Which Implant Brand?

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Today, the implant brands and the companies producing implants have increased so much that there are currently over a hundred implant brands applied in dentistry.

It is not possible for us to say such a thing as “The products of this company is safe whereas the others are not”. However, we know very well that this is one of the questions that bothers the patients the most.

We can give an answer to this only as such: the implant producers can roughly be divided into two categories. There are companies which have been producing and functioning in this field for a long time (over 20 years). Therefore, having seen the results of their implants used by dentists, they have developed their implants according to these results and returns, and have reserved a budget on the researches for the production of safer and more durable implants. Thus, the companies which have proved themselves should be mentioned along with the relatively new companies in the dental implant sector from which we have not yet gathered sufficient practical data.

It should be underlined again that this distinction relates only to testability. As a matter of fact, when many criteria such as, reliability, success, experience and durability and etc. of the companies are concerned, we come to the conclusion that each brand should be evaluated in its own terms.

Can we trust every implant brand?

According to us, there are more than enough dental implant brands which have proven their reliability and quality in the dental implant sector. However, right now, about 150 brands are mentioned in this sector. It is out of question that a dentist could test most of them in the presence of so many brands. The doctors can only see if there are any academic research carried out on the brands as much as they can follow. They can look at the academic studies in which they are compared to other implant brands in many aspects. One thing is certain that every implant brand is marketed to the doctors with praises. Unfortunately, the dental implant field has completely become a commercial space by the producing companies themselves and distributors. Therefore, doctors may access some manipulated information.

Which implant brands can we trust? Can you give a general information on the implant brands?

We – the surgical practitioners of this medical field- have to be very careful when giving the name of a safe brand. Because we can lead to the understanding that “as if the unmentioned implant brands are unsafe” by what we say about many of the other brands. This situation is first of all wrong in terms of medical ethics. Therefore, when answering this question, we ask the readers to show the following sensitivity: The brand names we are going to mention have proven themselves through their academic and literature researches and at the same time they are brands which are already used in our clinic. There are many other brands out of these and due to the lack of sufficient information on our behalf in relation to these brands, their names are not going to be mentioned.

We can analyze the implant brands under three main categories:

Some implant brands are known as the “leaders” of the sector and they are quite successful brands accepted by many dentists. A lot of researches and the global generality of these implants also prove this.

The implant brands that could be placed under this category are as follows:

Nobel Biocare (branemark): This dental implant brand, based in Sweden, is one of the most long-established dental implant brands and still has the largest dental implant market all around the world, mainly in Europe. The “all in four” system, developed especially in atrophic edentulous lower jaws has allowed the placement of a fixed prosthesis for many people and this brand has thus become the pioneer in the sector. Even though it cannot be claimed that this brand has a commanding lead in comparison to ten years ago, it is an implant brand which has proven its success and reliability for many years.

ITI (straummann): This implant brand, manufactured in Switzerland, apart from being a long-established and successful implant brand, is known to develop and hold the patent rights for SLActive surface implants, recognized as one of the most developed implant surfaces. Therefore, it is the top-ranking brand preferred by the dental surgeons almost all around the world and it greatly deserves that.

Biomet3i: This implant brand, manufactured in United Stated, is one of the most widely-used and long-established implant brands of the American continent. It has also been the subject matter for a lot of researches and dissertations of the American scientists and has proven its success sufficiently. When looked at the preliminary work and outcome of the brand’s future release, the platform switching implants, it seems quite assertive.

Astra Tech: This brand, manufactured in Sweden, is the most preferred among the platform switching implants. The brand, which has been bought by the sector giant, Dentsply, has been used safely by many doctors, mainly in Europe and in our country as well for many years.

SKY(bredent): This implant brand is one of the prominent dental companies in prosthesis, upper structure and prosthesis attachments. Manufactured and developed by bredent in Germany, it has been applied specifically to many patients and mouths because it allows immediate loading in edentulous patients, an angle until 35 degrees and  as a result of this it can be placed far away from the unwanted places, such as the sinus cavities or sinus channels. As it also allows the possibility of placement of fixed prosthesis for lower jaws which are extremely resorbable and inclusion of many upper structure alternatives, it has been applied widely on many specific mouths and patients. This brand has gradually become a largely preferred brand by the dental surgeons because of these facilities it offers.

Certainly, there can be many more brands carrying the “leader” quality, however, as we mentioned earlier, we have cited and mentioned briefly about these brands only because we know much more about them, we have used them and read about their academic articles.

On the other hand, we also follow some new brands which are ambitious and ready to do anything in order to achieve “success”. We read successful literature reviews written on these implant brands and we see the results by testing them personally.

Laser lok (biohorizon): Manufactured in U.S.A., this implant brand offers the dental surgeons aesthetic and successful solutions by its implants, named laserlok, especially for aesthetical teeth losses in front structure and its implants developed with the laser technology in the cervical area even though it does not have a large market in its home country. Due to the laser technology, it has been proven that it holds better to the gum attachments through academic researches and therefore is quite often preferred for the frontal area by the dental surgeons. In addition, this implant brand is advantageous for dental surgeons as it provides a widespread service network in our country.

Hiossen and Osstem: The only difference between these two implant brands, mainly manufactured in South Korea and a little bit in U.S.A., are their names. Hiossen is the name oriented for the European and American market; on the other hand, Osstem is the name used at other markets. The reason for this difference in name is probably the company’s concern in case they cannot market the implant with the label “made in S. Korea” in the European and American continents. Even though the origin of these two brands, which are totally the same apart from their names, are from South Korea, especially the passive placement in the bone in cases of late loading and in this aspect, almost the non-existence of bone losses of the implants in the cervical area in the early phase, which is one of the major problems for a lot of dental surgeons, have resulted with doctors preferring these two brands in many critical cases. The two brands, having a high level of success in terms of osseo-integration is the “leader” in Asia in the implant field.

Tekka: This implant brand, manufactured in France and brought to Turkey in 2010 by the distributor company, has already proven that it is a brand with many facilities for the dental surgeons with the possibilities for early loading through its aggressive structure, active hold, its short implant alternative with 6 mm and its quite wide platform even though it has not been tested satisfactorily in our country yet. In addition, it is an implant brand preferred by dental surgeons in lower jaws which allow only the placement of a 6 mm long implant, in urgent cases and cases which need immediate loading.

Xive-Ankylos (Friadent-Dentsply) : Xive and Ankylos brands, within one of the giants of the sector, Dentsply, are located in various parts of Europe, mainly in UK and Germany and they are assuring to both patients and doctors. Especially, implants with a 3 mm diameter, developed many years ago in Xive implant system, have constituted an important alternative for edentulous areas where the bone thickness is insufficient. The implant brand, Ankylos, on the other hand, has been one of the first in the sector to manufacture the platform switching implants and has proven the success of platform switching implants, especially in edentulous back areas. Another reason for preference of the Xive implants by the doctors is that they have one of the most widespread circulation and service network in Anatolia.

Other brands that could be placed under this category are as follows:

Camlog (U.S.A.), Zimmer-SwissPlus (U.S.A.-Switzerland), TBR implant (France)…

Because we have not used and tested these products personally, we preferred not to write about them even briefly. The reason we still mention their names is that they are respectable in the sector and have got good reputation.

Many implant brands seem to be imitating the products of the leading implant brands and trying to produce their prototypes.

Ethically, we don’t find it proper to mention those brand names directly. However, we can say the following: It is known that a significant amount of the manufactured implant brands, especially, in countries such as, China, Israel, South Korea, Malaysia, South Africa, South America, Eastern Europe and Russia, are implant manufacturers who try to produce the prototypes of the above-mentioned leading and successful implant brands.

Nevertheless, an implant manufacturing company should not be directly considered “unsuccessful” when it tries to imitate the implant model and surface structure of a successful implant brand. The real question concerns to what extent the manufacturing company is successful in its imitation.

Shouldn’t we rely on the non-European or non-American brands (for example those manufactured in South Korea, Israel, eastern Europe)?

We cannot ever claim such a thing. In fact, no doctor can come up with such an impression. We cannot say that an implant which is not produced in Europe or United States of America is unsuccessful or unreliable. As a matter of fact, we had mentioned in a previous answer that the implant brand Osstem-Hiossen, originating from South Korea, is almost one of the best implants of the world in its bone holding capacity and minimum bone loss in the cervical area. This means that we should not have a prejudice in our minds about the origin of the implant.

There is a number of implant brands, based completely on outsourcing or imitation, in Israel, South Korea and South America. However, at the same time, there are also companies in these regions which aim to be a totally separate brand and move away from its initial imitation phase by taking their work seriously, investing sufficiently in the field, and correcting the imperfections in the details of their prototype despite replicating it. In addition to correcting the imperfections, components of their own innovation are added to the implants. Moreover, targeting permanence in the market, they carry out R&D activities.

For example, one of the widely used implant brands in Turkey is MIS implants from Israel and they are used successfully by many dental surgeons. Apart from MIS or Osstem, Israeli implant brands, such as Alfabio, AB implants system, or South Korean implant brand Dentium are implant brands which have achieved success and reliability despite having some imperfections. According to us, the dental surgeons, the advantage of the above-mentioned implants in terms of price-performance can be summarized as the capacity to buy the required performance for a more convenient price and to have the implants for a more convenient price for the patients. Of course, we regard the success of these implant brands not in the same level as the previously mentioned leading implant brands. Because, becoming a leading implant brand in every respect requires a long time and thorough work from a to z.

What are the qualities of a successful implant? What does it mean to be a “leader” among the implant brands, what are the criteria for being a “leader”?

Having the “leader” quality among the existing implant brands in the market can be summarized as carrying more than one positive criteria and providing their continuance.

Becoming a world brand is only possible by proving that the it is a global brand like in all other sectors.

There are many qualities of becoming a global implant brand and a “leader” in the sector:

Establishing a deep-rooted structure from past to present and always consolidating its success during the process.

Being permanent, assuring doctors and patients its permanence.

Reserving sufficient capital for the business and always spending a significant amount of its capital on investments.

Hiring experienced, innovative technicians, engineers, chemists and scientist and providing every kind of resources for these people.

Forming an extremely serious and well-established technological infrastructure, following new technologies, using all technological benefits in the production, being unsparing in every kind of expenditure in this field.

Having a global vision and distributing network.

Having distributors carrying this vision in different countries

Organizing scientific symposium, congress or conferences for dental surgeons every year and look to the future under the guidance of these scientific meetings.

Being creative and having scientific patent rights which prove that their innovations are the “first-new discovery” in their own sector.

Being original, not being content with the existing situation and having an original design.

The criteria which the practitioners of the implants, the dental surgeons, describe as “imperfections” should be evaluated, changed and developed.

Providing every sort of possibilities for the research assistants who research and work on their dissertations at the universities with scientific study field and develop themselves according to these dissertations.

Being permanent, being permanent and being permanent again…

These are the first criteria that come to our minds about “leadership” and of course more can be added to the list. We know very well that a good implant brand is not only a good/successful implant brand. A good implant brand requires much more than that…

How do we know that an implant brand is manufactured in U.S.A. or in Europe? Is it enough to write “made in U.S.A.” or “made in German” or “made in Sweden” on the brand?

Unfortunately in today’s conditions, it is not enough to read the manufacturing country by looking at the package of the implant in terms of reliability.  The market anxiety of the implant brands and uneasiness about insufficient sales of their implants may lead them to different ways. Unfortunately, one of those ways is a camouflage that the implant brand is manufactured in U.S.A. or Western Europe even though it is not so.

Below are these camouflages in general within this field:

A group of implant manufacturers may show their original implant brand under a new name as if it is manufactured in Western Europe. For example, X company founds a new implant company in Switzerland for its implants which meets the required conditions, and then transports the implants manufactured in its own country to this country. After this, only the packaging is carried out in this new country and their implants are camouflaged to show as if they are manufactured in Switzerland.

Another group of implant brands chose a different way in this. They have the outer packaging done in one of the Western European countries and put the place of manufacture information only on the outer packaging.

In some countries where control is insufficient or almost non-existent in this area, some implant manufacturers may even stick a label on their implant box, sticker or leaflets as it they are manufactured in Western Europe or U.S.A. by taking the easy way out.

As a result, the camouflage and “deception” technique is not only aimed towards the patients, but also to the dental surgeons who are not/cannot be personally in command of the field. An implant marketer who comes with the aim of promotion to the doctor’s office may try to deceive the dental surgeon and therefore manipulate the information in this respect.

Our advice to patients and dental surgeons on this point is not be content with the information they are told, but research their validity and be more aware. Because, the real problem here is not the manufactured implants are from U.S.A. or one of the Western European countries, but the manipulation of the real information and knowledge and keeping them secret from people.

Are we going to rely on the implant brand or the dental surgeon?

Of course, to both of them. However, the person who is thinking of having an implant should first rely on the dental surgeon. Ultimately, whatever the implant brand is, the work lies in the dental surgeon in the last instance, i.e. the dental surgeon’s initiative, knowledge, experience, etc. and whatever the implant brand is both success and failure also belong to the dental surgeon. Because the patient sits on the dental surgeon’s seat and entrusts him/herself to the dental surgeon. After this, all responsibility belongs to the dental surgeon. After all is said and done, the implant brand that the dental surgeon chooses is a reliable brand in his/her own way and has preferred to use it for that reason.  The only thing the patient can do after sitting in that seat is to follow the directives of the dental surgeon, to use his/her medicines, and do the “do’s” and don’t do the “don’ts”. Would the dentist (the dentist applying the implant) want to be unsuccessful? Certainly not. Therefore, the dentist does not want to use a brand that would make him unsuccessful.

However, we still come across with such extreme cases that after seeing these examples, we suggest the following to the patients: be concerned about the implant brand that is going to be placed in your jaw and ask all the related questions to the dental surgeon. Ask and demand a copy of all the implant boxes, leaflets, certificates of warranty and stickers from your dental surgeon. Please don’t worry that your dental surgeon could think of you as distrustful when you ask for such requests and demands, because a similar system is adopted primarily in Europe and U.S.A. too. Even though the patient does not request to get them, the dental surgeon gives a copy of the implant box, certificate of warranty and sticker to the patient. This situation is a proof of a transparent relationship and informing rather than distrust.

Are there any implant brands manufactured in Turkey? Can we rely on these brands?

As far as we know the only and the first implant manufactured in Turkey is the implant brand “nucleoss”.

It is right for us to give a positive or negative comment on the implant brand since we have never personally used it. However, we can say this much based on what we have heard about the brand and applied researches on nucleoss within some dentistry faculties: it is an implant brand proven to be quite successful with data in terms of osseointegration (healthy integration with the bone).

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