Implant macro and microgeometry – impact on bone

As clinicians, we have the difficult task of selecting from many excellent implant options on the market today. Often our decision is based on many factors, including working with products that are adequately researched with a good literature base to support their use, a company representative that we like and that supports us effectively, and products produced by manufacturers that are large and stable (because we know that they will be around in the future!)

The key design features that we consider in our product selection includes using implants that have high primary stability: this is driven by our increasing use of immediate implant placement as well as immediate implant restoration protocols. We are also looking for implants that give us rapid secondary stability, i.e. bone-to-implant contact. Rough surfaces are clearly superior in this regard. What we often don’t think about is the impact of our drilling protocols and our surgical instrumentation on both primary and secondary stability. What we want to achieve is a ‘tight’ fit for initial stability (body and thread design as well as how we prepare the site), but also space for development of rapid bone-to-implant contacts (thread design or pitch and micro geometry).

We are particularly interested in newer surfaces like Laser-Lok (BioHorizons). We have found excellent crestal bone stability with this surface treatment, on both the standard and the platform-switched implants. In our opinion, the greatest benefit to using the platform-switched implant is its role in thickening the soft tissue at the head of the implant. What we are basically doing with this design change is creating greater soft tissue volume (like a tissue graft would do!). This is critical to protect crestal bone and to increase the probability of long-term  soft tissue stability. Some of the preliminary data on Laser-Lok suggests that this might also allow better soft tissue attachment to the implant or abutment … this still needs more research.

So, the bottom line is that our go-to implant today is:

  1. The BioHorizons tapered implant (high stability and thread design that provides room for a quick rise in BIC).
  2. Platform-switched in areas where we don’t need a wide occlusal table (molars- non-platform switched).
  3. We are really interested in the effect of Laser-Lok on our titanium or ceramic/metal base abutments, whether placed at surgery or after integration. Maybe this could be an important design feature to reduce our problems with peri-implant disease (mucositis and peri-implantitis). We will keep you posted.

Next … we’ll explore what’s happening with zirconia stems on our abutments!