Straumann®Bone Level Tapered Implant

Clinical Review

Designed for primary stability

Fast osseointegration

Immediate function

Broad treatment options

Roxolid® An alloy of titanium and zirconium with excellent mechanical properties

SLActive® surface allows fast and predictable osseointegration

Apically tapered implant body design allows underpreparation and is designed to support primary stability in soft bone

STRAUMANN® CROSSFIT® CONNECTIONRestorative flexibility with the prosthetic components

of the Straumann® Bone Level Implant line

HIGH PRIMARY STABILITY

Primary stability of dental implants, defined as the stability at the time of implant placement, is an important prerequisite for achieving successful osseointegration (Branemark et al.,1977; Meredith, 1998). High primary stability prevents micromovements of the implant and therefore war- rants its rigidity. This is important since the implant should not be sub-jected to micromotion of more than 50‒150 µm during the heal- ing phase in order to avoid fibrous tissue encapsulation (Cameron et al., 1973; Szmukler-Moncler et al., 1998). A study demonstrated that for ta-pered implants the initial stability is secured over the bone remodeling stages (Rokn et al., 2011).

FAST OSSEOINTEGRATION

Surface modifications play an important role in the speed of osseointe-gration and thereby influence implant stability as well as success of im-mediate and early loading protocols (Buser et al., 1991; Coelho et al., 2011; Elias et al., 2008; Shalabi et al., 2006). Straumann® SLActive® is a chemically modified hydrophilic surface which is clinically proven to accelerate the osseous healing* (Buser et al., 2004; Lang et al., 2011; Oates et al., 2007; Schwarz et al., 2007). The hydrophilic and chemi-cally active properties of SLActive® provide a larger accessible surface area for increased blood protein adsorption (Kopf et al., 2015), greater osteoblast differentiation and increased production of bone-building osteocalcin (Zhao et al., 2005) as well as stimulated blood vessel growth

One reason for this is that the tapered implant body design allows for preparing the site with tools one size smaller than the diameter of the implant, thus increasing the resis-tance to implant insertion. The lat-eral compression of the bone around the underprepared osteotomy walls leads to a continuous increase of insertion torque, an important observation especially for soft bone types as increasing peak torque values have been correlated to increased implant stability during the healing phase (Molly, 2006).

Straumann® Bone Level Tapered Implants have an apically tapered implant body and are designed for primary stability in soft bone and fresh extraction sockets.

*Compared to SLA

(Schwarz et al., 2008). Beyond that, studies with Roxolid® Implants with the SLActive® surface have osseointegration properties similar or even better than those of titanium SLActive® implants (Gottlow et al., 2012; Lang et al., 2011; Wen et al., 2013). Roxolid® is a metal alloy composed of ~15 % zirconium and ~85 % titanium, the only two metals commonly used in implantology that do not inhibit the growth of osteoblasts (Steinemann, 1998). Interestingly, titanium-zirconium alloys like Roxolid® have better biocompatibility than titanium (Ikarashi Y et al., 2005) and an up to 40 % higher fatigue strength than comparable titanium implants (Straumann data on file). Straumann® Bone Level Tapered Implants with the combination of Roxolid® and SLActive® surface speed up the process of new bone formation on the implant and thereby shorten the critical transition phase between primaryand secondary stability.

DID YOU KNOW?The current global tapered design implants market is continuously growing (Fig. 1). More and more dental experts use tapered implants. The trend is driven by the growing patient demand for the immediate restoration of esthetics and function, but with simpler, more cost-effective and less time-consuming treatment procedures.

Fig. 1: Current global tapered design implants market trends (iData Research Inc., 2013; Millenium Research Group, 2015).

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IMMEDIATE FUNCTION

Immediate function can offer many potential advantages such as reduced number of surgical procedures and an immediate esthetic and functional solution. It has been demonstrated that Straumann® Bone Level implants with SLActive® surface can success-fully be used in early treatment pro-tocols (Cordaro et al., 2012; Bornstein et al., 2010; Buser et al., 2013b). The micro-gap of the Straumann® Cross-Fit® connection is extremely small and is designed to reduce inflam- mation, which helps to preserve bone (Cochran et al., 2013; Heitz-Mayfield et al., 2013; Jung et al., 2008).

Thus, tapered implants are suitable for placement into fresh extraction sockets or into bone of low quality (Akkocaoglu et al., 2005) and can be successfully used in conjunction with immediate and early loading protocols when good primary stabil-ity and appropriate occlusal load are achieved.

BROAD TREATMENT OPTIONS

Many patients have difficult health conditions which could compromise the treatment outcome of implant therapy. In challenging indications especially, the use of an implant system which is clinically proven and backed by scientific literature is important to minimize the risk of treatment failure. High predict-ability of implant placement in augmented sites has been shown (Chiapasco et al., 2012a; Chiapasco et al., 2012b; Santing et al., 2013). The Straumann® Bone Level Tapered Implant mimics the shape of a natural tooth root which is advantageous in cases with anatomic constraints (Fig. 2), including facial undercuts, converging root tips, concave jaw structure or narrow atrophied ridges.

Immediate loading of overdentures supported by two implants reached 99 % survival rate after 12 – 40 months (Stoker and Wismeijer, 2011). Addition-ally, the tapered design is advantageous for full-arch fixed restorations, as the temporary prosthesis is often placed at the day of surgery. For this indica-tion, Straumann® Bone Level Tapered Implants are designed to provide the

Fig. 2: Female patient presenting with a prior oral-antral fistula. The fistula with the prior implant was obturated and the Straumann® Bone Level Tapered Implant offered the opportunity to avoid sinus involvement. Courtesy of Dr. Robert L. Holt.

DID YOU KNOW?A recent global survey among dental experts from 19 countries showed that ѹ There is a high level of satisfaction with the Straumann® Bone Level Tapered

Implant (Average rating 8.5 out of 10) ѹ The reason for satisfaction is mainly due to the ease of use, the advantages of

the Roxolid® material and the SLActive® surface

Straumann data on file

primary implant stability, which is needed for reliable anchorage of the temporary prosthesis in the bone. From an esthetic point of view, Strau-mann® Bone Level Implants have demonstrated excellent esthetic results and high patient satisfaction in daily dental practice (Filippi et al., 2013; Furze et al., 2012). Pleasing esthetic outcomes after early loading with healthy and stable peri-implant soft tissues in the anterior maxilla even af-ter 9 years have been reported (Buser et al., 2013a; Buser et al., 2013c; Buser et al., 2009; Buser et al., 2011). Therefore, Straumann® Bone Level Roxolid® SLActive® Implants have been tested in very challenging indications and successful treatment outcomes have been documented.

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The effect of different implant macrogeometries and surface treatment in early biomechanical fixation: an experimental study in dogs. J Mech Behav Biomed Mater. 2011 Nov;4(8):1974-81. Epub 2011 Jul 3. — Cordaro L et al. Implant-supported single tooth restoration in the aesthetic zone: transmucosal and submerged healing provide similar outcome when simultaneous bone augmentation is needed. Clin Oral Implants Res. 2013 Oct;24(10):1130-6. Epub 2012 Jun 15. — Elias CN. Relationship between surface properties (roughness, wettability and morphology) of titanium and dental implant removal torque. J Mech Behav Biomed Mater. 2008 Jul;1(3):234-42. Epub 2007 Dec 31. — Filippi A et al. A prospec-tive noninterventional study to document implant success and survival of the Straumann Bone Level SLActive dental implant in daily dental practice. Quintessence Int. 2013 Jul;44(7):499-512. — Furze D et al. Clinical and esthetic outcomes of single-tooth implants in the anterior maxilla. 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