Single Piece Basal Implants Vs. Active Threaded TTPHIL™ Bicortical Basal Anchored Implants

WHAT ARE THE DIFFERENCES BETWEEN SINGLE PIECE BASAL IMPLANTS VS  ACTIVE THREADED TTPHIL™ BICORTICAL BASAL ANCHORED IMPLANTS?

This post is not to support one particular technique. Each technique has its own pros and cons. We need to decide which is the best for your particular case. Every case is different. Every patient is different. Each one has their own priorities.. You need to take a call based on the presentation below. But before taking the decision you need to read this article.  

In this post we would like to tell the advantages of our technique and not to criticize the other techniques. We do both Single piece implants and Two piece Implants in our practice. We decide which implant technique to be used based on the patient location, Budget, treatment planning, number of teeth missing, location of the teeth missing- Front / Back, Upper Jaw/ Lower Jaw.

The first and foremost thing one should note is that Single piece implants have abutments and Implant fixture in one piece, hence needs to be cemented. There is no option for screw retention at all. In TTPHIL ™ Technique the restorations ( Implant Supported Crowns and Bridges ) can be either cement retained or screw retained depending on the case. Watch the video below to understand what are Single piece implants and two piece implants.

The other thing one should understand is that whether we are doing immediate loading or delayed loading. In Immediate loading we need to splint  or connect the bridges if multiple teeth needs to be replaced for equal force distribution in either of the techniques.  Because of this reason we prefer screw retention when we are replacing many teeth.  If one of the implant for suppose has a problem in future cement retained implant crown and bridges retrievability is impossible. We cannot repair the bridge. We need to cut the whole bridge which is traumatic. If you are planning to get a single implant replaced you can choose cement or screw retained option in case of front tooth missing. In case of back tooth missing it is advised to go for screw retained restorations because it is not located in the esthetic region. Now the recent developments in case of front tooth/ teeth replacements we are using pre angulated abutments.

screw retained restoration(Why we at THE DENTAL SPECIALISTS prefer cemented restorations is because  in these situations having a screw access in a visible area is unacceptable. When screw access to the implants are in aesthetic areas, the screw access can be re directed at times with use of pre angled abutments or the restoration should be retained with custom-made  CADCAM abutments and cement retained Implant supported restorations can be attached to implants with screws or can be cemented to abutments which are secured to implants with screws.)

This article will be written from this perspective and the advantages and disadvantages of each method of retention. It will be discussed under the following 10 headings:

1.Aesthetics

2.Retrievability

3. Retention

4. Immediate Implant placement

5. Passivity

6. Provisionals

7. Occlusion

8.Immediate loading

9. Impression procedures

10.Long term treatment planning

This post is mainly regarding Single Visit Dental Implant treatment. In most of the cases we at THE DENTAL SPECIALISTS  place Flap less or Pinhole or Key hole Implants ( without opening the gums) based on the clinical and radiographic guide assessment. But sometimes when the bone availability is less we prefer to open the gums and place the implants and bone grafts for better visibility and safety and long term results. Both the flapless ( Less when compared to Flap Opening) and flap opening procedures lead to gum shrinkages when we load immediately. Usually we replace the crowns and bridges immediately with in 2 days to week depending on the case. We used to do single piece implants for multiple and full mouth rehabilitations for Single Visit Dental Implants before, but because of three reasons we are now preferring screw retained restorations- gum shrinkage in cement retained implant restorationsFirst reason: We can expect some gum shrinage which cannot be  repaired in cemented bridges. In screw retained bridges with multi unit abutments  and CAD CAM MLS and ZIRCONIA technology we can repair it by sending it to the ceramic  laboratory Though screw retained restorations are more expensive they can be maintained and repaired. Second reason: In Cemented retained restorations the cement gets entrapped in the gums which leads to gum shrinkage leading to inflammatory changes because of the left out cement particles in the gum sulcus which  later leads to bone loss.

cutting the bridge cement retained restoration

Third reason: We need to cut the whole restoration or the bridge if any issue comes. If it is one single tooth replacement it is easy to cut but if multiple teeth replacements or full mouth replacements have to be done cutting the bridge is not easy. The only advantage of cement retained restoration is that the bridge will not come out but what if there are any issues in the implants. We should expect those and get the implants done.  We are getting them done once for all. Now its you to choose whether to go for cement or screw retained restorations based on the above article.

Aesthetics is better in cement retained restorations  but now with the Pre Angulated abutments with Micky Mouse screw this also has a solution. But very expensive..

Retrievability – Screw retained better than Cement retained. In case of any complication the bridge can be removed and can diagnose the situation easily.

Retention: In case of less mouth opening less than 7 mm abutments are used screw retained is always better when compared to cement retained restortions

Immediate implant placement: Screw retained restoration better because of repairability and maintenance.

Passivity and provisionals( Temporary teeth): Both are good

Occlusion: In screw retained restoration you can get it removed and add ons can be done later after osseous integration of the implants. Progressive loading is possible in screw retained restorations.

Immediate loading: Both cement and screw retained can be done.

Impression procedure: Its easy to do cement retained restorations. The doctor should be a Prosthodontist or skilled dental surgeon to take accurate impressions.

Long term Planning: Screw retained restoration is always better than cement retained restoration.

These are the prosthetic advantages why we choose ACTIVE THREADED TTPHIL™ BICORTICAL BASAL ANCHORED IMPLANTS?

We wish you to read the below articles which are more interesting about the TTPHIL™ technique.

Single Piece Implants- Disadvantages

TTPHIL Technique – Permanent Teeth in 2-9 Days


Still have doubts please feel free to call us on 00919963511139/ 00919959448800/ +919177671117. Its important for our team to clarify your doubts before you take a decission. The best way is to email us your  X-rays, OPG, CBCT and Intra Oral photos to dentalspecialistsindia@gmail.com. Our team will call you or email you which ever you are comfortable.

 

 

Single Piece Implants- Disadvantages

Single Piece / One Piece / Monobloc Implants- Disadvantages

What are the types of Dental Implants? Single Piece or One Piece Implants and Two Piece Implants. There are 3 parts in Dental Implants- Implant Fixture, Implant Abutment and Implant crown. Single Piece Implants- Disadvantages are many, but we place them in some limited cases where the load or stress is less especially in the front lower teeth.

In a Single piece or One Piece Implant, the difference is that the Abutment and Implant fixture is one piece during the fabrication. In a Two Piece Implant the abutment and Implant fixture are separate and are connected with a screw. The major disadvantage of  conventional two piece system is the screw loosening. The latest Q-lock Morse connection CAD CAM technology makes the two piece implant to one piece implant by tightening the screw at 30 Newton Centimetre torque. We at The Dental Specialists use the advanced morse connection technology to convert the two piece implants to One piece implants ( No more Screw loosenings as it used to happen in Conventional Two Piece Implants) .

Check the video below to understand the difference between Single Piece or One Piece Implants Basal implants , Switzerland, Conventional or Traditional Two Piece System and Unique Advanced  TTPHIL ™ technique followed at THE DENTAL SPECIALISTS: ADVANCED DENTAL IMPLANT CENTRE – Tall and Tilted Pin Hole Immediate Loading Technique. (The absence of a microgap between the implant and the prosthetic abutment (Q-lock Morse connection CAD CAM technology) at the bone crest level offers TTPHIL implants many clinical and technical advantages like strong unibody design, no split parts,single stage surgery with either flap or flapless approach and simple prosthetic technique)

The only advantage of single or one piece implant is that it reducing the cost of the abutment because it is manufactured in one piece. Hence it is cheaper when compared to a two piece implants. there are so many disadvantages of single piece implants when compared to TTPHIL-ALL TILT™ Technique. The prosthetic options in Single piece implants  or One piece implants are very less. Hence the crown and bridges aesthetic quality is very poor. Single piece implants  or One piece implants cannot be placed in tilted fashion because they come with straight abutments.

 

Must read for those who want to undergo Single piece implants. 

15 reasons why we don’t use Single piece or One piece implants in all situations…

 

1. Abutments cannot be customised. The company  manufactures the abutment with implant. Hence no customisation possible. The Single or one piece implants can only be bended. They can never be made parallel to the adjacent implant abutment which is possible in the laboratory by CAD CAM Designing. We used to do lot of trimming and abutment shaping in the patients mouth. This leads to lot of titanium dusting which is not good if swallowed. Only Direct impressions (Impressions need to be taken directly) which will take up lot of time keeping the patients mouth open for a long time which is traumatic for the implant patient. If its a full mouth case we have do lot of work chair side. This problem can be avoided in conventional Implants, where the Indirect Impressions (Customisation of the abutment is possible and is done in the laboratory reducing the chair side time)  can be taken, avoiding the patient to keep his mouth open for so long. Abutment milling done in the mouth and abutment milling done in the dental laboratory with the aid of CAD CAM ROBOTIC TECHNOLOGY (Computer Aided Designing, Computer Aided Machining) Which is precise according to you- Milling in the mouth or Milling in the laboratory?

TTPHIL Implants takes the advantage of fabricating the abutments and prosthesis with CAD CAM technology. Hence reducing the chair side time keeping the mouth open for so long, making the patient comfortable and less traumatic to the Implant Patient.

2. After the implant placement the abutment milling have to be done directly in the mouth itself. There is no other option because the implant fixture and the abutment is connected which is why it is  called single piece or one piece implants. If the implants are not milled immediately the abutments touch the opposing teeth not allowing the opposing arch to touch, sometimes in full mouth cases the abutments are not parallel to each other, Hence to make the abutments parallel, they are milled in the mouth (As said in the first point, they can never be made parallel precisely compromising in the final outcome) Disadvantages of milling the abutment in the mouth 1)Milling in the mouth requires lot of chair side time keeping the implant patient’s mouth open for a very long time which is more traumatic to the patient. 2) This leads to lot of titanium dusting which is not good if swallowed.  3) This leads to lot off stresses on the implant affecting the healing of the bone around the implant. 4) Abutment milling in Single piece implants is done with the airotor handpiece with Tungsten carbide burs which is not precise, Moreover leads to lot of frictional heat generation which is not good for bone healing around the implant or Oseointegration 5) Abutment milling in the mouth immediately after implant placement when the stability of the implant is not very good can lead to failure of the implant .

screw retained bridge the dental specialists venkat nagTTPHIL Implants at THE DENTAL SPECIALISTS take the advantage of fabricating the abutments and prosthesis with CAD CAM technology, hence reducing the chair side time keeping the mouth open for so long, making the patient comfortable and less traumatic to the Implant Patient.

3. In certain cases the bone availability and bone density may be less and bone thickness may be less, the implant stability in those cases is compromised or it may not be beyond 40 Newton Centimeter torque (which is the most essential factor for immediate loading). But we are forced to load the implant. Because it is a one piece system we cannot bury it also and keep it for bone integration or Osseointegration which is the most essential thing for long term success of the implant. Crestal Conventional Implants have the advantage of leaving the implant buried in the bone helping it for osseointegration. TTPHIL Implants has the advantage of both OSSEOFIXATION AND OSSEOINTEGRATION. We can at least bury the implant instead of loosing the implant.

 

 

all tilt 8 implantsTTPHIL implants engage the basal cortical bone which is very strong and least resistant to resorption. The Tall and Tilted implants are the key factor for the success, Hence we at THE DENTAL SPECIALISTS are able to give immediate loading to our implants. We achieve very high torque beyond 80 Newton Centimeter lwhich is strategic and key determinant factor for implant success. We engage all the strategic cortical basal bone which is highly mineralised and hence least resistant to resorption. The difference between the TTPHIL Implants and conventional Implants is that the Conventional Implants there is no bicortical anchorage, hence the stability achieved in most of the cases is less than 40 Newton Centimetre. Even if the conventional Implants achieve high torque during the Implant Insertion, the apical tip of the cortical bone rests in the soft trabecular bone, which is least resistant to resorption. This bone is very soft which helps only for the blood and nutritional supply. TTPHIL Implants engage the Bicortical Basal at the Strategic locations to achieve a very high torque beyond 70 NC, at the same time able to deliver high and precise prosthetic solutions with CAD CAM Zirconia and DMLS CAD CERAMIC CROWNS AND BRIDGES which is screw retained. (This point is discussed in detail in POINT 14)

4. Monobloc implants are very thin when compared to two piece  Conventional implants. In the above picture you can see the different implant types. Why the company have to manufacture two piece implants when single piece implants can be done in all the cases. For example when most of the times 6 implants or sometimes 8 implants are placed to replace upper full mouth complete edentulous jaw (When all teeth are missing in upper jaw), why we need to place more number of implants.

TTPHIL IMPLANTS.  Imagine the surface area of the implants when compared to Single or One piece conical Implants. The TTPHIL Implants almost have double the surface are when compared to one piece implants. Hence 6 implants in most of the cases are sufficient. Why you need to give more money when there is no advantage of placing more number of implants. Usually in the molar region when one implant is sufficient the single implant specialists use two implants which is not required in all the cases unless the edentulous space is more. The single piece implants are core conical, thin and engage the apical cortical bone, they need to be splinted. Hence the place 2 implants instead of one. Approximately 10- 12 single implants are placed for upper jaw. The more number of implants – More expensive it is. Think about it! sINGLE PIECE IMPLANTS DISADVANTAGES

 

5. Less Surface area- Conical Implants- Smooth Surface Implants- More Implants Required- More Money- More Investment. Since these implants are thin we need to place more number of implants. For example In a full mouth rehabilitation in the upper jaw, 6 implants are sufficient to hold the bridge of 14-16 teeth depending on case. The same thing when we use single piece implants we need to place minimum 10 to 12 implants.

6. Single piece or One Piece Implant abutments will not have a finish margin. There can never be precise finish margin since the abutment is already thin we cannot refine it more in the patients mouth. Moreover it will not be done in the laboratory for precise finish margins. Any abutment done outside the mouth we can clearly define the finish margins according to gum levels in individuals.

7. Since the abutment is thin the crown fabricated will have overhanging margins. Especially this will be a big problem when we restore single piece implants in the back region of the jaw. This leads to lot of food lodgement over a period of years. It is impossible to clean and maintain oral hygiene in these cases.

8. No CAD CAM software can be detected for a single piece implants. The crowns have to be done manually. Precision fit can never be given in these implant cases

9. We need to take direct impressions with Alginate or polyether or polyvinyl siloxane impression materials. In all cases we cannot take the impressions with Poly vinyl Siloxane (PVS) or polyether impression material which is more precise because they are rigid impression materials. In case the impression is taken with PVS impression material after the impression is poured with Die stone the cast breaks because the implant abutments are very thin. Precision is a factor when a direct impression are taken for fabrication of the crowns. Now some single piece implantologists use disposable transfers to avoid the breakage of the abutments in the cast. But to make them parallel the laboratory technician does lot of modifications in the laboratory. This will make the patient again to open their mouth for a long time , giving a traumatic experience to the patient. The doctor needs to modify the implants according to the technician who fabricated the prosthesis. In Screw retained technology the technician does according to the doctor’s impressions taking the help of CAD CAM SOFTWARE, which is highly precise.Nothing can go wrong here unless the doctor doesn’t take the impressions properly. The Implant specialist needs to be a Prosthodontist or a very good trained dentist to get precise Screw Retained Prosthetic Solutions- SRPS (Crown and Bridge or Bar  supported fixed hybrid dentures or Malo Bridge)  Food lodgement is the most important factor to be considered going for single piece implants. Usually to avoid food lodgement the single piece implantologists recommend supra gingival finish line and space between the the crown and bridge and the bone. They consider this as an advantage but for the patient always the patient feels that there is space between the prosthesis and the gums. Most of the patients complain that their tongue goes between the prosthesis and the gum which is very very Irritating, More over there is speech problem because of the gap. They complain that the pronunciation is not like before leading to compromised life.

10. The abutment for a single piece is the same for both front or back teeth cases. Back teeth we need a wide abutment to prevent over hangings and optimum porcelain thickness to prevent ceramic chipping.

11. Sub gingival finish margins is not possible in Single Piece or One Piece Implants. When we open the flap and a flapless technique is not possible in certain cases where bone availability is less, and ridge splitting is indicated these implants are not suggested.

12. Single piece implants are not suggested when the bone density is less which can be diagnosed with the Xray and Hounsfield units. In these cases we will not be able to achieve good torque ( 4oNC) beyond. Still the implant is exposed to the oral environment leading to stresses on the Implant from Day 1, which can lead to an implant failure.

13. Single piece implants are not possible when we use TTPHIL ALL TIL™ Technique,also ALL ON 4 implants technique. New concepts show that the tilted implants taking Bi cortical encourage , the implants can be loaded immediately.

14. Screw retained option is not possible. If any complication or food lodgement occurs in  Single Piece  implants, then the only option is to cut the crowns because they are cemented. Check the video below.

15. The crowns or bridges in Single Piece implants have to be cemented. This cement gets entrapped between the gums leading to bone loss and gum irritation. What ever cement is used radiopaque or Radiolucent cements its impossible to remove the complete implant residue below the crown and bridge, which goes into the gums. Cement retained prosthetic Solutions have a disadvantage that the implants are all connected to each other. If one of the implant is rejected and pain starts and is mobile( moving) , the whole bridge needs to be cut. This is the most traumatic experience to the doctor and the patient. Patient needs to open his or her mouth for so long to cut the bridge. Cutting the bridge is not so easy when compared to cutting the tooth. The airotor handpiece which rotates at 200000 RPM (Rotations per Minute) needs to cut the metal which should be done very carefully without injuring the cheeks, lips and tongue. Screw retained prosthetics avoids this hazard. As a patient one should be prepared. Both Single piece and conventional Implants can fail. Servicing is easy in  conventional Implants because they are screw retained which is not possible in Single Piece Implants.

 

Our next video shows various advantages of  TTPHIL IMPLANTS with CAD CAM HEXED TITANIUM MORSE CONNECTION abutments, which  can be placed in all the situations when bone is not there also. We can place the implants in a tilted fashion according to the bone availability which is not possible with either Single piece or even conventional Implant System. This is a unique protocol followed at THE DENTAL SPECIALISTS, HYDERABAD, INDIA. click here to know more..