond quickly.

One-piece, Application Specific Implants for Treatment of Narrow Ridges There are many clinical situations in which bone limitations may necessitate use of a narrow diameter. The term “Mini-implants” is generally attributed to implants with diameters of 3mm or less, 2.4mm and 2.8mm being the most popular diameters. Mini-implants are available from many companies with either Ball, ERA or O-ring abutment platforms for retention of over-dentures. There are also 3.0mmD 1-piece implants with application specific platform options available (Implant Direct, Calabasas, CA): GoDirect™ with a Zest LOCATOR® compatible platform for retaining over-dentures with GPS™ attachments, ScrewIndirect® with a multi-unit platform for screw-retained restorations and ScrewDirect® with a tapered abutment for cemented restorations.

Implants less than 3mm have not received FDA pre-market approval for claims of being a permanent tooth replacement, although they can be marketed with claims of “long-term” usage, an upgrade from their prior classification as temporary solutions.

Traditional mini-implants have a sharp, pointed apex to allow insertion in a socket not fully prepared to depth. These implants have gained popularity in part due to their relatively low cost compared to traditional implants from the major implant companies and because the narrow diameter encourages placement without laying a soft tissue flap. Both of these “simplified” surgical procedures have risks and

Reprint from: Implant Practice US, May/June 2012

drawbacks that should be considered.

Preparing a socket half the depth of the implant, and screwing in the pointed implant into unprepared bone will undoubtedly increase initial stability but, given the narrow diameter of mini-implants, there is an increased risk of implant fracture if

Tapered Implants with a rounded apex require preparation of the socket to full depth, giving the dentist the opportunity to determine the density of the bone. If soft bone is encountered, the tapered implant can be inserted into the undersized socket expanding and compressing the bone for increased stability. If dense bone is encountered, the dentist follows up with a final sizing drill closer to the diameter of the implant, eliminating the need to remove the implant after insertion is initiated.

Narrowing the apical end to a point reduces the strength of the implant compared to the same diameter implant with a rounded apex because of greater metal diameter in the lower half of the implant.

A recent study published by CLINICIANS REPORT, Dr. Gordon Christensen’s research group, compared fracture strengths of the 3.0mm and 3.7mm GoDirect 1-piece implants to commercially available 2.4mm and 2.9mm mini-implants.

One-Piece GoDirect™ 3.0mm One-Piece ImplantsGoDirect™ 3.0mm Implants Although there was only a 3.5% for use with Implant Direct’sfor Internal use with Implant Direct’s Internal increase in diameter between the and External GPS™ Overdenture and External GPS™ Overdenture

Attachments. Standard apex Attachments. (left) as Standard apex (left) as Strength Comparison as tested by CLINICIANS REPORT testedand

by CLINICIANS REPORT and Measured

by Break Force pointed apex (right) which will pointed be apex (right) which will be One-Piece GoDirect™ 3.0mm Implants available 3Q12. available 3Q12.

for use with Implant Direct’s Internal and External GPS™ Overdenture Attachments.

Standard apex (left) as tested by CLINICIANS REPORT and pointed apex (right).

(Newtons)

dense bone is encountered. The alternative procedure if dense bone is encountered is to unscrew the implant, prepare the socket to its full depth and re-insert the implant.

Dr. Gerald Niznick graduated from the University of Manitoba Dental School in 1966 and then earned a master’s degree in prosthodontics at Indiana University in 1968. He has been awarded 36 U.S. patents and has received honorary doctorate degrees. Reach him at drniznick@implantdirect.com.

Source: Gordon J. Christensen’s CLINICIANS REPORT, February 2012

2.9mm and 3.0mm implants, there was a 42% greater strength. The 3.7mm GoDirect demonstrated 30% greater strength, which is more proportional to the 23% increase in diameter compared to the 3.0mm GoDirect. Wider implants also provide greater surface area, thereby reducing the number of implants needed to provide the same amount of load carrying capabilities. The difference in diameter between 2.4mm and 3.0mm is only 0.6mm/2 = 0.3mm (0.012”) on each side, which is about the thickness of 3 human hairs so the diameter of the osteotomy required to place each of these diameter implants is not significant, especially with tapered implants in soft bone. Mini-implants gained popularity in part to the belief that narrower implants better facilitated insertion without requiring a soft tissue flap. This is a misconception because if the narrow implant was selected because of a narrow ridge, it is exceedingly unpredictable to blindly place an implant in the center

of the narrow ridge without causing buccal or lingual perforations. On the other hand, if the ridge is wide enough to predictably place the implant flapless in the center of the ridge, a Mini-implant, if placed in the center of the ridge, would only engage cancellous bone. A 3.7mm or wider implant would provide greater strength and stability in this situation, and fewer implants would be needed to achieve the same or even greater surface area for load support. A slight increase in implant diameter from 2.4mm to 3.0mm can also provide an adequate dimension as it emerges from the crest of the ridge, to provide a more natural emergence profile for cemented restorations and an adequate width for multi-unit (screw-retained) restorations.

The decision to place an implant without laying a flap depends on the clinician’s ability to visualize the ridge width in order to determine adequate bone to support the implant. This

cost of the procedures, which obviates the savings that have perpetuated the use of Mini implants.

Once the decision is made to lay a flap and visualize the ridge width, narrow lower edentulous ridges can often be flattened to create adequate width to place a 3.7mmD implant.

The visualization allows placement in the center of the ridge without perforations or compromise to the labial or lingual cortical plates. In narrow maxillary ridges, laying a flap provides opportunities to surgically spread and widen the ridge before implant placement, with or without bone grafting. A 3.0mm, evenly tapered screw implant with a rounded apex can be inserted into an undersized osteotomy using only a 2.3mmD drill, gradually expanding the cortical walls of the socket, compressing the soft bone and increasing mechanical retention for initial stability.

(G. Niznick: Clinical Oral Health 2000 “Achieving Success in Soft Bone”).

In the case shown, four 3.0mmD, 13mmL GoDirect™ implants where placed free-hand with a flapless surgery in a rather narrow ridge by a very experienced clinician. The X-ray reveals that there was more than adequate bone height to allow for removal of 4-6mm of crestal bone to achieve a wider ridge since the symphysis widens towards its base. Visualization of the edentulous ridge would have assured optimum placement in the center of the modified ridge without risking compromise to the buccal or lingual cortical plates. These 1-piece implants provide a cost-effective option for stabilizing overdentures and with the launch of the 3.0mmD with a pointed apex, will provide dental professionals a full range of diameter and surgical options with this system. As can be seen in the X-ray, the GoDirect implant is The internal threads of the GoDirect implant allow the addition of an extender (left) internally threaded, allowing subsequent attachment of different abutment if needed to accommodate soft tissue height or options if required for tissue overgrowth or a change of treatment options, conversion to a multi-unit abutment (right) for such as conversion to a screw-receiving abutment. treatment plan flexibility.

The GoDirect implant is not recommended for use in situations where the implants diverge more than 20-30 degrees.

The GPS™ attachments are available with GPS Abutments for a variety of popular implant platforms in both straight, 15 and 30 degrees.

GPS™ Internal Attachment designed to provide vertical and rotational stress-breaking. Under biting forces, the lateral walls of the liner flex outward to allow the retentive ball to move downward into the internal cavity. Indicated for use with 2 to 3 implants placed in the anterior symphsis, up to 30 degree divergence.

GPS™ External Attachment is recommended for cases of four or more implants which are relatively parallel or have platforms made parallel using angled abutments.

15° relative divergence

GPS™ straight and angled abutments (15° or 30°) for use with twopiece implants.

30° Distally inclined

15° relative divergence

15° Labially inclined

GoDirect® implants 60° relative divergence

Watch “All-over-4” 3D Graphic Video GPS angled abutments combined with GoDirect implants provide an economical solution for treating edentulous jaws.

GPS Attachment Pat. Pend.

Leading the Way GPS® with Internal Connection

- Retention Initially Retained when Tipped 10° - Vertical Resiliency for Less Stress on Implant

100%

Unlike GPS Internal Attachment, Zest's LOCATOR® initially loses 27% of its retention when tipped 10° 1

73%

GPS® Overdenture Attachment System

New Internal Cap Attachment with Added Advantages External Retention

Internal Retention

Pink Anodized Titanium Cap with increased retention in denture base

Maintains greater % of initial retention over the first year in function than Zest’s LOCATOR® Attachment (Insertion at 0° for 1200 cycles1)

+

Black Processing Cap made from high melting point plastic Abutment inserted with standard insertion tools for each system

Internal cavity of abutment allows for increased vertical resiliency with occlusal loading Titanium & nylon cap rotate together eliminating cavity for plaque and debris present with Zest’s LOCATOR Attachment

Straight Abutment with Cap Attachment, Transfer, Spacer & Comfort Cap: $100

GPS® Internal

Zimmer: $166; Straumann: $196 Nobel Biocare: $156, Zest Anchors Co: $156

LOCATOR® Dual Retention

Only GPS offers 15° & 30° Angled Abutments with LOCATOR®-compatible platforms Rated “Excellent” for “Tolerance of Non-Parallelism” in an Independent Report - Gordon J. Christensen CLINICIANS REPORT, November 2011

15° relative divergence

30° Distally inclined

15° relative divergence

15° Labially inclined

GoDirect® implants

GPS angled abutments accommodate the greatest degree of relative divergence available on the market Straight and angled GPS abutments are available for: NobelReplace, NobelActive, Straumann Tissue Level, Zimmer’s Screw-Vent, BioHorizons®, MIS & Blue Sky Bio Watch “All-over-4” 3D Graphic Video GPS angled abutments combined with GoDirect® implants provide an economical solution for treating edentulous jaws.

1-piece 3.0mmD GoDirect (standard apex, left) and GoDirect Mini (pointed apex, right) with GPS and LOCATOR® compatible platform.

60° relative divergence 1Data on file regarding GPS Internal and Zest Anchor’s LOCATOR attachment with dual retention.

LOCATOR® is a registered trademark of Zest Anchors Company. The GoDirect® and GPS® Systems are neither authorized, endorsed, nor sponsored by Zest Anchors Company.

Price comparisons based upon US list prices as of January 2013. All trademarks are the property of their respective companies.

www.implantdirect.com | 888-649-6425

The InterActive Evolution of Conical Connection Implants Author_Gerald A. Niznick, DMD, MSD

issn 2161-6531

Reprint from: Implants, March 2012

the international C.E. magazine of

North America Edition • Vol. 2

•

Issue 3/2012

oral implantology

3

2012

_c.e. article Graftless solutions in implant dentistry

_events AAIP and AAID gear up for annual meetings

_industry The InterActive evolution of conical connection implants

Fig 1.

Fig. 1: InterActive’s All-in-1 Packaging (4.3 mm shown).

Includes implant, fixture mount/abutment/transfer, cover screw and healing collar for convenience and up to 70 percent savings. (Photos/Provided by Implant Direct)

The publication of the 15 year results with Brånemark external hex screw implants (Adell R., Brånemark P-I., et al: Int. J. Oral Surg. 1981 10:387-416) documented the long-term success with osseointegrated titanium implants. The Core-Vent (1982) internal hex implant (Niznick G. US Pat. # 4,431,416) with cemented abutments brought versatile prosthetics to implant dentistry but it was the Screw-Vent® (1986) internal hex-thread connection with a lead-in bevel (Niznick G. US Pat. #4,960,381) that brought together stability and detachability. This connection facilitated the

design of narrow diameters implants and its stability made cementation in partially edentulous jaws the treatment of choice.

This type of implant-abutment connection became the cornerstone of modern implant design and is today referred to as a conical connection in the most popular implant systems. Before the patent’s expiration in 2007, this connection was licensed to eight different implant companies, and since, has been incorporated into most implants including the NobelActive™ and NobelReplace™ Conical Connection implants.

Whether the lead-in bevel is 45 degrees, as in the original Screw-Vent (Zimmer Dental), MIS or BioHorizons implants, 8 degrees (Straumann®), 11 degrees (Astra™) or 12 degrees (NobelActive™), a “conical” interface provides lateral stability to reduce the occurrence of screw loosening in comparison to butt joint connections (tri-lobe and external hex implants). One problem with increasing the slope of the lead-in bevel is that it moves the anti-rotational feature (internal hex) farther down the internal shaft, often requiring X-rays to verify full seating of the abutments. It also thins the walls of smaller diameter implants, increasing the risk of fracture under lateral load.

The new InterActive™ system of conical connection implants and abutments from Implant Direct (launch anticipated soon) provides a platform compatible to the NobelActive and NobelReplace Conical Connection. The InterActive abutments incorporate design modifications to help ensure full seating of the abutments without the necessity of confirming radiographs. This is accomplished by lengthening the hex and shortening the bevel so that a lack of full seating is readily apparent as the hex will be visible above the implant. Two other features also assist full seating. A piloting feature has been added to the bottom of the abutment’s hex to help guide insertion and an internal thread has been added to the abutment shaft to retain the screw while the abutment is rotated to a full seat in the implant’s deep hex. The contour of the InterActive abutments, transfers and healing collars have been designed for improved soft tissue management with a concave emergence profile. The InterActive implant is available in four diameters with the same platform for the 3.2mm & 3.7mm implants

Fig 3.

Fig 2. as the NobelActive 3.5mm implant, and the same platform for the 4.3mm and 5.0mm implants as used with the NobelActive implants of these diameters. The platforms are colorcoded for easy identification with matching anodized cover screws, healing collars and transfers. The body of the InterActive implant matches that of the successful Legacy2 implant with double lead body threads over the tapered 2/3rds of the implant for faster insertion.

These threads are flat based and become progressively deeper towards the apex for increased surface area. Three long vertical cutting grooves and tapered body with a round apex ensure the implant will follow the trajectory of the osteotomy and allow self-tapping insertion using dense-bone drills without the need for a bone tap.

An additional design improvement incorporated into these new implants is the combination of

Fig. 2: InterActive diameter and platform options (from left, 3.2, 3.7 (both with 3.0 mm platform), 4.3 and 5.0 (both with 3.4 mm platform)

coronal quadruple-lead micro-threads (Niznick Pat. #7,677,891) with the micro-grooves (Niznick Pat. Pending) Fig. 3: Abutment and matching for enhanced crestal bone healing collar with uniform concave preservation and initial stability. emergence profiles for soft-tissue The InterActive’s revolutionary 2management. piece fixture-mount (Niznick Pat. Pending) serves as a transfer and final preparable abutment. The square top is friction retained in the top of the abutment, and, when used as a transfer, will pull with the impression.

The abutment, attached to an implant analog, then snaps into the impression, mating metal with metal for accuracy. The square top also offers a torque safety feature, stripping when over-torqued to prevent damage to the implant’s interface. The All-in-1 Packaging of the InterActive further includes a cover screw that can be used for submerged healing or with a 2mm extender/healing collar (Niznick US Patent #7,396,231) for added value InterActive as featured on the cover and simplicity.

Dare to Compare on Innovation, Quality, Service and Value Legacy™3 Implant All-in-1 Packaging includes implant, abutment, transfer, cover screw & healing collar

$200 vs $6331 from Zimmer Dental Reality Check Zimmer Customers Save $433 with Legacy3

SwishPlant™ Implant All-in-1 Packaging includes implant, straight abutment, transfer, cover screw & healing collar

$200 vs $7372 from Straumann® Reality Check Straumann Customers Save $537 with SwishPlant

ReActive™ Implant All-in-1 Packaging includes implant, abutment, transfer &

$200 vs $7183 from Nobel Biocare™ Reality Check Nobel Customers Save $518 with ReActive

Implantology Basics and Beyond 24 CE CREDITS

Implant Dentistry 101 3 Day Introduction Course

12 CE

Laser Surgery: A Quantum Leap Forward

16 CE

3D Implantology

CREDITS

CREDITS

View Dr. Niznick’s 2-hour lecture & earn 2 CE credits FREE Dr. Gerald Niznick discusses how the latest implant design innovations are shaping the future of implantology.

2 Day Certification Course

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Introductory Offer: Make the switch & receive three FREE implants.4 Price comparisons based upon US list prices as of January 2013. All trademarks are property of their respective companies.

1US list price for Tapered Screw-Vent with micro grooves, healing collar & straight abutment 2US list price for SLActive Tapered Effect implant, closure screw, healing abutment, solid abutment, transfer and comfort cap.

3US list price for NobelActive with cover screw, impression coping & abutment 4Terms and conditions apply

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