After you have placed or at least restored a few implants with ideal position, vertical height, and occlusion, you’ve probably seen a little bone loss circumferentially around the neck of the implant.
This loss is commonly called “cratering” or “die-back,” and many professionals agree it is just an accepted consequence of implant therapy. I say, however, that this assumption is wrong! I think it’s wrong for dentists and potentially harmful to patients to simply accept what has seemed to be unavoidable for most implant systems. I am so confident in my opinion because I’ve found an implant system that doesn’t exhibit cratering, that doesn’t ask you to reduce crown size or contours or to minimize occlusal forces, that conserves more bone volume and therefore tissue volume, and that is backed by over ten years of clinical data and university studies. This new system is called ANKYLOS, and it provides a revolutionary connection to prevent bone loss.
With implant systems, it’s the connection that really counts. Other implant systems have external hexes, internal hexes, and triangles, and configurations that all share one common characteristic: movement after placement. The very fact that you can easily insert and remove an abutment into various mechanical locking anti-rotationally designed implant connections indicates a less than perfect fit. The fact that you can see and smell bio debris after removing a healing abutment or final abutment after it has been in place for a few weeks tells you that bacteria has been leaking around that connection.
Recently, one company announced that it had reduced the microgap by half that of a competing company, meaning there product still has a microgap present. Any gap is simply not good enough. A microgap allows a combination of micromovement and bacteria infiltration, resulting over time in bone loss.
For the past several months, a pilot program in the United States has studied, placed, and restored with the ANKYLOS implant system. ANKYLOS has been in use for over ten years in Germany and other countries. I am privileged to have been a part of this study. I’ve used this implant system in my practice; I’ve discussed results with other pilot program dentists; and I’ve traveled to Germany to see first hand the clinical results and the radiographic evidence and SEM studies of the components. ANKYLOS is sold under the Dentsply umbrella of companies and became available to doctors in the United States in October 2004.
The ANKYLOS implant is placed 1 to 2 mm below the crest of the bone. It can be placed at the crest, but to gain the maximum benefit of hard and soft tissue contours, placing below the crest is better. The internal conical connector is 2.4 mm in diameter no matter what size diameter implant you place.
The threads of this implant are more accentuated as you go apically in order to engage the medullary bone for stability. The cortical bone at the crest is denser but also more fragile when stressed. Therefore, when stress occurs, the cortical bone melts away, or “craters,” while the medullary bone, being more resilient, repairs itself, probably due to better blood supply. But the real key to success with this implant is the tapered (5.6º) conical connector. It has been precisely engineered to be bacteria proof and exhibit no micromovement. There is no microgap, therefore bacteria cannot infiltrate the implant abutment junction, ever.
This strong, rigid, sealed interface into an implant anchored into the medullary bone yields results that experienced implant dentists find hard to believe. Not only is the bone preserved at the crest, there are cases documented where bone growth over the platform of the implant is proven over time via radiographs. And, because the bone volume is preserved, the tissue volume is preserved as well. Also, the shape of the connector encourages more tissue (including circumferential and perpendicular fibers) to support the abutment/crown complex. In a nutshell, the aesthetics are great and long lasting, as is the tissue health.
Most implant systems are very comparable in their design and engineering. They share many common characteristics and have similar strengths and weaknesses. Their significant weaknesses are microgap and the resulting micromovement allowing bacterial contamination and bone loss. To solve these problems, ANKYLOS has constructed a tapered conical connector that is engineered to eliminate the microgap, and therefore eliminate the causes of crestal bone loss. This is more than just another implant system—this is the next generation of implant systems.
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