In my practice I use 3i and Biohorizons. I get great results. Surfaces enhance healing. With biohorizons the research shows soft tissue attachement at the crest.

I dont think there is a ranking. They are all good.

3i and Biohorizons are both easy to place and restore.

I have many questions on this. There are so many implant systems out there its hard to choose:
1.Are the implant systems ranked??
You can rank them based on cost, from highest to lowest. You can rank them based on whether they offer a broad product line or only a few design or abutment options. You can rank them on quality and credibility. You can rank them on customer service and marketing support. You can rank them on ease of ordering and organization of system. You can rank them on their annual sales or on how much they spend on research or on how much they give to Universities to buy influence and credibility.
Or you can just look at the product offering, the packaging, the price and the history of the company and figure out which offers the best value.

2.Which is the best implant systems in the world and which are the next five if any???
I think that anyone opjectively looking at the product offering from Implant Direct, its prices and its manufacturing facility viewable online on 5 cameras, would have to agree that Implant Direct is transforming the implant industry.
http://www.implantdirect.com/us/catalogs_Transforming_Implant_Industry.asp

3. Does the surface of the implant make 1 implant better then another? Is there any research comparing implant surfaces?
Consider how many implant companies claim superior bone attachment with their surfaces, whether TiUnite, SLActive, OsseoSpeed, Osseotite, Nanotite etc, and then look at what surfaces they use to compare with to make their claims - it is always their old surface - never a competitor's surface. None compare to HA because it would blow their surface away for speed of osseointegration or attachment strenght. None can prove that their claims of faster healing make any clinical difference, since initial stability allows for immediate loading, taking surface out of the mix. SO look for the implant designed to enhance initial stability such as Zimmer's tapered Screw-Vent, Implant Direct's implants and NobelActive - all follow the surgical protocol of inserting an implant in soft bone into an undersized socket - first demonstrated in this article.
http://www.implantdirect.com/pdf/SoftBoneArticle(3).pdf

4. Has the implant success rate changes over time?
Depends when you want to start counting from. Certainly success of all major implant systems today are better than the Branemark machined surface external hex implants. Success depends on how easy the implant is to insert and achieve initial fixation on a consistent basis in soft bone. The surface should not be as smooth as the 3i implants nor as rough as TPS surfaces (there is some questions being raised that TiUnite is too rough and will not maintain bone if exposed. )

5. What is the easiest system in placement.
Implant Direct's drills are double cutting with score-lines so you can use half the number of drills of other systems and don't need length specific drills. You also want an implant that is self-tapping so you do not need a bone tap, which requires an implant that is strong enough to take 100Ncm of torque. Next is the ease of restorations and here is where one-piece implants and all-in-one packaging counts.
The easiest system is a 1-piece implant if the platform is designed for the specific application you need. For example, two implants in the anterior mandible for an overdenture - The GoDirect includes the Locator compatible platform. Put the implant in and you are done. Similarly, the ScrewIndirect with a screw-receiving platform for fixed detachable cases or the ScrewDirect with a straight snappy abutment for a single lower molar. Next would be an implant that gives you everything you need to do the case in the same vial, including healing collar, transfer and abutment.

Dr. Niznick,

Are any of your implants designed for platform switching. I am firm believer in platform switching. Have been doing it for years and it works.

Here are a few reasons:
1. $350 per implant plus $48 for cover Screw. You can get an Implant Direct RePlant that goes in with the same Nobel drills, accepts the same abutments, has the same color coded platform, and even comes with a cover screw and fixture-mount that is a transfer and temporary abutment - for $150.... And it has several important design advantages as well. It is made of titanium alloy so the 3.5mmD implant will not break during insertion as has been reported with the Nobel Replace, made of CP titanium. It is self-tapping so you do not need to use a bone tap, saving a step and assuring increases stability. It has micro-threads that add to the surface area and to initial stability, while reducing bone loss. One study comparing RePlant to Replace in the same patients jaws demonstrated a higher success rate with RePlant - http://www.implantdirect.com/pdf/EAO_ImplGuidSurg_Final.pdf
And another reason is the packaging sterility - Nobel's implants are under investigation by Health Canada and the FDA for failing to maintain a sterile seal. http://www.implantdirect.com/newsletter_0/newsletter_18/nobel.htm
Now if these are not enough reasons to consider switching, then you should at least consider Implant Direct's Nobel Replace compatible abutments and save 50-70% on those. Oh yes, Implant Direct's drills are $60 compared to $160 from Nobel and they are not length specific so you will need about 1/4th as many.
As for Platform swithcing, Implant Direct makes the RePlus and ReActive tri-lobe implants with final abutments included and they have platform switching as well if that interests you.

Yes you are right - just look at Nobel's and Straumann's published financial statements on their websites and you will see that their cost of good is about 20%. It use to be 16% but since they now have to selectively discount to hang on to business due to pressures from Implant Direct, this has risen. Nobel has given away about $20M to dental schools to buy influence - a public company is not ultruistic by nature and can not give away its shareholders' money unless there is a business purpose. Nobel and Straumann have the largest booths and are platinum sponsors at meetings all over the world, buying influence and podium time. Corporate forumns before a large symposium can cost these companies $50,000+ once they pay the meeting organizers and pay for the speakers. Straumann gives about $20M a year to support the ITI group.. "support" is a euphanism for "we gave you money not tell everyone you use us because we have the best research." These large companies also give large discounts of 400-50% to large volume surgical specialists, making it up on non-discounted abutments to their referring dentists. They claim to have superior customer service because they have lots of salespeople, but they spend half their time negotiating volume discounts which are different depending on your negotiating skills and different if the companies feel threatened that the doctor will switch to Implant Direct.
The good news is that people like yourself have read the fairy tale story of the emperor's new cloths and realize that claims of superior research and endorsements from paid oppinion leaders do not mask the truth that 25 sense worth of titanium should not cost $350, no matter how much BS they sprinkle on it.

Dr. Niznick while I dont disagree with you on branding and companies paying for influence. I dont think you can be inpartial since you have an implant to sell. I am a long time Straumann user and have over 96% success rate. The healing I see with the SLA active surface is second to none. They do have plenty of research to support the implant success.

That being said, in this economic environment cheaper is better but some time you get what you pay for. How does your surface stack up on your straumann clone to the Straumann's sla and sla active. Do you have any research papers published to support those claims?

When I place a straumann implant the surface just sucks the blood up to the implant, which in my mind you get a more stable clot and better healing.

Jerry I couldnt agree with you more with this statement: "In fact a far more important issue is how much initial stability you can achieve and if it exceeds 35Ncm, you can immediate load so what does it matter what is happening at 3 or 4 weeks if you can immediate load"

I think people think that the surface makes all the difference in healing when in fact stability is the most important issue. Increase in intial stability=increase success in my mind.

I use biomet 3i NT internal implants. I have a high success and love the encode abutment. Very easy to send to their lab for abutment fabrication.

Let me address the last to postings, one from a 3i customer using the NT tapered implant and Encode healing collars, and the other being a believer in Dr. Misch and BioHorizons.

First of all, initial stability comes from more than just tapering an implant. It relates to the relationship between the taper of the implant and the demensions of the drills. 3i burned a lot of bridges by not getting the drill dimensions right when the NT was initially launched. What is needed are straight drills that prepare an undersized socket in soft bone to increase stability, and then make the hole big enough in dense bone that a bone tap is not needed. The Tapered Screw-Vent pioneered this concept of a soft-bone/hard-bone protocol and I wrote an article on it in 2000 that is posted on my website, entitled Achieving Success in Soft Bone. While there is very little if any difference between any of the rough surfaces such as TiUnite, SLA, SLActive, OsseoSpeed, SBM, RBM, MTX, there is a large difference (2u vs 20-30u) in all of these rough surfaces from the smooth surface on the 3i Osseotite or Nanotite implants. If you are not pursuaded by the shortcomings of 3i's surface, then lets talk about encode, a symptom of a prosthetic shortcoming. 3i unlike Nobel, Zimmer and Implant Direct, does not index their abutments - that means that an angled abutment does not necessarily tip away from the flat of the hex...it could be pointing anywhere. Therefore they make you buy an expensive encode healing collar and make custom milled abumtents when a stock abutment would work fine if you rotated the implant with the flat of the hex pointing to the labial. And if this is not enough, just check out the price of their gold screws.
Now for BioHorizons and Misch. Where are the 4 different threads for 4 qualities of bone that Carl insisted was critical? Where are the external hex Misch implants that he insisted was a better connection than the internal hex, until Zimmer licensed them on my 1986 design? Does anyone really think laser lines means anything? A study showed that lines of about 60 microns (not 8-12u as LaserLok has) accellerate osteoblast formation (not that anyone can prove that has any clinical significance once you get 35Ncm of initial stability.) BioHorizons did not even have the capacity to make their own implants until recently and may still not be making the majority of their products. And look at what they just did with their pricing. They now offer the implant mountless by removing the fixture-mount/abutment, but did not drop their price from the $340.
Implant Direct gives you the same taper as the Screw-Vent and uses the same drill dimensions as I developed for that system that I sold to Zimmer, for enhanced initial stability. We have micro-threads (now patented), not laser lines or in the case of 3i, no lines. We have SBM surface with 20 years of clinical success. You get this with the industries widest selection of diameter options and packaged with a final abutment, transfer, cover screw and healing collar for half the price of either BioHorizons or 3i.

Been using Zimmer for a while. For me all implants work but I have a great relationship with my rep. When I need her she is there. If I need an last minute implant its in my office that day.

Customer service should be factored in the price in my opinion.

The Zimmer Tapered Screw-Vent implants is still one of the best on the market - I also have, in the 11 years since I developed this implant and in the 9 years since I sold it to Zimmer, made significant improvements while maintaining the surgical and prosthetic compatibility with the Tapered Screw-Vent. I added micro-threads, got rid of the vent, extended the cutting groove farther up the implant, carried the blasted surface to the top, packaged it with a free healing collar and offered it in 3 thread variations and 3 fixture-mount options, one of which becomes a final abutment. Now if using new and improved designs or if a list price of $125-$175 compared to $365 are not significant factors in your decision process, then consider the better customer service that Implant Direct offers through all-in-one packaging that simplifies ordering, a knowledgeable sales force of 60 in the US and an intuitive online shopping cart. You do not need a salesperson to deliver an implant to you if you can get overnight deliver on orders placed before 3pm or if you can afford to hold an inventory because the implants cost 70% less.
Your Zimmer salesperson is doing a good job retaining a personal relationship with you that keeps you loyal - but you, as a professional person, need to evaluate the cost of that relationship in using outdated, overpriced implants. BUT if you want to keep using Zimmer implants, you should tell them you will do so if they drop the price to $175 or you are going to switch to Implant Direct. I guarantee they will shock you with how much they will discount to hang on to your business. When that happens, you can calculate how much you have been overpaying for that relationship for the last few years because that Zimmer Rep could have done better for you in the past but she knew you relied on her so she did not have to give you the discount she gives to other customers.

Here is a link to our shopping cart video to show how easy it is to order online: http://www.implantdirect.com/us/swf/tour/v12/New_Cart_Tour_09_1d.asp

Here is a link now posted on our website that will be posting the discounts the premium priced companies are making so that every dentist can get the same low prices.
http://www.implantdirect.com/us/ndr/Default.asp

Dr. Niznick while I respect your passion, you do have something to sell.

Quoting the VA study on HA implants hardly is evidence on the success rate of your system. HA implants while bone grew fast around them, they also failed equally as fast as they became exposed.

Do you have any recent studies on your current systems? What is the success rate of you system?

Here is a recent one by Straumann, as a disclosure I am a Straumann user:

Int J Oral Maxillofac Implants. 2004 May-Jun;19(3):408-12.

ITI implant use in private practice: clinical results with 5,526 implants followed up to 72+ months in function.
Fugazzotto PA, Vlassis J, Butler B.

progressiveperio@aol.com

PURPOSE: To evaluate the success and failure rates over time of ITI implants placed in 3 private practices and used in a variety of clinical situations. MATERIALS AND METHODS: ITI solid-screw implants (n = 5,526) were placed in 3 private practices and restored by a variety of clinicians. Numerous clinical scenarios were treated with the implants, which were in function for between 0 and 72+ months. RESULTS: After 72+ months the cumulative success rates were 94.8% for maxillary implants and 97.5% for mandibular implants. The overall cumulative implant success rate was 96.1%. Implants that failed to osseointegrate were included in the data as failures in the 0- to 12-month interval. The criteria of Albrektsson and associates were used to assess implant success or failure. DISCUSSION: The results, which were achieved in conjunction with numerous restorative clinicians, were comparable to those reported by other authors. The clinical viability of ITI implant use was thus reinforced. CONCLUSION: ITI solid-screw implants were a predictable treatment modality in 3 private practices for a variety of clinical applications.

I been using it for 7 plus years. The healing is great. The surface is bar none the best out there. I have a extremely low failure rate with this system with I think can be attributed to the SLA active surface.