Evolution and revolution: The Bone Growth Concept

Tell us about your background in dental implantology?
Medicadent was founded 36 years ago and provides a full-time restorative service delivered by 12 dentists. We placed our first implant 29 years ago, and I have been regularly placing implants for the last 22 years.

It was a privilege to have Prof. Manfred Lang as my mentor, he impacted me the most and hugely influenced the techniques I treat with today. I also benefitted from learning freehand implant placement as this really developed my manual dexterity.

More recently I have been providing my patients with immediate loading implants very successfully.

​What attributes should a clinician consider when choosing a dental implant system in terms of design and other important aspects?
Important criteria include the high-quality standards of an implant system and its ability to evolve and be adapted over time. The design phase is therefore crucial for this. I also strongly value systems that are user-friendly, intuitive and which provide a wide range of solutions for prosthetic applications which is certainly the case with the bredent SKY and copaSKY implants. Whilst it is important to have a wide range of solutions, it is also valuable to have a minimal number of components across the systems. This keeps the inventory low.

How long have you been using the SKY Implant system from bredent group?
I have used exclusively the bredent SKY implant system for the last 14 years and I really value the company’s high-quality standards as well as solutions that evolve thanks to a strong ethos of ongoing product development. I am particularly impressed with its systems’ design quality, very high primary stability, surface quality, excellent osseointegration, and the use of the Torx system for the internal connection. The integration of the prosthetic components always made me feel safe. In addition, the backtaper design on the copaSKY produces excellent results in respect of implant/bone relationship.

​Why is the backtaper on the blueSKY 5.0 and all copaSKY implants important?
The fact that these implants have a backtaper is important in two ways.

First of all, if you submerge the implants into 1-2 mm of bone, you achieve better results. In implants with a backtaper design, it is possible for the bone to grow into the space created in the upper part of the implant. This physically increases the resistance of the implant to lateral forces and reduces the risk of bone resorption. Additionally, if you can create sufficient keratinised soft tissue around the bone, the long-term success of the implant will be guaranteed.

Secondly, clinical experience has shown that I can insert almost all of the implants which do not require grafting as flapless. Especially since I started using the copaSKY implant type, which is a Backtaper, I have had the opportunity to improve this way of working because in this way, when I carry out flapless surgeries and place them 2 mm subcrestally, it is possible to use all kinds of superstructure materials at the same time without putting pressure on the bone. In some cases, I can use Er Yag laser to correct excess bone and work flapless in all appropriate cases.

How does putting bone chips on the backtaper help to prevent ingrowth of soft tissue into the subcrestal region?
If the implant is positioned 1-2mm subcrestally, the bone chips placed on it can act as scaffold and give support to new bone formation. Thus, preventing the ingrowth of the soft tissue.

What are the Platform - Switch, Zero Bone Loss, and Bone Growth Concepts?
All these design concepts complement one another and provide extra advantages for the longevity of the implants. When abutments are placed on the implants, they provide a narrower fit than the implant diameter, fostering the Platform-Switch concept. With this design, zero bone loss can be achieved, but it is the backtaper implant/bone relationship that actually promotes bone growth.

​What are the conditions necessary for the Bone Growth Concept?
I think the necessary conditions are:

1. Using a conical - backtaper design implant
2. Embedding this implant 1-2 mm subcrestally into the bone, preferably supported by bone
3. Applying a well-designed prosthesis on an ideally positioned and correctly selected abutment
4. Keratinised tissue support of sufficient quantity and thickness

​Is there evidence for the efficacy of the Bone Growth Concept?
If you embed the implant in the bone so that it is surrounded by the bone in four dimensions, bone augmentation occurs physiologically, even if you do not perform graft augmentation on it. Although I see the success of bone particle insertion on a case-by-case basis, unfortunately I do not have any documentation to scientifically substantiate whether it prevents soft tissue ingression.

With bredent blueSKY and SKY Classic implants (non-backtaper), which I mostly used before I moved to copaSKY, bone growth was low due to the design (even though I had very successful results). These implants are also large diameter implants and slim abutments can be integrated on them.

 

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