A while back implant companies started promoting fixtures with aggressive threads in an effort to satisfy our desire for increased initial stability. The overwhelming majority of my successful cases have been done with either a parallel walled tissue level fixture (Straumann TL or BSB One Stage) or Zimmer TSV. A couple of years ago Zimmer jumped on the bandwagon and developed the TSX fixture and I unfortunately took the bait. After placing 75-100 of these TSX fixtures using the same protocol as I would for the TSV I experienced entirely too many early post load failures like the one seen in the attached photo. After speaking with the folks at Zimmer it was determined that because I was not using the dense bone protocol, which I never use with the TSV, then I was causing these failures. At any rate I exchanged all of my TSX inventory for the traditional TSV and this experiment has taught me that I should stick with what has worked and continues to work while avoiding the tendency to try the latest and greatest new gadgets on the market. I firmly believe that implants are similar to classic music and the very best stuff has already been created.
i get what you’re preaching dr scotty. but your cut out of pano just have me confused. #3 obviously failed but i think its more than just type of implant. perhaps the prosthesis is to blame as well. #4 doesn’t even have a crown. Also you probably placed over 10 thousand implants throughout your career. at 5% failure that’s at least 500 implants. compared to some clinicians only placed hundreds of implants. You will see more failure than most of us.
You are correct about there being multiple factors contributing to this failure but it became an all too common scenario during my brief period of experimenting with this particular design. Because of my experience in placing less tapered and less aggressive fixtures I foolishly applied the same principals/protocol to this newer design. While I disagree with the notion that a fixture designed to achieve greater initial stability should be placed using a dense bone protocol that is what the smart people at ZimVie have concluded and they were generous enough to exchange my inventory for my preferred TSVM configuration. My take home message from this is “if it aint broke don’t fix it” and I have had too much success over the past two decades using “old school” fixture designs to jump on another band wagon. I think I will spend my next 8-10 years leading up to retirement from this profession utilizing the tools that work in my hands rather than experiment with concepts. I am the same person that abandoned tissue level fixtures 10-12 years ago only to be convinced by my own results to come full circle back to utilizing them. After all of these years and experimenting with multiple products (Nobel Biocare, 3i, Straumann, Zimmer, Implant Direct, Bio Horizons, Blue Sky Bio) my conclusion is that Zimmer TSVM and Blue Sky Bio One Stage stand above the rest in my hands and that is what I will stick with until the end. I am in no way saying that these two products are superior but they have proven themselves to be under the unique conditions of working for me!!