Dr. Gerald Niznick’s ‘Penalty Shots’: Taking aim at marketing claims

Dr. Niznick was recently featured in a webinar put on by SmartonX where he addressed the claims made by representatives of eight major implant companies, billed as the "Implant Faceoff". Each had one minute to represent their company’s products on 10 topics.

Dr. Niznick’s response webinar was billed as "Dr. Niznick’s Penalty Shots", critiquing the marketing claims of the respective companies made by their representatives.

Dental Tribune sat down with Dr. Niznick to talk about what dentists can learn from this webinar.

Which of the 10 categories did you make the argument Paragon’s implants offered features and benefits that distinguished itself from these eight leading implant companies, and why was Straumann not included in the participants?

Straumann was invited but did not send a representative. Since it is the largest implant company when combined with its subsidiary, Neodent, I included it in my discussions.

The image included here was the first slide in my presentation. One feature that seven of the eight (nine counting Straumann’s bone level implants) have in common is a rough, blasted surface to the top and, in some cases, also threads to the top.

I presented scientific articles showing that exposure of a rough surface to the soft tissue is one of the primary causes of peri-implantitis. The research shows that the rougher the exposed surface, the higher the incidence of biofilm formation that contributes to peri-implantitis.

Because of that fact, many dentists place the top of the implant subcrestal, which creates its own set of complications, including bone loss to the level of the implant-abutment junction.

The treatment of peri-implantitis is to smooth the rough surface, so why wouldn’t you start with a smoother trans-crestal surface, which has been shown as the best way to minimize peri-implantitis? Furthermore, scaling of the implant with a rough surface has been shown to release titanium particles and induce inflammation and osteolysis.

Having a 2 mm machined neck on the implant, especially if it has depth-gauge lines, facilitates vertical flexibility on placement. A neck that protrudes through the crestal cortical plate provides a zone of soft tissue attachment that is not disturbed every time a healing collar, transfer, scan adapter or abutment is attached and/or removed.

I also presented a study showing that placing an implant sub-crestal results in reduced stability because it is no longer in contact with the dense crestal, cortical bone.

Another reason for placing an implant sub-crestal is if the implant system has only one diameter internal shaft across all implant diameters. This makes it necessary to place the implant sub-crestal in order to create enough running room for the abutment to start to develop an acceptable emergence profile.

The reality of sub-crestal implant placement is:

• Bone will be lost to the level of the implant abutment junction no matter the connection.
• Placing the implant sub-crestal often requires profiling the bone at the entrance to the socket to accommodate for flared healing collars and abutments.
• Ridges are often uneven, necessitating sub-crestal placement in one area to avoid exposure of the blasted and threaded surface in other areas.

Here are eight of the 10 categories that I demonstrated Paragon’s implants have significant advantages. The other two categories, Armamentarium and Customer Support, could not be distinguished because the design of a surgical kit is a personal preference.

I did point out that when I was president of Implant Direct in 2011, an independent survey by Millennium Research ranked Implant Direct as the highest in customer satisfaction and that I would be employing the same sales strategy with teams of inside and outside sales people.

Having the largest sales force is no guarantee of superior customer support because of the high turnover of salespeople, and they generally focus on the high-volume users.

• Primary Stability in Soft Bone: Paragon’s even taper with progressively deeper threads assures initial stability. Many of the other implants are straight for the top half of the implant, and in the case of the Neodent and Straumann’s BLX, straight over the majority of their length.
• Restorative Ease: Many of the implant systems cite having only one platform across six or seven diameters as an advantage, but it compromises emergence profile and strength on wider implants. Paragon’s GEN5 has two color-coded platforms, and its GEN5+ and NizPlant Application Specific Implants have a single platform.
• Cost: Paragon’s GEN5 at $125, GEN5+ with MUA at $175 and NizPlant with Locator Compatible platform that also functions as an MUA at $135 are unmatched in innovation and value.
• Quality: Paragon is made in the United States by a core manufacturing team with more than 500 years of combined experience. Paragon, in an article in Manufacturing Today, was referred to as a company, “Where precision engineering and dental expertise converge”.
• Bone Maintenance: Paragon’s implants all have a 2mm machined, anodized neck with depth gauge score lines (patent pending), designed to provide unparalleled vertical flexibility with uneven ridges.
• Soft Tissue Health: Paragon’s 2 mm anodized neck, placed trans-cortical with 1 mm supra-crestal and 1 mm sub-crestal, assures a zone of undisturbed soft tissue attachment supra-crestal and a smooth surface even with 1 mm of bone remodeling.
• Inventory Management: The two application-specific implants, GEN5+ and NizPlant, eliminate the need for purchasing an abutment, and the machined neck with depth gauge lines reduces the need for inventorying abutments with different collar heights. Paragon implants’ evenly tapered body assures stability with short implants, reducing the need for angled implants with expensive angled abutments.
• Restorative Connection: GEN5 has the standard 45 degree lead-in bevel with two color-coded platforms to simplify abutment selection and assure strength and a good emergence profile. GEN5+ has a friction-fit 2 mm extender that converts to a Standard MUA by the attachment of a $25 prosthetic screw available in three heights.

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