Choosing the right system is a critical decision that is a significant investment in your professional development. A number of factors can help you narrow down your search, including published literature on success rates and complications, implant design factors, training availability, company support systems and personal recommendations.
A good place to start is to consider what we, as clinicians, are looking for in broad terms. We would like a high quality implant system which will lead to excellent short and long term success rates. This in turn will lead to improved patient satisfaction and trust, which leads to an enhanced professional reputation, contributing towards an improved working life. There are numerous practical features of an implant system that can contribute to (or detract from) these aims. Searching the literature shows most modern systems will have success rates over 90 per cent these days, and some even as high as 99 per cent.
Implant surfaces differ between manufacturers and as surface technology improves this becomes an increasingly important factor. Implant surfaces can affect the speed of osseointegration, the connective tissue attachment zone, the susceptibility to peri-implantitis and the aesthetic and functional success rates. It has become apparent that the crestal bone levels can be influenced and maintained by certain implant surfaces. Historically, implants surfaces have shown good connections to the bone (osseointegrated surfaces) but poor connections to the soft tissues, characterised by collagen fibres running parallel to the implant surface dissimilar to the attachment to natural teeth. This is often seen clinically as a tendency for more fragile gingival sulcus sometimes with a greater tendency for bleeding on probing. A significant advance in surface technology is the use of precision laser-etched channels at the crest of the implant which demonstrates collagen attachment directly to the implant in a manner which mimics the natural gingival attachment to a tooth. This is a significant step forward in surface technology that is noticeable clinically as a much more robust gingival sulcus and superior maintenance of the crestal bone height.
Surgical placement of the implant in a precise spatial relationship to the bone crest, gingival margin and adjacent teeth is the most critical factor in achieving a simple and aesthetic restorative outcome. Certain features may make this easier. If an abutment or similar guide pin is attached to the implant during placement it is much easier to position the implant optimally, making the whole procedure simpler, faster and more successful.
Restoratively, the healing abutments and impression copings should be well matched in size and shape. This allows the impressions to be taken more easily without compressing or repositioning the gingival margin position allowing the lab technician to more precisely locate the crown margin at the correct position.
Implant treatment can range from very simple to very complex and gaining a thorough foundation in the theory and practical aspects of implantology is paramount. Year length training courses have now become the accepted standard for implant training. Many companies offer their own educational support, and by aligning yourself with a particular company you are also gaining access to the knowledge and distinctive clinical culture of the other users of that system. This then is another factor to consider seriously.
References available on request.