We live in an age where many things are seen as disposable, but for the vast majority of us, quality still counts. When it comes to implants and abutments being surgically and clinically placed in a patient’s mouth, nothing can replace the top quality technology, design, materials and research that all form part of developing a high level product. Some will argue that cheaper copycat products are the same, but the research and the market feedback shows that this is often not the case.
Different implants may look similar to each other and be made of similar materials, but they are not all subject to the same rigor of material quality control and continuing quality verification. Design is just one part of a wider process involving many components crucial for success, from the choice of raw materials to consistent surface design and quality.
The term ‘bioequivalent’ is often used to describe a generic version of a branded drug or a medical product. However, a recent ruling in a German court seems to suggest that the term is not applicable to dental implants. This underlines the point that dentists are ill-advised to combine implant components from differing manufacture conformity, and highlights that the use of a mixed system approach voids the guarantees offered to dentist and patient by leading implant manufactures.
Research and reputation
With the great number of dental implant systems available in the UK, it’s alarming that only a handful of dental implant manufactures/suppliers can provide external research to support the quality of the materials used, the overall design of the implant, and clinically how the implant is likely to perform. Many implant companies piggyback onto research undertaken by the more established providers, stating “we use the same materials” or “the
principles are the same for all dental implant systems”, when clearly it is not acceptable to make such claims about systems that are not supported by their own research.
One of the largest long-term clinical studies on the survival and success of dental implants has recently been conducted at the University of Bern in Switzerland. The study assessed the outcome of 511 Straumann SLA tissue - level implants in 303 patients over 10 years.
Its authors concluded: “The present retrospective analysis resulted in a 10-year implant survival rate of 98.8 per cent and a success rate of 97 per cent. In addition, the prevalence of peri-implantitis in this large cohort of orally healthy patients was low with 1.8 per cent during the 10-year period”.
Price over quality
In light of the PIP scandal and the subsequent review of cosmetic surgery by Sir Bruce Keogh, the NHS medical director, highlighting that medical practitioners offering invasive procedures need to “look at the regulation and safety of products used in cosmetic surgery, and the care given to patients both during and after their treatment”. It is clear that the government is keen to change the current regulatory framework to support consumer rights and improve patient safety. This in turn will certainly have an impact, with the dental market seeing tighter regulation and more litigation. Dental practitioners will need to consider if it is really worth using an implant or abutment that claims to be ‘bioequivalent’ that is not supported by long-term research.
Choices
Currently practitioners will often rely on their restoring technician to select the abutment and may have little or no input into the choice of materials and components. The technician should choose the proven option, which is invariably the components from the original manufacturer but through habit or lack of knowledge or indeed the lure of a bit more profit some technicians will choose a copy. That choice may not be based on choosing the best product, but rather products from a favoured supplier, one with which they are familiar with or unfortunately, simply the cost.
Better communication between clinician and laboratory is essential so informed choice can be made on behalf of the patient. Inadvertently using an inferior product can have serious implications for the dentist professionally, his patients and practice. And when the difference in price is not considerable, the value of peace of mind offered by reputable products must be the deciding factor.
Better informed
Good two-way communication can be an excellent way to find out more about the products available, and the choice should be based on known and extensive research with comprehensive documentation. It’s unlikely that cheaper copycat products will have this scope of evidence.
Traceability
A major benefit of using a reputable manufacturer is traceability. For example each component from Straumann can be traced back to its origin. Each has a unique identifying number on the packaging, which can be checked online to ensure it is a genuine product.
References available on request.