7. Tawse-Smith A., Payne A.G.T., Kumara R., Thomson W.M. One-stage operative procedure using two different implant systems: A prospective study on implant overdentures in the edentulous mandible. Clin Implant Dent Relat Res 2001; 3-4; 185-193. Watson G.K., Payne A.G.T., Purton D.G., Thomson W.M. Mandibular overdentures: Comparative evaluation of prosthodontic maintenance of three different implant systems during the first year of service. Int J Prosthodont 2002; 15: 259- 266. Tawse-Smith A., Payne A.G.T., Kumara R., Thomson W.M. Early loading of unsplinted implants supporting mandibular overdentures using a one-stage operative procedure with two different implant systems: A 2-year report. Clin Implant Dent Relat Res 2002; 4: 33-42. Daly P.F., Pitsillis A., Nicolopoulos S., Occlusal reconstruction of a collapsed bite by orthodontic treatment, pre-prosthetic surgery and implant supported prostheses. A case report. SADJ 2001; 56-6; 278 – 282. Dellow A.G., Driessen C.H., Nel H.J.C. Scanning Electron Microscopy evaluation of the interfacial fit of interchanged components of four dental implant systems. Int J of Prosthodont 1997 10; 216 – 221. Peer Reviewed Publications
8. Nikellis,I., Levi A., Niccolopoulos, C. “Immediate loading of 190 endosseous dental implants: A prospective observational study of 40 patient treatments with up to 2-year data” Int J Oral and Maxillofac Implants 2004; 19(1): 116-123. Boyes-Varley J.G., Lownie J.F., Howes D.G., Blackbeard G.A. Surgical modifications to the Branemark Zygomaticus Protocol in the treatment of the severely resorbed maxilla: a clinical report. Int J Oral Maxillo Facial Implants 2003. Boyes-Varley J.G., Lownie J.F., Howes D.G., Blackbeard G.A. Surgical modifications to the Branemark Zygomaticus protocol. COIR 2002; 13-4; xxxii Butz, S.J., Huys,LW. Long-term success of sinus augmentation using a synthetic alloplast: in 20 patients, a 7 year clinical report. Implant Dent. 2005 Mar; 14(1):36-42. Boyes-Varley J.G., Lownie J.F., Howes D.G. The Zygomatic Implant Protocol in the treatment of the severely resorbed maxilla. SADJ 2003; 58:3; 106-114. Peer Reviewed Publications
9. Esposito M., Grusovin, M.G., Coulthard, P., kThomsen, P., Worthington, H.V. A 5-year follow-up comparative analysis of the efficacy of various osseointegrated dental implant systems: a systematic review of randomized controlled clinical trials. Int J Oral Maxillofac Implants. 2005 Jul-Aug;20(4):557-68. Hall JA., Payne AG., Purton DG., Torr B., A randomized controlled clinical trial of conventional and immediately loaded tapered implants with screw-retained crowns. Int. Journal of Prosthodontics 2006 Jan-Feb;19(1):17-9. Hall JA., Payne AG., Purton DG., Torr B., Duncan WJ., DeSilva RK., Immediately restored, single-tapered implants in the anterior maxilla: prosthodontic and aesthetic outcomes after 1 year. Clin Implant Dent Relat Res. 2007 Mar;9(1):34-45. Vandeweghe S, Ackermann A, Bronner J, Hattingh A, Tschakaloff A, De Bruyn H. A Retrospective, Multicenter Study on a Novo Wide-Body Implant for Posterior Regions. Clin Implant Dent Relat Res. 2009 Dec 3. Peer Reviewed Publications
21. Cross Section of 3.5 TriNex Implant Thicker wall to minimize fracture or distortion Platform switch Binon’s work showed less fit of components increases chances of screw loosening
22. Cross Section of 3.5 TriNex Implant Thicker wall to minimize fracture or distortion Platform switch Internal Hex for insertion
23. Cross Section of 3.5 TriNex Implant Thicker wall to minimize fracture or distortion Platform switch Internal Hex for insertion Smaller polished collar 0.6mm vs. 1.5mm
24.
25. Cross Section of 03.5 TriNex Implant Threads extending to apex of implant
26.
27. Improvements of other Tri-Lobe Designs Thicker wall Platform switch Smaller polished collar 0.6mm vs. 1.5mm Threads extending to apex of implant Internal Hex for insertion Compatible w/ Nobel Biocare
32. Efficient is being effective without wasting time, effort, or expense It implies the least costly production means without sacrificing quality
33.
34. Schropp L, Isidor F. Timing of implant placement relative to tooth extraction. J Oral Rehabil. 2008 Jan;35 Suppl 1:33-43. Review. Wagenberg B, Froum SJ. A retrospective study of 1925 consecutively placed immediate implants from 1988 to 2004 . Int J Oral Maxillofac Implants. 2006 Jan-Feb;21(1):71-80. Chen ST, Wilson TG Jr, Hämmerle CH. Immediate or early placement of implants following tooth extraction: review of biologic basis, clinical procedures, and outcomes. Int J Oral Maxillofac Implants. 2004;19 Suppl:12-25. Review. Immediate Implant Placement Immediate implant placement shortens treatment time, decreases the number of surgical procedures, and often eliminates need for grafting When certain parameters are met, long term results of immediate implant placement appears comparable to delayed placement Single rooted relatively easy, but multi-rooted teeth difficult
35. Molar sockets are too large and complex to allow for immediate placement of conventional implants
36. Delayed placement will result in longer treatment time and often a bone graft will be required Bone grafts are costly and time consuming
37.
38. The Solution Develop an implant design and surgical protocol to facilitate immediate implant placement into molar sites This would optimize / preserve available bone and significantly reduce the time, complexity, and cost of treatment
40. Bucco-palatal = 10.7 mm range = 7.4 -14 mm M D B P 7.9 10.7 Cervical dimensions Maxillary first molar Mesio-distal = 7.9 mm Range = 6.4 -10.9 mm Woelfel 1990
41. Bucco-lingual = 9.0 mm Range = 7.3 -11.6 mm M D B P 7.9 10.7 Cervical dimensions Mandibular first molar Mesio-distal = 9.2 mm Range = 7.7-12.4 mm M D 9.2 L B 9.0 Woelfel 1990
49. Socket Preparation Instruments same as tapered implants until final Round bur to create pilot hole Twist drills to enlarge 4.0mm, 5.0mm, 6.0mm tapered final shaping drill Final dedicated MAX shaping drill
55. Final Dedicated MAX Shaping Drill Six total: One for each length and diameter of implants 8mm diameter MAX 7mm length 9mm length 11mm length 9mm diameter MAX 7mm length 9mm length 11mm length
66. Final Dedicated MAX Osteotomes Six total: One for each length and diameter of implants 8mm diameter MAX 7mm length 9mm length 11mm length 9mm diameter MAX 7mm length 9mm length 11mm length
67. MAX Implant Dedicated Instruments Drills Taps Osteotomes Three dedicated instruments to facilitate MAX placement
81. Angled fixture mount allows symmetrical rotation when inserted How Do You Place This Implant? dimple on most coronal side of restorative platform 0.6mm thread pitch
84. Tilted Implants Literature Review 1 . Sütpideler M. Eckert SE, Zobitz M. An KN . Finite element analysis of effect of prosthesis height, angle of force application, and implant offset on supporting bone. Int J Oral Maxillofac Implants. 2004 Nov-Dec;19(6):819-25. 2. E, Griggs JA, Powers JM, Englemeier RL . Effect of abutment angulation on the strain on the bone around an implant in the anterior maxilla: a finite element study. J Prosthet Dent. 2007 Feb;97(2):85-. 3. Cehreli MC, Iplikcioğlu H, Bilir OG . The influence of the location of load transfer on strains around implants supporting four unit cement-retained fixed prostheses: in vitro evaluation of axial versus non-axial loading, J Oral Rehabil. 2002 Apr;29(4):394-400. 4. Brosh T, Pilo R, Sudai D . The influence of abutment angulation on strains and stresses along the implant/bone interface: Comparison between 2 experimental techniques. J Prosthet Dent 1998;79:328-334. 5. Clelland NL, Lee JK, Bimbenet OC, Brantley WA . A three-dimensional finite element stress analysis of angled abutments for an implant placed in the anterior maxilla. J Prosthodont 1995; 4:95-100 6. MC, Lplikçioğlu H . In vitro strain analysis and off-axial loading on implant supported fixed partial dentures. . Implant Dent. 2002;11(3):286-92. 7. O’Mahony A, Bowles Z, Woolsey G, Robinson SJ, Spencer P . Stress distribution in the single-unit osseointegrated dental implant: finite element analyses of axial and off-axial loading. Implant Dent. 2000;9(3):207-18. 8. Clelland NL, Gilat A, McGlumphy EA, Brantley WA . A photoelastic and strain gauge analysis of angled abutments for an implant system. Int J Oral Maxillofac Implants. 1993;8(5):541-8. 9. Celletti R, Pameijer Ch, Bracchetti G, Donath K, Persichetti G, Visani I . Histologic evaluation of osseointegrated implants restored in nonaxial functional occlusion with preangled abutments. Int J Periodontics Restorative Dent. 1995 Dec;15(6):562-73. 10. Barbier L, Schepers E . Adaptive bone remodeling around oral implants under axial and nonaxial loading conditions in the dog mandible. Int J Oral Maxillofac Implants. 1997 Mar-Apr;12(2):215-23.
85. Tilted Implants Literature Review 11. SF, Wolfinger GJ, Balshi TJ . Analysis of 356 pterygomaxillary implants in edentulous arches for fixed prosthesis anchorage. Int J Oral Maxillofac Implants. 1999 May-Jun;14(3):398-406. 12. Balshi SF, Wofinger GJ, Balshi TJ . Analysis of 164 titanium oxide-surface implants in completely edentulous arches for fixed prosthesis anchorage using the pterygomaxillary region. Int J Oral Maxillofac Implants. 2005 Nov-Dec;20(6):946-52. 13. Valerón JF, Valerón PF . Long-term results in placement of screw-type implants in the pterygomaxillary-pyramidal region. Int J Oral Maxillofac Implants. 2007 Mar-Apr;22(2):195-200. 14. Ahlgren F, Størksen K, Tomes K . A study of 25 zygomatic dental implants with 11 to 49 months' follow-up after loading Int J Oral Maxillofac Implants. 2006 May-Jun;21(3):421-5. 15. Aparicio C, Ouazzani W, Garcia R, Arevalo X, Muela R, Fortes V . A prospective clinical study on titanium implants in the zygomatic arch for prosthetic rehabilitation of the atrophic edentulous maxilla with a follow-up of 6 months to 5 years. Clin Implant Dent Relat Res. 2006;8(3):114-22. 16. Becktor JP, Isaksson S, Abrahamsson P, Sennerby L . Evaluation of 31 zygomatic implants and 74 regular dental implants used in 16 patients for prosthetic reconstruction of the atrophic maxilla with cross-arch fixed bridges Clin Implant Dent Relat Res. 2005;7(3):159-65. 17. Farzad P, Andersson L, Gunnarsson S, Johansson B . Rehabilitation of severely resorbed maxillae with zygomatic implants: an evaluation of implant stability, tissue conditions, and patients' opinion before and after treatment. Int J Oral Maxillofac Implants. 2006 May-Jun;21(3):399-404. 18. Eger DE, Gunsolley JC, Felmman S . Comparison of angled and standard abutments and their effect on clinical outcomes: a preliminary report. Int J Oral Maxillofac Implants. 2000 Nov-Dec;15(6):819-23. 19. Sethi A, Kaus T, Sochor P . The use of angulated abutments in implant dentistry: five-year clinical results of an ongoing prospective study. Int J Oral Maxillofac Implants. 2000 Nov-Dec;15(6):801-10. 20. Sethi A, Kaus T, Sochor P, Axmann-Krcmar D, Chanavaz M . Evolution of the concept of angulated abutments in implant dentistry: 14-year clinical data. Implant Dent. 2002;11(1):41-51.
86. Tilted Implants Literature Review 21. Krekmanov L, Kahn M, Rangert B, Lindström H . Tilting of posterior mandibular and maxillary implants for improved prosthesis support. Int J Oral Maxillofac Implants. 2000 May-Jun;15(3):405-14. 22. Maló P, Nobre Mde A, Petersson U, Wigren S . A pilot study of complete edentulous rehabilitation with immediate function using a new implant design: case series Clin Implant Dent Relat Res. 2006;8(4):223-32. 23. Rosén A, Gynther G . Implant treatment without bone grafting in edentulous severely resorbed maxillas: a long-term follow-up study. J Oral Maxillofac Surg. 2007 May;65(5):1010-6. 24. Calandriello R, Tomatis M . Simplified treatment of the atrophic posterior maxilla via immediate/early function and tilted implants: A prospective 1-year clinical study. Clin Implant Dent Relat Res. 2005;7 Suppl 1:S1-12. 25. Krennmair G, Fürhauser R, Krainhöfner M, Weinländer M, Plehslinger E . Clinical outcome and prosthodontic compensation of tilted interforaminal implants for mandibular overdentures. Int J Oral Maxillofac Implants. 2005 Nov-Dec;20(6):923-9. 26. Aparicio C, Perales P, Rangert B . Tilted implants as an alternative to maxillary sinus grafting: a clinical, radiologic, and periotest study. Clin Implant Dent Relat Res. 2001;3(1):39-49. 27 Msu ML, Chen FC, Kao HC, Cheng CK . Influence of off-axis loading of an anterior maxillary implant: a 3-dimensional finite element analysis. Int J Oral Maxillofac Implants. 2007 Mar-Apr;22(2):301-9. 28. Zampelis A, Rangert B, Heijl L . Tilting of splinted implants for improved prosthodontic support: a two-dimensional finite element analysis. J Prosthet Dent. 2007 Jun;97(6 Suppl):S35-43. 29. Francetti L, Agliardi E, Testori T, Romeo D, Taschieri S, Fabbro MD . Immediate rehabilitation of the mandible with fixed full prosthesis supported by axial and tilted implants: interim results of a single cohort prospective study. Clin Implant Dent Relat Res. 2008 Dec;10(4):255-63. 30. Testori T, Del Fabbro M, Capelli M, Zuffetti F, Francetti L, Weinstein RL . Immediate occlusal loading and tilted implants for the rehabilitation of the atrophic edentulous maxilla: 1-year interim results of a multicenter prospective study. Clin Oral Implants Res. 2008 Mar;19(3):227-32.
87. Tilted Implants Literature Review 31. Capelli M. Zuffettii F, Del Fabbro M, Testori T . Immediate rehabilitation of the completely edentulous jaw with fixed prostheses supported by either upright or tilted implants: a multicenter clinical study. Int J Oral Maxillofac Implants. 2007 Jul-Aug;22(4):639-44. 32. Rosén A, Gynther G . Implant treatment without bone grafting in edentulous severely resorbed maxillas: a long-term follow-up study J Oral Maxillofac Surg. 2007 May;65(5):1010-6. 33. Bedrossian E, Rangert B, Stumpel L, Indresano T . Immediate function with the zygomatic implant: a graftless solution for the patient with mild to advanced atrophy of the maxilla. Int J Oral Maxillofac Implants. 2006 Nov-Dec;21(6):937-42. 34. Koutouzis T, Wennström JL . Bone level changes at axial- and non-axial-positioned implants supporting fixed partial dentures. A 5-year retrospective longitudinal study. Clin Oral Implants Res. 2007 Oct;18(5):585-90. Epub 2007 Jun 30 35. Cruz M, Wassall T, Toledo EM, da Silva Barra LP, Cruz S . Finite element stress analysis of dental prostheses supported by straight and angled implants. Int J Oral Maxillofac Implants. 2009 May-Jun;24(3):391-403. 36. Lin CL, Wang JC, Ramp LC, Liu PR . Biomechanical response of implant systems placed in the maxillary posterior region under various conditions of angulation, bone density, and loading Int J Oral Maxillofac Implants. 2008 Jan-Feb; 23(1):57-64. 37. Al-Ghafli SA, Michalakis KX, Hirayama H, Kang K . The in vitro effect of different implant angulations and cyclic dislodgement on the retentive properties of an overdenture attachment system. J Prosthet Dent. 2009 Sep;102(3):140-7. 38. Bellini CM, Romeo D, Galbusera F, Agliardi E, Pietrabissa R, Zampelis A, Francetti L . A finite element analysis of tilted versus nontilted implant configurations in the edentulous maxilla Int J Prosthodont. 2009 Mar-Apr;22(2):155-7. 39. Fortin T, Isidori M, Bouchet H . Placement of posterior maxillary implants in partially edentulous patients with severe bone deficiency using CAD/CAM guidance to avoid sinus grafting: a clinical report of procedure Int J Oral Maxillofac Implants. 2009 Jan-Feb;24(1):96-102. prospective study. Clin Oral Implants Res. 2008 Mar;19(3):227-32. Epub 2008 Jan 3.
88. Tilted Implants Literature Review 40. Bevilacqua M, Tealdo T, Pera F, Menini M, Mossolov A, Drago C, Pera P . Three-dimensional finite element analysis of load transmission using different implant inclinations and cantilever lengths . Int J Prosthodont. 2008 Nov-Dec;21(6):539-42. 41. Agliardi EL, Francetti L, Romeo D, Taschieri S, Del Fabbro M . Immediate loading in the fully edentulous maxilla without bone grafting: the V-II-V technique. Minerva Stomatol. 2008 May;57(5):251-9, 259-63. 42. Zampelis A, Rangert B, Heijl L .Tilting of splinted implants for improved prosthodontic support: a two-dimensional finite element analysis. J Prosthet Dent. 2007 Jun;97(6 Suppl):S35-43. Erratum in: J Prosthet Dent. 2008 Mar;99(3):167. 43. Francetti L, Agliardi E, Testori T, Romeo D, Taschieri S, Fabbro MD . Immediate rehabilitation of the mandible with fixed full prosthesis supported by axial and tilted implants: interim results of a single cohort prospective study. Clin Implant Dent Relat Res. 2008 Dec;10(4):255-63. Epub 2008 Apr 1. 44. Testori T, Del Fabbro M, Capelli M, Zuffetti F, Francetti L, Weinstein RL . Immediate occlusal loading and tilted implants for the rehabilitation of the atrophic edentulous maxilla: 1-year interim results of a multicenter prospective study. Clin Oral Implants Res. 2008 Mar;19(3):227-32. Epub 2008 Jan 3. 45. Cruz M, Wassall T, Toledo EM, da Silva Barra LP, Cruz S . Finite element stress analysis of dental prostheses supported by straight and angled implants Int J Oral Maxillofac Implants. 2009 May-Jun;24(3):391-403. 46. Kao HC, Gung YW, Chung TF, Hsu ML . The influence of abutment angulation on micromotion level for immediately loaded dental implants: a 3-D finite element analysis. Int J Oral Maxillofac Implants. 2008 Jul-Aug;23(4):623-30 47. Las Casas EB, Ferreira PC, Cimini CA Jr, Toledo EM, Barra LP, Cruz M . Comparative 3D finite element stress analysis of straight and angled wedge-shaped implant designs. Int J Oral Maxillofac Implants. 2008 Mar-Apr;23(2):215-25. 48. Markarian RA, Ueda C, Sendyk CL, Laganá DC, Souza RM . Stress distribution after installation of fixed frameworks with marginal gaps over angled and parallel implants: a photoelastic analysis. J Prosthodont. 2007 Mar-Apr;16(2):117-22.
89. Tilted Implants Literature Review Tilted implants are a safe and effective treatment that has many benefits for the patient
90.
91. Added components Smaller screws Added modes of failure Increased cost Increased time Large Screw Retained Restorations
92. 2 mm minimum distance To correct angle More time and cost than going direct to implant Potential aesthetic problems Angle corrected abutments often require tabling of bone Templates for lab to mouth
93.
94.
95. Anatomy and/or bone loss often lead to less than ideal implant location in the maxillary anterior making their restoration difficult Problem:
96.
97.
98. Co-Axis Implant Development It was determined by digital photographic analysis and cephalometric evaluation that an angle correction of 12 degrees would allow for vast majority of maxillary anterior implant restorations to be screw retained Edentulous areas
99. C. Nikolopoulos, Oral Surgeon P. Youvanoglou, Pros. G. Ioannou, Technican Co-Axis Implant No intermediate abutments No tabling bone
100. Co-Axis 24 º External hex with slightly shorter screws and healing components
103. The Co-Axis Implant Co-Axis implant may be placed into available bone while leaving the restorative platform in an optimal position Use Co-Axis implants in locations where conventional implants would require a bone graft or result in the inability to easily or adequately restore the implant Correct angle in implant, not the restoration
104. Co-Axis Implant Instrumentation 12 degree direction indicator (after twist) 12 degree direction indicator (after final shaping) in 10, 13 and 15mm
109. Is It Strong Enough With That Thin Wall? Straight Implant Co-axis Implant Same amount of titanium just more on one side than other
110. Finite element analysis 3.75 mm Implant Ext. Hex 350N load at 22° to long axis 350N load at 22° to long axis Finite element analysis Co-Axis 12 degree Finite Element Analysis
118. 10 degrees More vertical placement of implants Under contouring of restoration Narrower healing caps Platform switching Immediate restoration Increase amount of tissue
119. Vertical Placement of Implants In Anterior Maxilla Anatomy of the anterior maxilla often results in facially inclined implants that leads to long teeth
120. In same osteotomy site a Co-Axis implant will result in more mid-facial soft tissue than a straight implant
121. “ Need my crown recemented” Emergency immediate restoration
131. The Co-Axis implant has two distinct axes to allow easier replication of the two planes nature gave maxillary anterior teeth
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137. Thank You Brian A. Mahler, D.D.S., P.L.C. 10550 Warwick Avenue Fairfax, Virginia [email_address]
Editor's Notes
Southern has all these studies available upon request
Rct’s
Southern Philosophy. If only one best for you and patients than so be it
Benefit not first, not last
Take good idea and make it better
Nobel’s Select internal connection had been around about 5 yeas
Strength testing thicker wall tri lobe minimize flowering fracture or distorts top tri-lobe area ,or late fractures
Along w/ thicker tri lobe wall section helps fatigue added internal hex to minimize forces that may flower or distort top tri-lobe area
Smaller polished collar + micro-groves
Originally when Nobel developed immediate load experimental
lots of small changes that make it better for some cases,
Literature available form Southern
Just because unique doesn’t mean it’s a good thing, must not sacrifice quality
If not do one or more of above why??? Southern unique products , immediate placement
Shortens treatment time, more efficient, but molars lost more often in adults
Where the profile is strait or slightly tapered
Delayed placement is inefficient
Problem not as efficient as single rooted
Look at size of sockets 6, 6.5,. Or even 7mm usually too small
over 2 years of trials and 3 modifications developed the following history interesting, not time
Available in all 3 connections, use wide connectors
Location of self tapping flutes, lengths of 7mm, 9mm, 11mm
Round bur
Twist drills, 2 and 3mm
Large tapered drills work up depending on density and amount of bone
Notice so far same burs as for other impants
Final dedicated tapered drill
Insert impant
Countersink. 2 by 2 rule
Red arrows show all 4 walls have contact w/ implant and yellow arrow shows no contact, suture over need graft material to stop down growth or as is. 2 by 2 rule
Tarnow at AO, if not suture over site leave space clot, some graft other do not, very experienced users think depth of placement more important than graft
Hard to pull, leaves more attached tissue. Most do not suture
Note inter-proximal countersink again
voerman
Beyond the drills this tap/drill excellent for controlTap also drills some
Soft bone, single roots second molars, small sinus communications no big thing
Instruments are same for placement of any implant except for the final instrument before placement which is one of three
Implants are actually undersized for sockets, history of wides
Single implant into mesial or distal root
Exposed threads, not deep enough or inadequate or damaged buccal plate
Osteotome, six indentations
Dr. Graves, submitting article w/ 160 ?, and my numbers. Over 300 w/ about 94%?
60% to 80%
Another unique implant , allows me to be more efficient w/o sacrificing quality, larger cases and less likely scenario
12 degree 4mm external hex and 24 degree external hex use shorter screws, rest compatible
One optimal position, 0.6mm tread pitch
All three connections on 12 degree
Note internal hex is where insertion tool engages implant, minimize distortion or fracturing, more efficient
As with MAX more efficient for me , discuss large cases first, smaller next larger cases, full arch, want screw retained
I did literature review Southern has my literature review available and part referenced in Co-Axis article
48 articles up to 15 years follow up
Works, less time and cost, maxillary sinus, mandibular nerve
Co-Axis takes access opening to the lingual, Fermit, light cured temporary , this how started in early 1990’s
With tooth and if bone loss significant
2 24 degree in posteriors and 4 12 degrees in anterior
Surgeon gets his bone, restorative dentist gets his desired platform position.
For me, Screw retained or cemented not discuss I do most efficient,, larger cases screw retained, bridge taper porcealin chipper
Makes using tilted implants easier for dentist and patients
3 exposed threads and 15mm?, anterior less stress on screw
FDA approval, most stringent to my knowledge. My experience 6 years
Implant higher interproximal like Nobelperfect or Innovas Anatomical implant, protottype
Problem single teeth, midfacial bone interproimal determined by bone on adjacent teeth
Dictated by anatomy, amount of bone
Theoretical, but does it happen
Everyday example
Surgical axis vs. prosthetic axis,
Believe secret to better esthetics in single teeth is:
The picture on R side shows what would be facial access opening of screw due to either bone loss before placement, angulation of facial plate relative to where clinical crown of natural tooth was, or poor surgical placement .
Anterior routinely done,
My conclusions about Coax and max with regard to what they do for my practice and my patients