Key Factors Influencing Osseointegration of Dental Implants

David CuervoTécnico Especialista en Prótesis Dental en DESS Dental

June 18, 2024

Introduction to Oral Implantology

Oral implantology has transformed dental clinical practices, proving that rehabilitating patients with single, multiple, or complete tooth loss using dental implants is a reliable treatment with a high success rate. The favorable long-term outcomes of oral implant treatments are linked to osseointegration and the positive response of peri-implant tissues.

Essential Elements for Bone Regeneration and Osseointegration

Several crucial factors are necessary for bone regeneration and subsequent osseointegration of a dental implant: cells, clot formation, blood supply, and mechanical stability. Despite meeting these criteria, the total amount of regenerated bone, its long-term stability, and the incidence of complications can vary.

Microscopic histological section of bone embedded in the titanium surface of a dental implant (black)

Enhancing Implant Longevity

Although the longevity of implants is now considered highly reliable, ongoing efforts aim to improve the long-term success of implant rehabilitations and minimise healing complications. This is particularly vital when implant restorations necessitate significant bone regeneration. Factors such as implant surface/design, biomaterials used, surgical technique (submerged vs. non-submerged healing), prosthesis attributes (abutment characteristics, platform changes), and patient-specific factors (systemic health, oral hygiene, compliance) all influence the outcomes.

Biological Aspects of Bone Regeneration

Understanding the biological processes during bone regeneration is crucial to grasp how different local and systemic factors impact the regenerative process. Primary healing is essential for successful bone regenerative procedures, with clinician experience, manual dexterity, and patient adherence to pre- and post-operative instructions significantly influencing post-surgical complications.

Implant Surface and Bone Regeneration

Analysing clinical evidence shows that implant surface properties can significantly affect peri-implant bone regeneration. Implants vary not only in surface topography but also in design, prosthetic connection, and loading protocol. Proper adjustment of implant surface features could enhance bone regeneration, especially in challenging clinical scenarios.

Impact of Prosthetic Factors

Implant Loading Times

Traditionally, dental implants are prosthetically loaded after a 3 to 6-month healing phase post-implant surgery. To reduce treatment time and accommodate patients, immediate and early prosthetic loading of implants has been introduced. The different implant loading times are:

Immediate Loading

An implant-supported prosthesis is placed on the same day or the day after implant placement.

Early Loading

An implant-supported prosthesis is placed between 1 week and 2 months after implant placement.

Conventional Loading

Implants heal for more than 2 months after placement without connecting a prosthesis.

While immediate and early loading protocols offer quick rehabilitation, careful occlusion consideration is necessary to minimise non-axial forces on the implant. Adequate primary implant stability (30-35 N/cm) is required for immediate loading, which can be challenging in the upper maxilla and in patients needing simultaneous bone regeneration.

Impact of Patient-Related Factors

Risk Factors for Implant Loss

Multiple patient-related factors can affect treatment outcomes: gender, general health status, periodontal status, jaw location, and age at the time of implant placement are all risk factors for implant loss. A patient-centered peri-implant care protocol is recommended, including:

• Updating medical, social, and oral history, risk assessment, and patient feedback.
• Assessing the oral situation: health of peri-implant tissues, prosthetic components, and patient’s oral hygiene ability.
• Controlling risk factors (e.g., smoking, dry mouth, glycemic control).
• Professional intervention with an individualised oral health plan, including oral hygiene training and dentition/implant prophylaxis.
• Determining check-up intervals based on patient, implant, and restoration risk factors.

Systemic Diseases

Osteoporosis

Osteoporosis, associated with reduced bone quality and increased cortical porosity, may affect jawbone quality. Osteoporotic bone should be treated as type IV, and a longer healing period for implant osseointegration is recommended before prosthesis insertion.

Tobacco

Smoking adversely affects wound and bone healing due to local and systemic actions. Nicotine increases platelet adherence, leading to micro clots and ischemia.

Diabetes Mellitus

Diabetes mellitus is linked to complications in the skeletal system, collectively known as “diabetic bone disease” or “diabetic osteopathy.”

Final Considerations for Successful Dental Implant Osseointegration

While patient-related factors are not absolute contraindications for implant-associated bone regeneration, they influence treatment success and complication risks. Therefore, selecting patients carefully, managing underlying medical conditions and associated risk factors, and consulting with the patient’s physician when necessary is recommended.

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David Cuervo

Técnico Especialista en Prótesis Dental en DESS Dental

DESS^® Flat Seat Screw: The Ultimate Solution for Full Arch Restorations

In the dynamic world of implant dentistry, continual innovations are revolutionising prosthetic restorations. These advancements not only streamline procedures but also significantly enhance the quality of life for patients by improving the functionality and comfort of their prosthetic solutions.

One notable shift is the growing adoption of Direct on Multi-Unit (MUA) techniques, which eliminate the need for a Ti-Base in certain prosthetic scenarios. This method represents a departure from conventional practices, favouring streamlined procedures that could lead to more effective results.

Challenges with Conical Screws: Rosen Screw, Powerball Screw, Vortex Screw

Several manufacturers have responded to this trend by developing unique screws tailored for direct on MUA applications, such as the Rosen Screw, Powerball Screw, and Vortex Screw. Despite their differences, these products share a common design element: a conical screw base intended to prevent loosening.

However, the inherent design of conical screws can introduce challenges. Specifically, the alignment within the MUA connection geometry often isn’t perfect due to the multiple connections involved.

This misalignment can cause mechanical instability and impact the longevity of the implant-supported structures. The resulting stress could potentially lead to fractures in weaker screws or damage to the prosthesis if it bears the brunt of the force.

Conical Screws Limitations

Through rigorous testing, our engineering team has identified several drawbacks of conical screws, including:

• Reduced preload between the zirconia and MUA.
• Dependence on the precision of the milling machine for surface contact.
• Unpredictable final screw seating height, leading to potential collision issues and early screw loosening.
• Misalignment between the zirconia axis and the MUA.

DESS^® Solution: The Flat Seat Screw

To overcome all the issues caused by conical screws, DESS^® has developed the FLAT SEAT SCREW, a new solution for direct on MUA applications.

Advantages of DESS^® Flat Seat Screw

• Increased preload force ensures a secure connection between the full arch and MUA.
• Accommodates discrepancies in screw hole milling.
• Provides a consistent and reliable surface contact area, minimising the impact of manufacturing deviations.
• The flat seat enhances control over screw positioning and tightness.
• Allows for self-centering of the screw in alignment with the MUA axis, thanks to its adaptive seating.

Enhanced Performance and Durability

Our comparative tests have shown that the DESS^® Flat Seat Screw achieves superior preload, distributing forces more evenly across the seating surface. This leads to a more robust and durable prosthetic restoration, less prone to damage even when using softer materials.

Innovative Torx Socket Design

Furthermore, the new DESS^® Screw features a Torx socket design. This innovation, combined with the DESS^® libraries, supports angled screw channels up to 25°, enhancing the structural integrity and aesthetic quality of the final prosthetic.

In summary, the DESS^® Flat Seat Screw represents a significant advancement in the field of implant dentistry, providing a more stable, reliable, and aesthetically enhanced solution for direct on MUA restorations.

CONICAL BLT | When innovation meets sustainability

We are really proud to present The First Zero Waste Implant on the market: DESS^® CONICAL BLT.

DESS Dental’s commitment to environmental sustainability has brought us to adopt a full ESG policy to reduce waste and our impact on the environment. We have gone one step further by extending this philosophy to the product’s lifecycle: we have created the Zero Waste Implant with “infinite packaging”.

How is the Zero Waste Implant achieved?

We have achieved the First Zero Waste Implant on the market by developing two different initiatives:

1. Reduction of the paper and plastic of our packaging to the minimum. Instead, we have introduced our ground-breaking Titanium vial. Why? Because a titanium vial can be sterilised and re-used multiple times, creating ZERO Waste.
2. Waste collection process that assures full recycling, guaranteeing no waste is generated from our packaging.

We recycle or re-use 100% of its packaging.

• 100% Recyclable cardboard box
• Widely Recyclable PET blister
• Titanium reusable and recyclable vial

The recycling cycle

We have come full circle by creating a process that ensures full sustainability of the product’s life cycle. We assume the integral collection of the packaging, making sure no waste is generated.

Go to The Zero Waste Implant page to discover more about it.

The Optimal Bone Level Implant

Fully compatible with Straumann^® BL, DESS^® CONICAL BLT has been carefully designed to be the optimal Bone Level Implant solution.

Bone Level tapered Implant Design

CONICAL BLT’s bone level tapered implant design allows for maximised crestal bone preservation and micro-gap control.

Transmucosal or submucosal healing combined with the use of a healing abutment results in a less invasive and faster treatment, thus avoiding a secondary surgical intervention.

Discover all CONICAL BLT components available.

CONICAL BLT | Designed to perfection.

The DESS Implant is improved with several features and benefits that enable it to excel in efficiency, quality and durability, characteristics that allow CONICAL BLT to achieve the best results and, consequently, a longer implant lifespan.

Discover the attributes that make CONICAL BLT the smartest choice for implantology treatment.

The connection | Dual Function

Internal Conical connection at 15^o with four internal grooves that improve stability and reduce the chances of screw loosening whilst engaging the prosthetic component for easy alignment.

The conical connection allows for a better sealing of the implant-abutment connection, therefore being more effective against leakages compared to flat connections.

Osseointegration Surface Technology

CONICAL BLT’s surface is composed of a double treatment of acid etch and sandblasting that assures optimal bone growth.

DESS^® Osseointegration Surface Technology complies with SLA standards and is achieved by using two different processes which, when combined, present a double range roughness composed of large “holes” due to sandblasting,

and microroughness due to acid etching,

making this double treatment the optimal surface topography for osseointegration.

Coldworked Titanium Grade IV

CONICAL BLT is composed of cold worked Titanium Grade 4 for superior mechanical resistance.

Tapered Apical and Self-cutting design.

CONICAL BLT’s tapered apical and self-cutting design is ideal for soft or very soft bone, where primary stability is key.

Full range of Prosthetic Abutments

DESS Dental’s full portfolio of prosthetic abutments and relevant components is available for CONICAL BLT.

Furthermore, thanks to DESS^® Pure Switch Concept, CONICAL BLT is 100% compatible with the ‘brand of reference’ abutments and components and can be used in combination with them.

The Surgical Kit

• Designed to be simple and easy to use.
• Customisable to the different protocols arranging the drills as per the case needs.
• Drills available in 4 different lengths: 25mm, 29mm, 33mm & 41mm.
• 100% compatible with the kits of the brand of reference.

Download the CONICAL BLT catalogue to get all the information about the surgical kit and its components.

If you want to learn more about DESS^® CONICAL BLT, you can visit the CONICAL BLT website, download the catalogue or head to this product’s section on our website. You can also contact us for more information at support@dessdental.com.

Revolutionize your digital impressions with DESS^® Intraoral Scan Abutment

As part of our ongoing product profile series, where we showcase some of the most innovative solutions in the dental industry, we are thrilled to present our third featured product: DESS^® Intraoral Scan Abutment.

Dental technology is constantly evolving, with new products and innovations emerging all the time, making digital dentistry workflows more precise than ever. In this context, Intraoral scanners have revolutionized the way dental professionals create digital impressions of their patients’ teeth and gums. However, the accuracy of these scans is heavily dependent on the stability of the scan abutment used.

In this article, we’ll take a closer look at one of the most innovative scan abutments on the market today: the DESS^® Intraoral Scan Abutment, a solution that has quickly gained a reputation among dental professionals for its exceptional quality, ease of use and accurate results.

Let’s explore what makes this product so unique and how it can benefit dental professionals and their patients.

The DESS^® Intraoral Scan Abutment is designed to work seamlessly with all scanners on the market. It is made from high-quality titanium and features a unique anti-rotation design that ensures precise scanning every time. With the DESS^® Intraoral Scan Abutment, dental professionals can save time, reduce patients chairside time, and improve the overall accuracy of their treatment planning.

To discover more about DESS^® Intraoral Scan Abutment, review the following features and benefits:

• Zirconium Nitride (ZrN) coating.
  The ZrN coating is a surface enhancement treatment that ensures high durability as well as radiopacity, preventing any glitter effects along with the SelectGrip^® Surface.

• SelectGrip® Surface for an optimal scan without glitter effects.
  DESS Dental applies the sandblasting treatment during the manufacturing process, resulting in a flawless finish that produces a perfect scan, free from any glitter disturbances. This achievement is almost impossible to get through a laboratory manual procedure.

• Perfect design for a perfect scanning.
  o No sharp edges to avoid scanning noises.
  o Orientation shape on a higher position to maximize visibility.
  o Good stitching performances for intraoral use.

• Suitable for both intraoral and desktop use.

• Manufactured in Titanium Grade V ELI

• No screw hole nor screwdriver to avoid distortion.
  DESS Intraoral Scan Abutment has a captive screw for an easy and safe manual positioning, thus avoiding any distortions caused by a screw hole or screwdriver. In addition, the captive screw allows a second unscrewing step for cleaning and autoclaving.

• Manual tool included.
  DESS Intraoral Scan Abutment includes its manual tool to facilitate insertion and screwing/unscrewing.

• Digital Workflow.
  DESS Intraoral Scan abutment can be used in conjunction with DESS free libraries for Exocad, 3Shape, and Dental Wings, providing a seamless and efficient workflow for dental professionals.

• Compatible with 32 implant systems:

NobelActive®, NobelReplacecc, Nobel Replace Select, Nobel Brånemark®, 3i Osseotite®, 3i Certain®, Straumann® Soft Tissue Level & synOcta®, Straumann® Bone Level, Straumann® BLX, Neodent® Grand Morse, Zimmer Screw-Vent®, Astratech Implant SystemTM EV, Astratech OsseospeedTM, Dentsply Friadent® Xive®, Dentsply Ankylos® C/X, Osstem® TS, Camlog®, Conelog®, Biohorizons® Internal, Biohorizons® Externald, MIS® Seven, MIS® C1, MIS® V3, Megagen® Anyridge, Anthogyr Axiom®, Medentis ICX®, Globald in-kone®, Dentium Superline® & Implantium®, Bego Semados®, Biotech Kontact®, BTI®, Phibo® TSH®, DESS® Multi-Unit Connection.

Additionally, DESS Dental integrates the Pure Switch concept into our full product range, ensuring that all our products and their parts are designed to perfectly match the implant connection.

In conclusion,DESS^® Intraoral Scan Abutment is an exceptional product that has been specifically designed to improve the accuracy and efficiency of digital dentistry workflows. With its anti-rotation design and ZrN coating, our scan abutment provides accurate results that are free from any glitter disturbances. Dental professionals can save time and reduce patient chairside time with this product, and its integration in all intraoral and desktop scanners and compatibility with a wide variety of implant systems makes it a versatile solution for both intraoral and desktop use. TheDESS^® Intraoral Scan Abutment is also easy to clean and sterilize, making it a cost-effective and reliable solution for dental practices.

If you wish to have more information about DESS^® Intraoral Scan Abutment, you can head to the Scan Abutments section on our website or contact us at info@dessdental.com.

As part of our ongoing product profile series, where we showcase some of the most innovative products in the dental industry, we are excited to present our second featured product – DESS^® AURUMBase^®.

In this article, we will delve into the AURUMBase^® unique features, benefits, and applications. Whether you are an experienced dental professional or simply curious about the latest advances in dental technology, join us as we take an in-depth look at what makes DESS^® AURUMBase^® a standout product in the market and why it is worth exploring for dental professionals seeking cutting-edge restorative solutions.

DESS^® AURUMBase^® is the ultimate angled solution, with the most flexible angular channel on the market since 2015.

DESS Dental offers the AURUMBase^® as a solution in clinical cases where the prosthetic screw access hole is unfavorably positioned due to the long axis of the implant. With the DESS^® AURUMBase^®, an angular adjustment of up to 25^o in 360^o rotation can be made without sacrificing retrievability nor compromising aesthetic results. This effectively solves the problem.

To learn more about DESS^® AURUMBase^®, read its features and benefits bellow:

• Gold anodised surface for better aesthetic results.
A warmer gold hue has aesthetic advantages, being easier to integrate to the gingival tone compared to the standard titanium.

• SelectGrip^® Surface: offers 500% more bonding retention than an untreated surface.
This is achieved through a sandblasting treatment applied during the manufacturing process, resulting in a flawless finish that also preserves a clean gingival area, an achievement almost impossible to get in laboratory manual procedure.

• Short shaft to give 360^o angular freedom.
AURUMBase^® has a 3mm cementing surface height that allows 360^o angular freedom whilst conserving a bonding area of more than 33 mm². It also counts with parallel walls to increase strength and retention.

• Specially designed emergence hole.
Up to 30% size reduction in the emergence hole design within CAD libraries to further improve the flexibility and aesthetic outcome. Furthermore, AURUMBase^® has a bevelled-edged chimney to optimise the driver angulation.

• Manufactured in Titanium Grade V ELI.

• AURUMBase^® Castables.
Unique preformed castable caps in straight, 10^o and 20^o angles to facilitate prosthetic work using traditional casting procedures.

• Torx^® ball screw and driver.
Torx^® based screw and driver that allow full recommended torque even at full angulation.

• Compatible with 23 implant systems:

Astratech Implant SystemTM EV, Astratech Osseospeed^TM, Biohorizons^® Internal, Camlog^®, Conelog^®, Dentsply Friadent^® Xive^®,3i Certain^®, 3i Osseotite^®, Megagen^® Anyridge, Medentis ICX^®,Mis^® Seven, Multi-Unit, Neodent^® Grand Morse, Nobel Active® & Nobel Replace^® CC, Nobel Brånemark^®, Nobel Replace Select, Osstem^® TS, Phibo^® TSH^® , SuperlineTM & Implantium, Straumann^® BLX, Straumann^® Bone Level, Straumann^® Soft Tissue Level & synOcta^®, Zimmer Screw-Vent^®.

In addition, DESS Dental counts with the Pure Switch concept across our full product range, which is based on the principal that all our products are designed to match the implant connection to perfection.

If you wish to have more information about DESS^® AURUMBase^®, you can have a look at the AURUMBase^® catalogue, head to this product’s section on our website or contact us at info@dessdental.com

Dental laboratories and milling centers without FDA certification can become FDA compliant by using DESS^® Blanks and Ti-Bases.

DESS^® Blanks and Ti-Bases are now PNP FDA accredited, upgrading the FDA accreditation for these products achieved in 2017.  This allows dental laboratories and milling centers to comply with FDA regulations without being FDA registered or having a QMS in place by using DESS^® Blanks and Ti-Bases and following DESS^® Digital Soutions IFU.

The dental laboratory industry is increasingly utilizing CAD/CAM automated manufacturing techniques. Meanwhile, the FDA is reviewing regulatory requirements for these processes and making changes, such as the modification of the 510(k) requirements for Ti blanks and Ti bases used in dental implant abutments. Both these abutments fall under Product Code NHA and are subject to the same FDA regulations. The FDA requires that manufacturers, including dental laboratories and milling centers, become “validated milling centers” and implement manufacturing procedures in line with Quality System regulations.

Furthermore, the “establishment exemption” for CAD/CAM procedures in dental laboratories is being phased out, meaning that more laboratories will need to register with the FDA and allow for FDA audits.

This scenario has raised fears of a potential closure of milling centers and dental laboratories which are not FDA accredited. Thanks to DESS^® new FDA accredited Digital Dentistry Workflow, any non-FDA certified milling centers and dental laboratories have the opportunity to remain operational since, by using DESS^® Digital Dentistry Workflow products and following our Digital Solutions IFU, they do not need to obtain the pertinent FDA certification.

This is hugely positive news for the sector as our certification will help many dental laboratories and milling centers to stay in business. Additionally, we are pioneers in the industry in obtaining this accreditation therefore we are offering a very exclusive value for businesses.

DESS® is fully aware that performing a save practice that contributes to the patient’s health and safety is a number one priority for milling centers and dental laboratories, reason why we can assure that DESS® FDA 510(k) certification guarantees that any milling center or dental laboratory that follows our Digital Dentistry Workflow with our products, is 100% compliant with FDA policies therefore in accordance with health and safety guidelines.

The range of DESS® products covered by DESS® FDA PNP accreditation is:

• DESS^® Ti-Base^®
• DESS^® AURUMBase^®
• DESS^® ELLIPTIBase^®
• DESS^® C-Base^®
• DESS^® Pre-milled Blanks

Furthermore, DESS^® FDA approved Digital Dentistry Workflow integrates the following components: 

• 18 Implant System Compatibilities that include 56 implant platforms.

Astra Tech EV, Astra Tech OsseaoSpeed^TM, BioHorizons, Biomet 3i Certain®, Biomet 3i OSSEOTITE®, Camlog, Firadent XiVE, MegaGen AnyRidge, Neodent Grand Morse, NobelActive®, NobelReplace® / Nobel Prallel Conical, NobelReplace® Trilobe, Nobel Branemark System®, Osstem TS, Straumann® BLX, Straumann® Bone Level, Straumann® Tissue Level, Zimmer Screw-Vent® / Tapered Screw-Vent®.

• Scan files from intraoral and desktop scan abutments.
• CAD / CAM software.
• Ceramic material.
• Titanium material.
• Milling machine.
• Associated tooling and accessories.

(*) Read the Digital Solutions Summary to know the present conditions of the workflow implied. You can also access the Digital Solutions IFU. The workflow elements will be always expanded to make sure you are up to date.